| Background: Since the implementation of the lung allocation score (LAS) system in the United States, candidates are being more appropriately chosen for the waitlist. However, the implementation of LAS also means that listed candidates tend to have more advanced disease at listing, and data suggests that recipients with higher LAS at transplant have increased posttransplant mortality. This points to the usefulness of identifying predictors of LAS, and few studies have examined how impairments in psychological functioning predict LAS. The current study evaluated the effect of pretransplant symptoms of depression and anxiety and use of maladaptive coping strategies on LAS. Methods: 128 patients with end-stage lung disease (ESLD) completed the PHQ-9 and GAD-7 to assess for symptoms of depression and anxiety, respectively, and the Brief COPE to determine self-reported coping styles. LAS at the time of listing (LAS-L) and at a second timepoint were collected from the medical record to enable calculation of change in LAS (DeltaLAS), and patients were categorized as having worsened disease, or disease that was unchanged or improved. Hierarchical multiple regressions and binomial logistic regression were utilized. Results: The data revealed significant relationships between LAS-L and depressive symptoms, anxiety symptoms, and two types of adaptive coping. As anxiety symptoms increased, patients were more likely to evidence clinical deterioration, while use of active coping was associated with a greater likelihood of having unchanged disease severity over the study period. Conclusion: Owing to its close association with mortality, LAS has been used as a measure of disease severity on the lung transplant waiting list. While not directly used in the LAS calculation, components of psychological functioning appear to predict disease severity. This suggests the benefit of early assessment of and intervention for psychological distress among patients with advanced lung disease, prior to referral for lung transplantation. |
