Pre-transplant Psychosocial Predictors of Smoking and 5-year Survival in Liver Transplant Recipients: A Single-center Retrospective Cohort Study

Background: Assessment of psychosocial functioning has become a standard step in evaluating the suitability of transplant candidates. Research evidence about the validity of pre-transplant psychosocial assessment in predicting post-transplant outcomes is controversial. In this scenario, psychosocial predictors of smoking in liver transplant (LT) recipients are neglected. This study aims to investigate psychosocial predictors of smoking and 5-year survival in a large sample of LT recipients. Methods: A retrospective analysis of clinical reports of psychosocial screening carried out through clinical interviews was performed on a sample of 563 consecutive LT recipients. Clinical data were obtained by inspection of digital medical records. Results: Three main components underlying clinical reports of psychosocial assessment were identified, that is: component 1 = level of readiness to transplant, psychological stability, and cognitive abilities; component 2 = psychiatric and substance use history; and component 3 = social and family support. Component 1 significantly predicted post-transplant smoking (P < .001) and 5-year survival (P .010). Component 2 significantly predicted post-transplant smoking (P = .032). Patients with alcoholic and viral hepatitis showed a greater risk of smoking and non-achieving 5-year survival after transplantation when compared with patients with different causes of liver failure. Conclusions: Findings of this study highlight the predictive validity of psychosocial assessment and support its clinical utility. Further research contributions are needed to define the most clinically useful way to perform psychosocial assessment and utilize it to facilitate the best outcomes for transplant recipients.