EVALUT study investigates the psychosocial burden of LTx patients

A lung transplantation is a serious medical intervention that fundamentally changes the lives of affected patients. Already in the period before, but also after a lung transplantation (LTx) LTx patients are often also mentally stressed. It is known that a higher level of depressive symptoms negatively affects the survival probability after LTx. As part of a project at the German Center for Lung Research, scientists at MHH are investigating the psychosocial burden on LTx patients and their predictive significance for different outcomes following the LTx.

Since the end of 2017, the guideline of the German Medical Association for the evaluation of waiting list guidance and organ mediation for LTx also includes a psychosocial evaluation. Such identified risk factors enable the targeted use of clinical interventions and indicate which patients need special psychological care after transplantation. Determining the individual psychological stress situation is, therefore, in the interest of both the patient and the practitioner.

In the context of a study scientists around Prof. Dr. Martina de Zwaan and Dr. Mariel Nöhre from the Department of Psychosomatics and Psychotherapy of the Hannover Medical School, examined how the psychosocial burden on patients before LTx can be reliably determined. The EVALUT study (Evaluation before lung transplantation) examined the Transplant Evaluation Rating Scale (TERS), which is widely used. With this tool patients are interviewed in structured expert-based interviews on ten aspects that capture the psychosocial functioning level.

In 2016 and 2017, a total of 361 patients were interviewed about their mental stress situation before being listed on the LTx. So far, 114 of these patients have been interviewed again after one year. The scientists were able to show that an increased TERS value, among other, is associated with a reduced quality of life and an increased tendency to depression. There was also a high TERS score in patients who quit smoking just a few years ago. There was no association with the severity of the lung disease or the physical symptoms. Therefore, the authors of the study estimate the TERS as a well-suited tool with clinical applicability for the assessment of psychosocial problems in patients before lung transplantation.

The project was well received by the patients and a continuation and development is planned. The study was developed in the first cooperation of the Department of Psychosomatics and Psychotherapy with BREATH. Prof. de Zwaan says: "We look forward to working together with the DZL in the future. We hope to gain further insights into the predictive value of psychosocial problems for the course of LTx. In future projects, we plan to refine the psychosocial evaluation before LTx and to examine the patients even longer term after the LTx. "



Nöhre M. et al. Psychometric properties of the German version of the Pulmonary-specific Quality-of-Life Scale in lung transplant patients. Front Psychiatry. 2019



Bild: MHH

Prof. Dr. Martina de Zwaan, Director of the Clinic for Psychcosomatics and Psychotherapy, Hannover Medical School