*Purpose: Patients with end-stage organ failure who receive organ transplants often experience anxiety symptoms. Currently, however, these symptoms frequently remain un-detected. Systematic screening for anxiety may help identify patients with moderate/severe symptoms, who may benefit from multidimensional assessment and support. The purpose of this study is to assess a 2-step approach, where an ultra-brief screening tool (Edmonton Symptom Assessment Survey-revised- Anxiety item (ESASr-A) or Generalized Anxiety Disorder-2 (GAD-2)) is followed by a more precise tool (Patient Reported Outcomes Measurement Information System Anxiety Computer Adaptive Test (PROMIS-A-CAT)), to screen for anxiety symptoms in solid organ transplant recipients.

*Methods: In a multicenter cross-sectional study, we administered multiple symptom screening questionnaires to solid organ transplant recipients. Using data from patients who completed ESASr-A, GAD-7 and PROMIS-A-CAT, we compared screening performance and efficiency between the scenario in which patients completed PROMIS-A-CAT and hypothetical scenarios where only patients above the pre-screening cut-off would have completed PROMIS-A-CAT. Screening performance was evaluated by sensitivity and specificity. Efficiency was characterized by the average number of questions completed by subjects in the different scenarios.

*Results: A total of 126 kidney transplant recipients, 71 liver transplant recipients, and 12 kidney pancreas recipients were included in this analysis. The mean (SD) age of the entire cohort was 54 (13) years and 61% of the subjects were male. For the 2-step method, using a cut-off of ≥1 and ≥2 for ESASr-A and GAD-2, respectively, produced the best combination of sensitivity and specificity (ESASr-A sensitivity 0.73, specificity 0.91; GAD-2 sensitivity 0.73, specificity 0.94). Most patients who completed more than 5 PROMIS-A-CAT items scored <3 on GAD-7. Compared to administering only PROMIS-A-CAT to all patients, the 2-step method reduced the average number of questions patients had to complete from 6 to 4 for both 2-step screening scenarios.

*Conclusions: A 2-step anxiety screening method using either ESASr-A or GAD-2 followed by PROMIS-A-CAT has acceptable specificity and sensitivity, and can be most helpful to reduce questionnaire burden among patients with no symptoms. Screened in patients will need clinical assessment to establish diagnosis and decide on appropriate psychosocial support.

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