*Purpose: We sought to summarize the available literature regarding the psychosocial effects of the waiting period on pre-transplant adult heart or lung transplant candidates and their caregivers and their relationship via systematic review and meta-analysis.

*Methods: We searched Ovid EMBASE, Ovid MEDLINE, EBSCO CINAHL, and Ovid PsycINFO databases from 1998 to July 2018 for articles in any language reporting pre-transplant emotional and physical health assessments of adult heart or lung transplant candidates and their primary caregivers. Inclusion was determined by two independent reviewers, with a third resolving any disagreements. Data regarding article details, quality, caregiver characteristics, and patient characteristics were extracted independently and in duplicate. Meta-analysis was performed using RevMan 5.3 (Copenhagen, Denmark) for outcomes reported by two or more studies. I² statistic was used to assess heterogeneity.

*Results: Our search yielded 411 unique studies, with 11 meeting inclusion and exclusion criteria—4 heart, 4 lung, and 3 including both heart and lung transplant patients. Overall, 469 patients (153 heart, 316 lung) and 454 caregivers were included. Mental health and mood disturbances were evaluated in seven studies (4 evaluated depression, 2 evaluated anxiety, 2 evaluated overall mental health). Quality of life in the pre-transplant period was evaluated in six studies. Depression (p<0.00001), anxiety (p = 0.02), and mood disturbance (p = 0.0003) scores were higher in patients compared to caregivers. Quality of life was found to be very low in patients and average in caregivers. Relationship dynamics in the form of social intimacy, ways of providing support, and interpersonal functionality were measured separately in three studies. Interpersonal functionality scores were normal for both patients and caregivers, suggesting that either group did not consider their relationship dysfunctional in the pre-transplant period. The remainder of instruments measured coping strategies, subjective distress, religiosity, psychological adjustment, and desire for control.

*Conclusions: Further standardization of the psychosocial assessment in the pre-transplant period could include exploring quality of life measures and patient-caregiver relationship dynamics rather than focusing solely on psychoaffective disorders. As evidenced by the few studies which objectively examined patient-caregiver dynamics in the pre-transplant period, further research is warranted to understand the intricacy of this relationship.

« Back to 2019 American Transplant Congress