Transplantation · 2026
Palliative Care Utilization and Timing for Patients Undergoing Solid Organ Transplantation in a Large Multicenter Cohort.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Kenaston Matthew W, Baldeo Ryan, Murphy Tyler K
Аннотация
BACKGROUND: Although solid organ transplant prolongs survival in end-stage disease, recipients face high symptom burden and complex decisions at multiple junctures. Palliative care (PC) may address these needs, but referrals in transplant programs are infrequent, often reactive, and the benefits remain unclear.
METHODS: We retrospectively studied 12 676 heart, liver, lung, and kidney transplants across 3 Mayo Clinic sites (2018-2024). PC encounters were classified as pretransplant (≤1 y before admission), peritransplant (during hospitalization), or posttransplant (≤1 y after discharge).
RESULTS: Only 8.3% engaged PC, with patterns varying by organ and timing. Heart programs demonstrated the highest overall engagement, primarily pre- and peritransplant, whereas lung and kidney referrals occurred more often after discharge. Earlier timing coincided with longer survival, whereas peri- and posttransplant encounters occurred closer to death. In heart transplantation, pre- and peritransplant PC were observed in recipients with lower procedural volume and fewer short-term readmissions. Liver and lung cohorts displayed variable patterns. Kidney referrals occurred infrequently and were concentrated among recipients with higher morbidity. Timing of inpatient consultation showed a strong positive correlation with hospital length of stay, and pretransplant PC coincided with higher rates of goals-of-care discussions and fewer hospital interventions. Adapting screening criteria to focus on high-risk recipients, PC was associated with fewer short-term readmissions for heart and lung recipients.
CONCLUSIONS: PC among solid organ transplant was infrequent and varied. Referral timing often aligned with patient morbidity and mortality. Structured, prospective validation of screening methods may identify patients most likely to benefit from palliative involvement.
METHODS: We retrospectively studied 12 676 heart, liver, lung, and kidney transplants across 3 Mayo Clinic sites (2018-2024). PC encounters were classified as pretransplant (≤1 y before admission), peritransplant (during hospitalization), or posttransplant (≤1 y after discharge).
RESULTS: Only 8.3% engaged PC, with patterns varying by organ and timing. Heart programs demonstrated the highest overall engagement, primarily pre- and peritransplant, whereas lung and kidney referrals occurred more often after discharge. Earlier timing coincided with longer survival, whereas peri- and posttransplant encounters occurred closer to death. In heart transplantation, pre- and peritransplant PC were observed in recipients with lower procedural volume and fewer short-term readmissions. Liver and lung cohorts displayed variable patterns. Kidney referrals occurred infrequently and were concentrated among recipients with higher morbidity. Timing of inpatient consultation showed a strong positive correlation with hospital length of stay, and pretransplant PC coincided with higher rates of goals-of-care discussions and fewer hospital interventions. Adapting screening criteria to focus on high-risk recipients, PC was associated with fewer short-term readmissions for heart and lung recipients.
CONCLUSIONS: PC among solid organ transplant was infrequent and varied. Referral timing often aligned with patient morbidity and mortality. Structured, prospective validation of screening methods may identify patients most likely to benefit from palliative involvement.