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Xie Y, Liu J, Lin K, Fu X, Yan Y, Xie Y, Tan Z, Liu Q, Li J, Wang L, Zhou Y, Ye C, Cen M, Xu L, Yan Y, Yang F, Yang Y, Li Y, Jiang H. The longitudinal change of depressive symptoms among people living with HIV in Guangdong Province, China: A network analysis. J Affect Disord 2025; 383:69-77. [PMID: 40286931 DOI: 10.1016/j.jad.2025.04.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2025] [Revised: 04/22/2025] [Accepted: 04/23/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND Depression may change over time among people living with HIV (PLHIV). This study aimed to understand longitudinal change of depression among PLHIV in China, and the impact of change in depression on mortality. METHODS A cohort study was conducted to collect data on depressive symptoms among PLHIV at baseline and one-year follow-up in Guangdong Province from May 2018 to June 2019 and continued to follow up until June 2023. Generalized estimating equations were used to explore factors associated with depression. Network analysis was used to explore the interrelations between specific depressive symptoms at baseline and one-year follow-up. RESULTS 30.9 % of 792 participants had a pattern of remission at one-year follow-up, 6.3 % had persistent depression at both baseline and one-year follow-up, and 5.9 % had new-onset depression at one-year follow-up. 46 (5.8 %) participants died. High levels of education, HIV-related symptoms, high levels of HIV-related stigma, and low social cohesion were longitudinally associated with a higher risk of depression. Network analysis revealed that "Depressed mood" and "Sadness" had high centrality in both the baseline and follow-up networks, with "Fearful" being the most increased central node at follow-up compared to baseline. Cox regression after propensity score weighting showed that the groups with new-onset and persistent depression had a higher risk of mortality than the non-depressed group. CONCLUSION More attention should be paid to individuals with high levels of education and those with HIV-related symptoms. Interventions targeting symptoms with increased centrality nodes, reducing HIV-related stigma and improving social cohesion may also help to reduce depression among PLHIV.
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Affiliation(s)
- Yufan Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
| | - Jun Liu
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Kaihao Lin
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
| | - Xiaobing Fu
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Yao Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
| | - Yingqian Xie
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Zhimin Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
| | - Qicai Liu
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou 510440, China
| | - Junbin Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou 510440, China
| | - Lihua Wang
- Jiangmen Center for Disease Control and Prevention, Jiangmen 529030, China
| | - Yi Zhou
- Zhuhai Center for Disease Control and Prevention, Zhuhai 519060, China
| | - Chenglong Ye
- Yangjiang Center for Disease Control and Prevention, Yangjiang 529500, China
| | - Meixi Cen
- Yunfu Center for Disease Control and Prevention, Yunfu 527300, China
| | - Lu Xu
- Shantou Center for Disease Control and Prevention, Shantou 515041, China
| | - Yubin Yan
- Huizhou Center for Disease Control and Prevention, Huizhou 516003, China
| | - Fang Yang
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Yi Yang
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Yan Li
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China.
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China.
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Müller E, Härter M, Higgen S, Barten MJ, Eickhoff D, Grahammer F, Reinsberg N, Sterneck MR, Buchholz A. The development and psychometric evaluation of specific problem lists reflecting psychosocial distress of patients before and after solid organ transplantation. Front Psychol 2025; 16:1481641. [PMID: 40432801 PMCID: PMC12106308 DOI: 10.3389/fpsyg.2025.1481641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 04/28/2025] [Indexed: 05/29/2025] Open
Abstract
Introduction Psychosocial distress is common in patients before and after solid organ transplantation. Regular screening facilitates the early identification of distressed patients and the provision of appropriate professional care. However, feasible screening tools that address the specific problems of transplant patients are missing. Thus, the aim of this mixed methods study was to develop transplant-specific problem lists for patients before (transplant candidates) and after (transplant recipients) solid organ transplantation which can be used as a quick and easily applicable screening tool for psychosocial distress. Method An electronic database search resulted in a preliminary item list including 36 problems common in transplant candidates and 44 problems in transplant recipients. A total of N = 117 patients and N = 48 health care providers participated in a paper-pencil survey to assess the relevance and comprehensibility of the problem lists. Qualitative interviews about the clarity and completeness of problem lists were performed with N = 58 patients and N = 3 transplant nurses. Data analysis included the calculation of descriptive statistics and content analysis of interviews and survey open response fields. To test the concurrent validity of the problem list for patients, patients completed the problem list in combination with the National Comprehensive Cancer Network (NCNN) distress thermometer and a short form of the Patient Health Questionnaire (PHQ-4) as part of routine care. Results The finalized list for transplant candidates includes 21 items and the list for transplant recipients 22 items, each covering four categories: problems in everyday life, social problems, worries and anxieties, physical and psychological problems. In the course of the study, sufficient data was gathered only from transplant recipients (N = 100). The number of problems endorsed by transplant recipients correlated significantly with measures of depression and distress (distress: r = 0.41, p < 0.001; PHQ-4: r = 0.63, p < 0.001; PHQ-2: r = 0.53, p < 0.001; GAD-2: r = 0.60, p < 0.001). The developed problem lists cover relevant psychosocial problems and can help to identify distress in patients before and after transplantation. Discussion The problem list for transplant recipients showed sufficient concurrent validity, psychometric properties of the problem list for transplant candidates should be investigated in further studies.
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Affiliation(s)
- Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sanna Higgen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus J. Barten
- Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Doreen Eickhoff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Grahammer
- Center for Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nele Reinsberg
- Department of Human Medicine, Faculty of Medicine, MSH Medical School Hamburg, Hamburg, Germany
- MSH Medical School Hamburg, ICAN Institute for Cognitive and Affective Neuroscience, Hamburg, Germany
| | - Martina R. Sterneck
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Yoo YJ, Lee J, Kim DG, Kang M, Koh HH, Min EK, Lee JG, Kim MS, Joo DJ. Outcomes and risk factors for de novo major depressive disorder after liver transplantation: Nested case-control study. Ann Hepatol 2025; 30:101779. [PMID: 40068765 DOI: 10.1016/j.aohep.2025.101779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Revised: 12/18/2024] [Accepted: 12/20/2024] [Indexed: 03/22/2025]
Abstract
INTRODUCTION AND OBJECTIVES Major depressive disorder (MDD) is a major psychiatric complication of liver transplantation (LT). Here, we aimed to analyze the impact of de novo MDD on survival post-LT and identify risk factors for this disorder among LT recipients. MATERIALS AND METHODS A retrospective analysis was conducted on 1350 LT recipients at Severance Hospital, Korea, from July 2005 to December 2022. Patients with MDD were matched 1:5 with controls using a nested case-control design to control for immortal time bias. RESULTS During follow-up post-LT, 58 patients (4.3 %) were newly diagnosed with MDD. The median time from LT to MDD diagnosis was 316 (interquartile range 46-920) days. Patients with MDD had significantly lower graft survival rates than controls at 1, 3, and 5 years after matching (89.5 %, 75.3 %, and 66.5 % vs. 95.5 %, 91.5 %, and 86.4 %, respectively; P = 0.003). Multivariable Cox regression identified de novo MDD as an independent risk factor for reduced graft survival (hazard ratio 2.39, 95 % confidence interval [CI] 1.15-4.98, P = 0.003). Independent risk factors for de novo MDD included female sex (odds ratio [OR] 2.29, 95 % CI 1.16-4.53, P = 0.017), alcoholic liver disease (OR 2.36, 95 % CI 1.16-4.75, P = 0.016), pre-transplant encephalopathy (OR 2.95, 95 % CI 1.49-5.79, P = 0.002), and lower hemoglobin levels (OR 0.85, 95 % CI 0.73-0.98, P = 0.025). CONCLUSIONS In our matched population of nested case controls, de novo MDD significantly reduced the survival of LT recipients. Screening and early intervention are required for LT recipients with risk factors for MDD.
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Affiliation(s)
- Young Jin Yoo
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
| | - Jinhee Lee
- Department of Psychiatry, Yonsei University, Wonju College of Medicine, Wonju, South Korea
| | - Deok-Gie Kim
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea.
| | - Minyu Kang
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
| | - Hwa-Hee Koh
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun-Ki Min
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Geun Lee
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
| | - Myoung Soo Kim
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Jin Joo
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
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Higgen S, Müller E, Barten MJ, Eickhoff D, Grahammer F, Härter M, Bart S, Sterneck MR, Buchholz A. Pilot implementation of two specific problem lists before and after solid organ transplantation into routine care. Front Psychol 2025; 15:1481643. [PMID: 39895976 PMCID: PMC11782271 DOI: 10.3389/fpsyg.2024.1481643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 12/18/2024] [Indexed: 02/04/2025] Open
Abstract
Introduction Psychosocial distress and mental health problems are common in patients before and after solid organ transplantation and can negatively affect morbidity, mortality, and adherence. Even though regular screening is recommended to identify patients with high levels of distress, the implementation in routine care has been insufficient so far. Methods Two newly developed problem lists for patients before and after transplantations were pilot implemented for 8 weeks at the Medical Center Hamburg Eppendorf (UKE) to identify factors facilitating and impeding their implementation. Results Health care professionals evaluated its appropriateness, feasibility, and the cooperation with the psychologists before (HCPs: n = 23) and after (HCPs: n = 19) the implementation. Four psychologists assessed the appropriateness and feasibility by answering to open-ended and close-ended questions. Additionally, patients before (n = 8) and after (n = 100) transplantation filled out the screening and rated its acceptance. Only the data of the patients after transplantation were analyzed due to the small sample size of patients before transplantation. HCPs and psychologists rated the screenings as very appropriate [HCPs: M = 3.84 (SD = 0.77) to M = 4.32 (SD = 0.58)]. It was also highly accepted among patients [M = 4.23 (SD = 0.85) to M = 4.68 (SD = 0.65)]. Contentment with the psychological support and understanding of the mental health problems among HCPs increased significantly from before to after the implementation (U = 107.50, p < 0.05, r = 0.33; U = 107.00, p < 0.05, r = 0.34). The feasibility of the problem list post-Tx in routine care, however, was seen as challenging [HCPs: M = 3.11 (SD = 1.05) to M = 3.47 (SD = 1.07)]. Discussion The distress screening was accepted and improved the cooperation between different professions. Barriers to implementation can be lack of staff and resources. Future studies should assess the adoption and sustainability of the screening in routine care.
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Affiliation(s)
- Sanna Higgen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus J. Barten
- Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- University Transplant Center, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Doreen Eickhoff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- University Transplant Center, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Florian Grahammer
- Center for Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Bart
- Department Health Sciences, University of Applied Sciences Hamburg, Hamburg, Germany
| | - Martina R. Sterneck
- University Transplant Center, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
- Department of Internal Medicine, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- University Transplant Center, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
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Sun XQ, Xu Y, Wu XL, Zhi JJ, Gu YM. Factors Influencing Stress Disorders in Intensive Care Unit (ICU) Patients After Liver Transplantation: A Cross-Sectional Study. Ann Transplant 2024; 29:e944320. [PMID: 39587450 DOI: 10.12659/aot.944320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2024] Open
Abstract
BACKGROUND Evidence on psychological factors associated with post-transplant post-traumatic stress disorder (PTSD) in liver transplantation (LT) patients is limited. Identifying the psychological factors associated with post-transplant PTSD would help to understand the symptoms of PTSD and take preventive measures. The aim of this study was to investigate factors influencing stress disorders in Intensive Care Unit (ICU) patients 1 year after LT. MATERIAL AND METHODS We assessed data from 184 LT patients at our hospital between January 2020 and December 2022. According to the PCL-C score, the patients were divided into the PTSD group (score ≤37) and the non-PTSD group (score >37). The demographic data, clinical data, the pain visual analogue scale (VAS), the anxiety and depression scale (HADS), and the psychological resilience scale (CD-RISC score) were compared between the 2 groups. Pearson correlation analysis was used to analyze the correlation between PCL-C and VAS, HADS, and CD-RISC, and logistic regression was used to analyze the factors influencing PTSD. SPSS 23.0 software was used for statistical analysis. RESULTS The average age of the 184 participants was 53.17 years (±3.47) and 66.85% of the subjects were male. The prevalence rate of post-transplant PTSD was 22.83% and the total score on the PCL-C scale was 32.47±7.81. Pearson correlation analysis showed that PCL-C score was positively correlated with VAS (r=0.312, P=0.012) and HADS (r=0.412, P<0.001), and negatively correlated with CD-RISC (r=-0.468, P<0.001). Logistic regression analysis showed that the symptom of post-transplant PTSD was significantly associated with higher VAS (OR=1.058, P=0.007) and HADS (OR=1.885, P<0.001) scores and lower CD-RISC (OR=2.213, P<0.001) score, which indicated that higher VAS and HAD scores were risk factors that contributed to PTSD and lower CD-RISC was a protective factor against PTSD. CONCLUSIONS We found that pain, anxiety, depression, and resilience were associated with symptoms of PTSD in LT patients in the ICU. Nursing staff should seek to relieve their patients' pain and assure provision of targeted health education and personalized psychological counseling to reduce the risk of PTSD after LT.
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Affiliation(s)
- Xiao-Qing Sun
- Department of Nursing, Capital Medical University Youan Hospital, Capital Medical University, Beijing, China
| | - Ying Xu
- Department of Nursing, Capital Medical University Youan Hospital, Capital Medical University, Beijing, China
| | - Xiu-Lian Wu
- Department of Nursing, Capital Medical University Youan Hospital, Capital Medical University, Beijing, China
| | - Jing-Jing Zhi
- Department of Nursing, Capital Medical University Youan Hospital, Capital Medical University, Beijing, China
| | - Yan-Mei Gu
- Department of Nursing, Capital Medical University Youan Hospital, Capital Medical University, Beijing, China
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Hutto A, Zikry TM, Bohac B, Rose T, Staebler J, Slay J, Cheever CR, Kosorok MR, Nash RP. Using a natural language processing toolkit to classify electronic health records by psychiatric diagnosis. Health Informatics J 2024; 30:14604582241296411. [PMID: 39466373 DOI: 10.1177/14604582241296411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2024]
Abstract
Objective: We analyzed a natural language processing (NLP) toolkit's ability to classify unstructured EHR data by psychiatric diagnosis. Expertise can be a barrier to using NLP. We employed an NLP toolkit (CLARK) created to support studies led by investigators with a range of informatics knowledge. Methods: The EHR of 652 patients were manually reviewed to establish Depression and Substance Use Disorder (SUD) labeled datasets, which were split into training and evaluation datasets. We used CLARK to train depression and SUD classification models using training datasets; model performance was analyzed against evaluation datasets. Results: The depression model accurately classified 69% of records (sensitivity = 0.68, specificity = 0.70, F1 = 0.68). The SUD model accurately classified 84% of records (sensitivity = 0.56, specificity = 0.92, F1 = 0.57). Conclusion: The depression model performed a more balanced job, while the SUD model's high specificity was paired with a low sensitivity. NLP applications may be especially helpful when combined with a confidence threshold for manual review.
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Affiliation(s)
- Alissa Hutto
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Tarek M Zikry
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Buck Bohac
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Terra Rose
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jasmine Staebler
- Department of Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Janet Slay
- Department of Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - C Ray Cheever
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Michael R Kosorok
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
- Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, NC, USA
| | - Rebekah P Nash
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Bulbuloglu S, Gunes H. Mindfulness-based cognitive therapy for adherence of immunosuppressive treatment in liver transplant recipients: A randomized controlled trial. Explore (NY) 2024; 20:102979. [PMID: 38245470 DOI: 10.1016/j.explore.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE The aim of this study was to analyze the effects of mindfulness-based cognitive therapy on the adherence of liver transplant recipients to immunosuppressive therapy with a randomized controlled design. METHOD This randomized controlled trial was performed with 120 liver transplant recipients hospitalized at the liver transplant department of a research and practice hospital (n = 120). While we administered no intervention to the patients in the control group (n = 60), we provided Mindfulness-Based Cognitive Therapy to those in the experimental group (n = 60). We used the Mindful Attention Awareness Scale and the Immunosuppressant Therapy Adherence Scale to collect data. We utilized descriptive statistics, paired-samples t-tests, independent-samples t-tests, one-way analysis of variance, and chi-squared tests to analyze the data. RESULTS After the intervention, the immunosuppressive therapy adherence levels of the experimental group increased significantly (p < 0.01). On the other hand, the control group had significantly higher adherence to immunosuppressive therapy and significantly higher levels of mindfulness in the pretest phase than it did in the posttest phase (p < 0.01). CONCLUSIONS Complete adherence to immunosuppressive therapy is imperative for the prevention of graft rejection in liver transplant recipients. In our study, the experimental group equipped with enhanced mindfulness had higher adherence to immunosuppressive therapy. Therefore, the use of Mindfulness-Based Cognitive Therapy in the promotion of adherence to immunosuppressive therapy is recommended.
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Affiliation(s)
- Semra Bulbuloglu
- Division of Surgical Nursing, Nursing Department, Health Sciences Faculty, Istanbul Aydin University, Istanbul, Turkey.
| | - Hüseyin Gunes
- Division of Surgical Nursing, Nursing Department, Health Sciences Faculty, Bayburt University, Bayburt, Turkey
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Berg T, Aehling NF, Bruns T, Welker MW, Weismüller T, Trebicka J, Tacke F, Strnad P, Sterneck M, Settmacher U, Seehofer D, Schott E, Schnitzbauer AA, Schmidt HH, Schlitt HJ, Pratschke J, Pascher A, Neumann U, Manekeller S, Lammert F, Klein I, Kirchner G, Guba M, Glanemann M, Engelmann C, Canbay AE, Braun F, Berg CP, Bechstein WO, Becker T, Trautwein C. [Not Available]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:1397-1573. [PMID: 39250961 DOI: 10.1055/a-2255-7246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Affiliation(s)
- Thomas Berg
- Bereich Hepatologie, Medizinischen Klinik II, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Niklas F Aehling
- Bereich Hepatologie, Medizinischen Klinik II, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Tony Bruns
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Martin-Walter Welker
- Medizinische Klinik I Gastroent., Hepat., Pneum., Endokrin. Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Tobias Weismüller
- Klinik für Innere Medizin - Gastroenterologie und Hepatologie, Vivantes Humboldt-Klinikum, Berlin, Deutschland
| | - Jonel Trebicka
- Medizinische Klinik B für Gastroenterologie und Hepatologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Frank Tacke
- Charité - Universitätsmedizin Berlin, Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Berlin, Deutschland
| | - Pavel Strnad
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Martina Sterneck
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Hamburg, Hamburg, Deutschland
| | - Utz Settmacher
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Daniel Seehofer
- Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Eckart Schott
- Klinik für Innere Medizin II - Gastroenterologie, Hepatologie und Diabetolgie, Helios Klinikum Emil von Behring, Berlin, Deutschland
| | | | - Hartmut H Schmidt
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Hans J Schlitt
- Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Johann Pratschke
- Chirurgische Klinik, Charité Campus Virchow-Klinikum - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Andreas Pascher
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - Ulf Neumann
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Steffen Manekeller
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Frank Lammert
- Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - Ingo Klein
- Chirurgische Klinik I, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Gabriele Kirchner
- Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg und Innere Medizin I, Caritaskrankenhaus St. Josef Regensburg, Regensburg, Deutschland
| | - Markus Guba
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Universitätsklinikum München, München, Deutschland
| | - Matthias Glanemann
- Klinik für Allgemeine, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Cornelius Engelmann
- Charité - Universitätsmedizin Berlin, Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Berlin, Deutschland
| | - Ali E Canbay
- Medizinische Klinik, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Deutschland
| | - Felix Braun
- Klinik für Allgemeine Chirurgie, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schlewswig-Holstein, Kiel, Deutschland
| | - Christoph P Berg
- Innere Medizin I Gastroenterologie, Hepatologie, Infektiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Wolf O Bechstein
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Thomas Becker
- Klinik für Allgemeine Chirurgie, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schlewswig-Holstein, Kiel, Deutschland
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Sahoo S, Mishra E, Premkumar M. Antidepressants in People With Chronic Liver Disease and Depression: When Are They Warranted and How to Choose the Suitable One? J Clin Exp Hepatol 2024; 14:101390. [PMID: 38515504 PMCID: PMC10950710 DOI: 10.1016/j.jceh.2024.101390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Most chronic medical illnesses are associated with significant psychiatric comorbidity, especially in the form of depression, anxiety, and suicidality. Chronic liver disease (CLD) is no exception to this and rather is placed uniquely as compared to other diseases because of its intersection with alcohol use disorder and other substance use, which in itself is a mental illness. Patients with CLD may have comorbid psychiatric illnesses; the pharmacokinetic concerns arising out of hepatic dysfunction which affects pharmacotherapy for depression and vice versa. The high prevalence of medical comorbidities with CLD may further complicate the course and outcome of depression in such patients, and diagnostic and management issues arise from special situations like transplant evaluation, alcohol use disorder, and hepatic encephalopathy or multifactorial encephalopathy seen in a disoriented or agitated patient with CLD. For this narrative review, we carried out a literature search in PubMed/PubMed Central and in Google Scholar (1980-2023) with the keywords "depression in cirrhosis", "antidepressants in liver disease", "anxiety in liver disease", "depression in liver transplantation", and "drug interactions with antidepressants". This review presents a comprehensive view of the available research on the use of antidepressants in patients with CLD, including deciding to use them, choosing the right antidepressant, risks, drug interactions, and adverse reactions to expect, and managing the same. In addition, liver transplant fitness and the overlap of hepatic encephalopathy with neuropsychiatric illness will be discussed.
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Affiliation(s)
- Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Eepsita Mishra
- Department of Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Madhumita Premkumar
- Department of Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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10
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Arango-Posada MDM, Prada-Escobar AI, Marín-Hernández C, Monsalve-Franco V, Restrepo-Bernal D. Successful treatment for serious depression with suicidal risk in a heart transplant patient. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2024; 53:210-216. [PMID: 39127545 DOI: 10.1016/j.rcpeng.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/18/2022] [Accepted: 03/07/2022] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Major depressive disorder is related to unfavourable outcomes in patients with severe comorbidities. In transplant patients, major depression is associated with worse clinical outcomes. CASE REPORT We present the case of a 55-year-old man with a heart transplant due to heart failure of ischaemic origin. Six months after the transplant he developed depressed mood, anhedonia and suicidal ideation with a score of 20/27 on the PHQ-9 depression screening scale. After receiving mirtazapine 30 mg/night for a week and persisting with a high suicide risk, it was decided to administer ketamine infusion for 24 h, with which a significant improvement in mood was observed, and the disappearance of suicidal ideation 24 h after the infusion. DISCUSSION Depression in transplant patients is a factor associated with graft loss and post-transplant mortality, in addition to favouring other negative outcomes such as deep vein thrombosis. CONCLUSIONS Ketamine infusion was shown to be an effective and safe option to treat major depression with suicidal risk in a heart transplant patient.
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11
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Singal AK, Leggio L, DiMartini A. Alcohol use disorder in alcohol-associated liver disease: Two sides of the same coin. Liver Transpl 2024; 30:200-212. [PMID: 37934047 DOI: 10.1097/lvt.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
Alcohol-associated liver disease (ALD) has emerged as the leading indication for liver transplantation (LT) worldwide, with 40% of LTs in the United States performed for ALD in 2019. The ALD-related health care burden accelerated during the COVID-19 pandemic, especially in young individuals. Alcohol use disorder (AUD), which focuses on the negative effects of alcohol on psychosocial, physical, and mental health, is present in the majority of patients with ALD, with moderate to severe AUD in 75%-80%. During the last decade, early liver transplantation (eLT) has emerged as a lifesaving treatment for selected patients with alcohol-associated hepatitis; these patients may have a higher risk of using alcohol after LT. The risk of alcohol use recurrence may be reduced during the pretransplant or post-transplant period with AUD treatment using behavioral and/or pharmacological therapies and with regular monitoring for alcohol use (self-reported and complemented with biomarkers like phosphatidylethanol). However, AUD treatment in patients with ALD is challenging due to patient, clinician, and system barriers. An integrated model to provide AUD and ALD care by hepatologists and addiction experts in a colocated clinic starting from LT evaluation and selection to monitoring listed candidates and then to following up on recipients of LT should be promoted. However, the integration of addiction and hepatology teams in an LT program in the real world is often present only during evaluation and candidate selection for LT. Data are emerging to show that a multidisciplinary integrated AUD treatment within an LT program reduces recurrent alcohol use after LT. If we want to continue using early liver transplantation for patients with severe alcohol-associated hepatitis, LT programs should focus on building integrated multidisciplinary care teams for the integrated treatment of both AUD and ALD.
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Affiliation(s)
- Ashwani K Singal
- Department of Medicine, University of South Dakota, Vermillion, South Dakota, USA
- Department of Gastroenterology and Hepatology, Avera McKennan University Hospital, Sioux Falls, South Dakota, USA
- Department of Transplant Hepatology, Avera Transplant Institute, Sioux Falls, South Dakota, USA
- Department of Medicine, VA Medical Center, Sioux Falls, South Dakota, USA
| | - Lorenzo Leggio
- Department of Neuropsychopharmacology Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, Division of Intramural Clinical and Biological Research, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Medicine, Division of Addiction Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Neuroscience, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Andrea DiMartini
- Departments of Psychiatry and Transplant Surgery, and the Clinical and Translational Science Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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12
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Varshney M, Dhingra K, Choudhury A. Psychosocial Assessment and Management-related Issues Among Liver Transplant Recipients. J Clin Exp Hepatol 2024; 14:101261. [PMID: 38076366 PMCID: PMC10709203 DOI: 10.1016/j.jceh.2023.07.414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/22/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND AND AIM Liver transplant cases have been rising and becoming the choice of treatment for many patients with end-stage liver diseases. With an increasing number of qualified treatment centers and facilities, the effectiveness of liver transplants has been observed to increase over the years. But the success of liver transplants and the quality of life post-transplant have been observed to be influenced due to psychiatric comorbidities. METHOD We searched for literature using terms for 'Psychosocial factors', 'liver transplant', 'psychiatric disorders', 'treatment outcomes', and related terms, 'AUD/SUD' in three databases: PubMed, Embase, and Scopus. Articles published in English and that provided original data analyses were included while commentaries and review articles were excluded. This review article focuses on an association between various psychiatric disorders/ Substance Use Disorder (SUD)/Alcohol Use Disorder (AUD) and liver transplant outcomes which indicated the need for psychiatric treatment and its role in improved overall transplant outcomes and enhanced quality of life. RESULTS Majority of the studies indicated a negative association between psychiatric disorder, AUD, and SUD with the treatment outcomes post liver transplant. A few studies were found supporting a multidisciplinary approach to handling liver transplant patients for a more effective and improved treatment outcome. CONCLUSION The current evidence suggests a need for developing an integrated approach to assessment and management of psychiatric and psychosocial issues related to liver transplant recipients.
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Affiliation(s)
- Mohit Varshney
- Department of Psychiatry, ILBS Hospital, Vasant Kunj, New Delhi, 110070, India
| | - Kriti Dhingra
- Department of Psychiatry, ILBS Hospital, Vasant Kunj, New Delhi, 110070, India
| | - Ashok Choudhury
- Department of Hepatology, ILBS Hospital, Vasant Kunj, New Delhi, 110070, India
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13
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Lee TH, Duong N, Sutha K, Simonetto DA, Paul S. Liver transplantation for people of minoritised sexual and gender identities in the USA. Lancet Gastroenterol Hepatol 2023; 8:1152-1162. [PMID: 37837981 DOI: 10.1016/s2468-1253(23)00238-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 10/16/2023]
Abstract
The number of people who report to be of minoritised sexual or gender identities in the USA, including lesbian, gay, bisexual, transgender, queer, and other sexuality-diverse and gender-diverse identities, has been increasing in the past decade. This diverse and unique population continues to experience not only health disparities but also psychosocial, economic, and legal disparities in accessing and receiving health care, including liver transplantations. As liver transplantation is life-saving for people with end-stage liver disease, understanding the factors that can affect access to and quality of liver transplantation care in people of minoritised sexual and gender identities in the USA, including differential social supports, insurance coverage, and medical and psychiatric comorbidities, is crucial. Actions, such as collecting sexual orientation and gender identity data, implementing inclusive language, recognising implicit biases, building diverse teams, providing a safer environment, and supporting further research to understand the unique health challenges are needed to ensure equitable access to high-quality liver transplantation care for people of minoritised sexual and gender identities.
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Affiliation(s)
- Tzu-Hao Lee
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Division of Abdominal Transplant, Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Nikki Duong
- Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Ken Sutha
- Division of Nephrology, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Douglas A Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Sonali Paul
- Section of Gastroenterology, Hepatology, and Nutrition, Center for Liver Diseases and Transplant Institute, University of Chicago Medicine, Chicago, IL, USA
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14
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Doyle T, Schmidt B, Scaglione S. Prevalence of depression and anxiety symptoms by liver disease etiology. Clin Liver Dis (Hoboken) 2023; 22:89-94. [PMID: 37799635 PMCID: PMC10550025 DOI: 10.1097/cld.0000000000000068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/13/2022] [Indexed: 10/07/2023] Open
Affiliation(s)
- Todd Doyle
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL, USA
| | - Benjamin Schmidt
- Division of Gastroenterology and Hepatology, Saint Louis University, St. Louis, MO, USA
| | - Steve Scaglione
- Department of Hepatology, Loyola University Medical Center, Maywood, IL, USA
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15
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Scott AJ, Correa AB, Bisby MA, Dear BF. Depression and Anxiety Trajectories in Chronic Disease: A Systematic Review and Meta-Analysis. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:227-242. [PMID: 37607505 DOI: 10.1159/000533263] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION People living with chronic diseases are at an increased risk of anxiety and depression, which are associated with poorer medical and psychosocial outcomes. Many studies have examined the trajectories of depression and anxiety in people with specific diseases, including the predictors of these trajectories. This is valuable for understanding the process of adjustment to diseases and informing treatment planning. However, no review has yet synthesised this information across chronic diseases. METHODS Electronic databases were searched for studies reporting trajectories of depression or anxiety in chronic disease samples. Data extracted included sample characteristics, results from trajectory analyses, and predictors of trajectories. Meta-analysis of the overall pooled prevalence of depression and anxiety trajectories was conducted, and qualitative synthesis of disease severity predictors was undertaken. RESULTS Following search and screening, 67 studies were included (N = 61,201 participants). Most participants followed a stable nonclinical trajectory for depression (69.0% [95% CI: 65.6, 72.2]) and anxiety (73.4% [95% CI: 66.3, 79.5]). Smaller but meaningful subsamples followed a trajectory of depression and anxiety symptoms consistently in the clinical range (11.8% [95% CI: 9.2, 14.8] and 13.7% [95% CI: 9.3, 19.7], respectively). Several clinical and methodological moderators emerged, and qualitative synthesis suggested that few aspects of disease severity were associated with participants' trajectories. CONCLUSION Most people with chronic disease follow a trajectory of distress that is low and stable, suggesting that most people psychologically adjust to living with chronic disease. Evidence also suggests that the nature and severity of the disease are not meaningful predictors of psychological distress.
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Affiliation(s)
- Amelia J Scott
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Ashleigh B Correa
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Madelyne A Bisby
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
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16
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de Zwaan M, Erim Y, Kröncke S, Vitinius F, Buchholz A, Nöhre M. Psychosocial Diagnosis and Treatment Before and After Organ Transplantation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:413-416. [PMID: 37101343 PMCID: PMC10437037 DOI: 10.3238/arztebl.m2023.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 01/06/2023] [Accepted: 03/29/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND This new clinical practice guideline concerns the psychosocial diagnosis and treatment of patients before and after organ transplantation. Its objective is to establish standards and to issue evidence-based recommendations that will help to optimize decision making in psychosocial diagnosis and treatment. METHODS For each key question, the literature was systematically searched in at least two databases (Medline, Ovid, Cochrane Library, and CENTRAL). The end date of each search was between August 2018 and November 2019, depending on the question. The literature search was also updated to capture recent publications, by using a selective approach. RESULTS Lack of adherence to immunosuppressant drugs can be expected in 25-30% of patients and increases the odds of organ loss after kidney transplantation (odds ratio 7.1). Psychosocial interventions can significantly improve adherence. Metaanalyses have shown that adherence was achieved 10-20% more frequently in the intervention group than in the control group. 13-40% of patients suffer from depression after transplantation; mortality in this group is 65% higher. The guideline group therefore recommends that experts in psychosomatic medicine, psychiatry, and psychology (mental health professionals) should be involved in patient care throughout the transplantation process. CONCLUSION The care of patients before and after organ transplantation should be multidisciplinary. Nonadherence rates and comorbid mental disorders are common and associated with poorer outcomes after transplantation. Interventions to improve adherence are effective, although the pertinent studies display marked heterogeneity and a high risk of bias.
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Affiliation(s)
- Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg
| | - Sylvia Kröncke
- Department of Medical Psychology at the Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne
| | - Angela Buchholz
- Department of Medical Psychology at the Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover
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17
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Kaplan A, Korenjak M, Brown RS. Post-liver transplantation patient experience. J Hepatol 2023; 78:1234-1244. [PMID: 37208108 DOI: 10.1016/j.jhep.2023.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 05/21/2023]
Abstract
Given improvements in post-transplant patient and graft survival, there is a growing need to focus on patient experience and health-related quality of life (HRQOL). Though liver transplantation can be life-saving, it can also be associated with significant morbidity and complications. Patient HRQOL improves after transplantation, but it may not improve to that of age-matched cohorts. Understanding patient experience and the factors that contribute to it, including physical and psychological health, immunosuppression and medication adherence, return to employment or school, financial burden, and expectations, helps when thinking creatively about potential interventions to improve HRQOL.
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Affiliation(s)
- Alyson Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY, USA
| | | | - Robert S Brown
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY, USA.
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18
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Jing W, Bi C, Fang Z, Qian C, Chen J, Yu J, Tian G, Ye M, Liu Z. Neuropsychiatric sequelae after liver transplantation and their possible mechanism via the microbiota-gut-liver-brain axis. Biomed Pharmacother 2023; 163:114855. [PMID: 37163780 DOI: 10.1016/j.biopha.2023.114855] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023] Open
Abstract
Patients after liver transplantation are often impacted by mental and even neuropsychiatric disorders, including depression, sleep disorders, anxiety, and post-traumatic stress disorder. Neuropsychiatric sequelae have an adverse impact on rehabilitation and can even incapacitate people, reducing their quality of life. Despite screening tools and effective treatments, neuropsychiatric sequelae after liver transplantation (NSALT) have not been fully diagnosed and treated. Current research suggests that NSALT may be partly related to intestinal microbial variation, but the detailed mechanism remains unclear. In this review, we describe the clinical and diagnostic features, prevalence, prediction, clinical course and outcome, management, and treatment of NSALT; we also summarize their mechanisms through the microbiota-gut-liver-brain axis. Finally, we propose to improve NSALT on the basis of adjusting the gastrointestinal flora, immune inflammation or vagus nerve (VN), providing a novel strategy for clinical prevention and treatment.
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Affiliation(s)
- Wenhao Jing
- Department of Psychiatry, Shaoxing seventh people's hospital, Mental Health Center, School of Medicine, Shaoxing University, Shaoxing 312000, Zhejiang, China; Department of Pharmacology, School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China; Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China
| | - Chenchen Bi
- Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China
| | - Zhou Fang
- Department of General Practice, Lizhu Branch, Shaoxing Second Hospital, Shaoxing 312000, Zhejiang, China
| | - Chao Qian
- Department of Psychiatry, Shaoxing seventh people's hospital, Mental Health Center, School of Medicine, Shaoxing University, Shaoxing 312000, Zhejiang, China
| | - Jiaqi Chen
- Department of Pharmacology, School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China; Department of Emergency Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Jingru Yu
- Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China
| | - Guoqiang Tian
- Department of Psychiatry, Shaoxing seventh people's hospital, Mental Health Center, School of Medicine, Shaoxing University, Shaoxing 312000, Zhejiang, China
| | - Mengfei Ye
- Department of Psychiatry, Shaoxing seventh people's hospital, Mental Health Center, School of Medicine, Shaoxing University, Shaoxing 312000, Zhejiang, China.
| | - Zheng Liu
- Department of Pharmacology, School of Medicine, Shaoxing University, Shaoxing, Zhejiang 312000, China.
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19
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Kimura H, Kishi S, Narita H, Tanaka T, Okada T, Fujisawa D, Sugita N, Noma S, Matsumoto Y, Ohashi A, Mitsuyasu H, Yoshida K, Kawasaki H, Nishimura K, Ogura Y, Ozaki N. Comorbid psychiatric disorders and long-term survival after liver transplantation in transplant facilities with a psychiatric consultation-liaison team: a multicenter retrospective study. BMC Gastroenterol 2023; 23:106. [PMID: 37020184 PMCID: PMC10074684 DOI: 10.1186/s12876-023-02735-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVE Comorbid psychiatric disorders negatively affect the survival rate of patients with some physical disorders. In liver transplant recipients, various psychiatric disorders have been identified as worsening prognosis. However, little is known about how the presence of any comorbid (overall) disorders affect the survival rate of transplant recipients. In this study, we examined the effect of overall comorbid psychiatric disorders on survival rate in liver transplant recipients. METHODS A total of 1006 recipients who underwent liver transplantation between September 1997 and July 2017 across eight transplant facilities with a psychiatric consultation-liaison team were identified consecutively. Recipients were categorized into those with comorbid psychiatric disorders and those without comorbid psychiatric disorders. In the comorbid psychiatric disorder group, psychiatric disorder diagnosis and time of diagnosis were investigated retrospectively. RESULTS Of the 1006 recipients, 294 (29.2%) had comorbid psychiatric disorders. Comorbid psychiatric disorders in the 1006 recipients were insomnia (N = 107, 10.6%), delirium (N = 103, 10.2%), major depressive disorder (N = 41, 4.1%), adjustment disorder (N = 19, 1.9%), anxiety disorder (N = 17, 1.7%), intellectual disability (N = 11, 1.1%), autism spectrum disorder (N = 7, 0.7%), somatic symptom disorder (N = 4, 0.4%) schizophrenia (N = 4, 0.4%), substance use disorder (N = 24, 2.4%) and personality disorder (N = 2, 0.2%). The most common time of psychiatric disorder diagnosis was within the first 3 months after liver transplantation (51.6%). The final mortality in patients with comorbid psychiatric disorder diagnosis during the five periods (pretransplant, transplant to 3 months, months to 1 year, 1 to 3 years, and over 3 years posttransplant) was 16.2%, 18.8%, 39.1%, 28.6%, and 16.2% respectively, and there were no significant differences between the five periods (χ2 = 8.05, df = 4, p = 0.09). Overall comorbid psychiatric disorders were significantly associated with shorter survival time (log-rank test: p = 0.01, hazard ratio: 1.59 [95% confidence interval: 1.14-2.21], survival rate at the endpoint [%]: 62.0 vs. 83.3). However, after adjusting for confounding variables using Cox proportional hazards regression, there was no significant effect of overall comorbid psychiatric disorders on prognosis. CONCLUSION Comorbid psychiatric disorders did not affect the survival rate of liver transplant recipients in this study.
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Affiliation(s)
- Hiroyuki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan.
| | - Shinichi Kishi
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
| | - Hisashi Narita
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Kita14, Nishi5, Kita-Ku, Sapporo, 060-8648, Japan
| | - Teruaki Tanaka
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Kita14, Nishi5, Kita-Ku, Sapporo, 060-8648, Japan
- Department of Psychiatry, KKR Sapporo Medical Center, 1-6-3-40, Hiragishi, Toyohira-Ku, Sapporo, 062-0931, Japan
| | - Tsuyoshi Okada
- Department of Psychiatry, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University Graduate School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Naoko Sugita
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shun'ichi Noma
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yosuke Matsumoto
- Okayama University Hospital Gender Center, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Ayako Ohashi
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Hiroshi Mitsuyasu
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Department of Psychiatry, Tanushimaru Central Hospital, 892 Masuoda, Tanushimaru, Kurume, Fukuoka, 839-1213, Japan
| | - Keizo Yoshida
- Kariya Yoshida Mental Clinic, 2F, FBterrace Bldg, 2-40 Aioi-Cho, Kariya-Shi, Aichi, 448-0027, Japan
| | - Hiroaki Kawasaki
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-Cho, Shinjyuku-Ku, Tokyo, 162-8666, Japan
| | - Yasuhiro Ogura
- Department of Transplantation Surgery, Nagoya University Hospital, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
- Institute for Glyco-Core Research (iGCORE), Nagoya University, Furo-Cho, Chikusa-Ku, Nagoya, 464-8601, Japan
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20
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Fuochi E, Anastasio L, Lynch EN, Campani C, Dragoni G, Milani S, Galli A, Innocenti T. Main factors influencing long-term outcomes of liver transplantation in 2022. World J Hepatol 2023; 15:321-352. [PMID: 37034235 PMCID: PMC10075010 DOI: 10.4254/wjh.v15.i3.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/24/2022] [Accepted: 02/22/2023] [Indexed: 04/11/2023] Open
Abstract
Liver transplant (LT) outcomes have markedly improved in the recent decades, even if long-term morbidity and mortality are still considerable. Most of late deaths are independent from graft function and different comorbidities, including complications of metabolic syndrome and de novo neoplasms, seem to play a key role in determining long-term outcomes in LT recipients. This review discusses the main factors associated with late mortality and suggests possible strategies to improve long-term management and follow-up after liver transplantation. In particular, the reduction of drug toxicity, the use of tools to identify high-risk patients, and setting up a multidisciplinary team also for long-term management of LT recipients may further improve survival after liver transplantation.
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Affiliation(s)
- Elisa Fuochi
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Lorenzo Anastasio
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Erica Nicola Lynch
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
- Department of Medical Biotechnologies, University of Siena, Siena 53100, Italy
| | - Stefano Milani
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Tommaso Innocenti
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
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21
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Biyyala D, Joseph R, Varadharajan N, Krishnamoorthy Y, Menon V. Incidence and prevalence of depressive, anxiety, and insomnia symptoms among adult liver transplant recipients: A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 80:26-34. [PMID: 36549018 DOI: 10.1016/j.genhosppsych.2022.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Psychological morbidity among transplant recipients may negatively impact post-transplantation outcomes. Our objectives were to compute pooled incidence and prevalence estimates for depressive, anxiety, and insomnia symptoms among adults who underwent liver transplant. METHODS Electronic searches of MEDLINE, PubMed Central, CINAHL, and Google Scholar were carried out from inception to October 2022 to identify observational studies conducted among adult liver transplant recipients which measured depression, anxiety, and/or insomnia. We used the Joanna-Briggs tool for study quality appraisal. RESULTS Sixty-five studies (pooled N = 12,183) provided data for meta-analysis. The one-year pooled point prevalence rate for depressive symptoms was 25% (95% Confidence Intervals [CI]: 20% to 30%; I2 = 94%; 37 studies; N = 6088) while that of anxiety and insomnia symptoms were 29% (95% CI: 21% to 38%; I2 = 96%; 28 studies; N = 4016) and 28% (95% CI: 16% to 43%; I2 = 98%; 14 studies; N = 1834), respectively. The findings remained robust across subgroup and sensitivity analyses. Most included studies had low or moderate risk of bias. CONCLUSIONS Depressive, anxiety, and insomnia symptoms are commonly prevalent following liver transplantation. Our findings, though limited by high heterogeneity across analyses, have important implications for screening, management, and prevention of psychological morbidity in this group. SYSTEMATIC REVIEW REGISTRATION This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD 42021276008).
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Affiliation(s)
- Deepika Biyyala
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Rini Joseph
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Natarajan Varadharajan
- Department of Psychiatry, ESIC Medical College and PGIMSR, K.K.Nagar, Chennai 600078, India
| | - Yuvaraj Krishnamoorthy
- Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai 600078, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
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22
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Whitsett MP, Goswami Banerjee A, Serper M. Assessment of mental health in patients with chronic liver disease. Clin Liver Dis (Hoboken) 2022; 20:52-56. [PMID: 36033429 PMCID: PMC9405502 DOI: 10.1002/cld.1214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/21/2021] [Accepted: 01/19/2022] [Indexed: 02/04/2023] Open
Abstract
Content available: Audio Recording.
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Affiliation(s)
| | | | - Marina Serper
- Gastroenterology and HepatologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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23
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Winder GS, Mellinger JL. CAQ Corner: Psychosocial and ethical considerations in patient selection for liver transplantation. Liver Transpl 2022; 28:1376-1384. [PMID: 35377543 DOI: 10.1002/lt.26470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Gerald Scott Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica L Mellinger
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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24
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Ahmed O, Lee A, Vachharajani N, Chang SH, Park Y, Khan AS, Chapman WC, Doyle MM. Reviewing Patient-Reported Outcomes 1 Year after Orthotopic Liver Transplantation. J Am Coll Surg 2022; 235:69-77. [PMID: 35703964 DOI: 10.1097/xcs.0000000000000244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND With improved survivorship in liver transplantation (LT), there is an emerging focus on functional recovery and health-related quality of life (HRQoL) after surgery. The present study aimed to assess HRQoL after LT using the Patient-Reported Outcomes Measurement Information System (PROMIS). STUDY DESIGN This was a prospective analysis of LT recipients between 2020 and 2021. A total of 238 patients were contacted by phone at 3, 6, and 12 months postoperatively using the PROMIS 29-Profile. Scores were recorded and computed using the HealthMeasures Scoring Service. RESULTS PROMIS was available for 174 patients at 3 (n = 58), 6 (n = 57), and 12 months (n = 59). Overall, mean PROMIS scores were 47.6 ± 3, 47.6 ± 3, and 47.6 ± 3 at 3, 6, and 12 months, respectively. Most domains improved postoperatively by 12 months except for anxiety and sleep disturbance measures. The lowest domain in the immediate postoperative period was physical functioning, but this had the closest return to normative population values. Pain interference was above the population reference during the initial postoperative period, improving by 12 months where they were below mean population values. Depression and fatigue scores improved by 6 months and appeared to stabilize by 12 months post-LT. Patients demonstrated increased social participation, and scores were remarkably higher than general population means at each timepoint. CONCLUSION LT can impact physical, mental, and social health which, in this setting, remains largely unexplored using PROMIS instruments. We report that although overall patient well being can improve, some mental health domains require further consideration during the postoperative period.
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Affiliation(s)
- Ola Ahmed
- From the Division of Abdominal Organ Transplantation, Department of Surgery (Ahmed, Lee, Vachharajani, Khan, Chapman, Doyle)
| | - Angela Lee
- From the Division of Abdominal Organ Transplantation, Department of Surgery (Ahmed, Lee, Vachharajani, Khan, Chapman, Doyle)
| | - Neeta Vachharajani
- From the Division of Abdominal Organ Transplantation, Department of Surgery (Ahmed, Lee, Vachharajani, Khan, Chapman, Doyle)
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery (Chang, Park), Washington University School of Medicine, St. Louis, MO
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery (Chang, Park), Washington University School of Medicine, St. Louis, MO
| | - Adeel S Khan
- From the Division of Abdominal Organ Transplantation, Department of Surgery (Ahmed, Lee, Vachharajani, Khan, Chapman, Doyle)
| | - William C Chapman
- From the Division of Abdominal Organ Transplantation, Department of Surgery (Ahmed, Lee, Vachharajani, Khan, Chapman, Doyle)
| | - Mb Majella Doyle
- From the Division of Abdominal Organ Transplantation, Department of Surgery (Ahmed, Lee, Vachharajani, Khan, Chapman, Doyle)
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25
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Nilsson K, Westas M, Andersson G, Johansson P, Lundgren J. Waiting for kidney transplantation from deceased donors: Experiences and support needs during the waiting time -A qualitative study. PATIENT EDUCATION AND COUNSELING 2022; 105:2422-2428. [PMID: 35272905 DOI: 10.1016/j.pec.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/28/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The study aimed to explore and describe patients' experiences of the transplantation process and the support they had received during the waiting time. METHOD Semi-structured interviews were conducted with 14 patients currently waiting for kidney transplantation from deceased donors (n = 7) or recently having received kidney transplantation (n = 7). Interviews were transcribed, anonymized and analysed inductively using thematic analysis. RESULTS Two themes and seven sub-themes were identified. The first theme, "Swaying between hope and despair" describes patients' perceptions of waiting for transplantation as a struggle, their expectations for life after the upcoming transplantation and experienced disappointments. The second theme, "Making your way through the waiting time", describes support, strategies and behaviours used to manage the waiting time. CONCLUSION Patients described life while waiting for kidney transplantation as challenging, involving unexpected events, not understanding the transplantation process and having unrealistic expectations on life after transplantation. They also described support, strategies and behaviours used, some of which led to unwanted consequences. PRACTICE IMPLICATIONS Patients waiting for kidney transplantation from deceased donors need continuous and easily available education, practical and emotional support to manage the waiting time. Transplantation specific education is also needed to facilitate preparation for transplantation and adjustment to life after transplantation.
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Affiliation(s)
- Kristina Nilsson
- Department of Internal Medicine in Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden.
| | - Mats Westas
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Department of Internal Medicine, Norrköping, Sweden
| | - Johan Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
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26
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Kong D, Lu P, Solomon P, Shelley M. Gender-based depression trajectories following heart disease onset: significant predictors and health outcomes. Aging Ment Health 2022; 26:754-761. [PMID: 33663280 DOI: 10.1080/13607863.2021.1891202] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Using a nationally representative sample of U.S. older adults (50+), this study investigates gender-based depression trajectories following heart disease onset and associated risk of disability and mortality over an 8-year period. METHOD Six waves of longitudinal data from the Health and Retirement Study (2006-2016) were used (n = 1787). Heart disease onset was defined as self-reporting no heart disease at baseline but reporting a positive diagnosis in a subsequent wave. Growth Mixture Modelling identified depression trajectories. Multinomial logistic regression models determined significant predictors of depression trajectories. Cox proportional-hazards models examined the associated disability and mortality risks. RESULTS Three distinct depression trajectories were identified, including persistent minimal depression (men: 68.65%; women: 60.17%), moderate depression (women: 29.70%; men: 17.97%), and chronic depression (women: 10.12%) or emerging depression (men: 13.38%). Younger age and depression status at baseline were associated with women's chronic depression and men's emerging depression. Chronic/emerging and moderate depression were associated with higher disability risks than was minimal depression among both women and men (hazard ratios [HR] ranged from 2.12 to 3.92, p < 0.001). Only men's emerging depression was linked to higher mortality risk compared to minimal depression (HR = 2.03, p < 0.001). CONCLUSION Longitudinal course of depression following onset of heart disease is heterogeneous in later life. Unfavorable depression trajectories (i.e. moderate, chronic, and emerging) were associated with higher disability risk compared to the minimal depression trajectory. Study findings characterize risk stratification regarding depression after heart disease onset, which can inform the development of interventions to improve health outcomes among older adults with heart conditions.
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Affiliation(s)
- Dexia Kong
- Rutgers University Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
| | - Peiyi Lu
- Departments of Political Science and Statistics, School of Education, Iowa State University, Ames, IA, USA
| | - Phyllis Solomon
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Mack Shelley
- Departments of Political Science and Statistics, School of Education, Iowa State University, Ames, IA, USA
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27
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Miller-Matero LR, Hecht LM, Elsiss F, Miller MK, Son J, Ling S, Segal A, Bryce K. Acceptance of Illness Among Patients Pursuing Transplantation or Left Ventricular Assist Device. J Clin Psychol Med Settings 2021; 29:162-167. [PMID: 34076825 DOI: 10.1007/s10880-021-09793-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/26/2022]
Abstract
Acceptance of illness is related to better mental health among patients with chronic illness; however, this construct has not been evaluated as part of routine transplantation evaluations. The purpose of this study was to create a brief measure of acceptance of illness for patients pursuing organ transplantation and examine how acceptance is related to distress. Retrospective medical record reviews were conducted for 290 patients who completed a routine psychosocial evaluation prior to transplant listing which included the Illness Acceptance Scale (IAS). Internal consistency for the IAS was excellent (Cronbach's alpha = .92). Illness acceptance was negatively correlated with depression, anxiety, and catastrophizing and was not related to health literacy or health numeracy. The IAS is a reliable and valid measure for patients who are pursuing thoracic transplant or left ventricular assist device. Clinicians may want to screen transplant candidates for illness acceptance and refer those with lower levels to psychological interventions.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, USA.
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, USA.
| | - Leah M Hecht
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, USA
| | - Farah Elsiss
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, USA
| | - Mary Kate Miller
- Behavioral Health, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, USA
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, USA
| | - John Son
- Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Shu Ling
- Behavioral Health, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, USA
| | - Antú Segal
- Behavioral Health, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, USA
- Transplant Institute, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Kelly Bryce
- Behavioral Health, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, USA
- Transplant Institute, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
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28
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Herzer K, Sterneck M, Welker MW, Nadalin S, Kirchner G, Braun F, Malessa C, Herber A, Pratschke J, Weiss KH, Jaeckel E, Tacke F. Current Challenges in the Post-Transplant Care of Liver Transplant Recipients in Germany. J Clin Med 2020; 9:jcm9113570. [PMID: 33167567 PMCID: PMC7694452 DOI: 10.3390/jcm9113570] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/25/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023] Open
Abstract
Improving long-term patient and graft survival after liver transplantation (LT) remains a major challenge. Compared to the early phase after LT, long-term morbidity and mortality of the recipients not only depends on complications immediately related to the graft function, infections, or rejection, but also on medical factors such as de novo malignancies, metabolic disorders (e.g., new-onset diabetes, osteoporosis), psychiatric conditions (e.g., anxiety, depression), renal failure, and cardiovascular diseases. While a comprehensive post-transplant care at the LT center and the connected regional networks may improve outcome, there is currently no generally accepted standard to the post-transplant management of LT recipients in Germany. We therefore described the structure and standards of post-LT care by conducting a survey at 12 German LT centers including transplant hepatologists and surgeons. Aftercare structures and form of cost reimbursement considerably varied between LT centers across Germany. Further discussions and studies are required to define optimal structure and content of post-LT care systems, aiming at improving the long-term outcomes of LT recipients.
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Affiliation(s)
- Kerstin Herzer
- Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
- Knappschafts-Klinik Bad Neuenahr, 53474 Bad Neuenahr-Ahrweiler, Germany
| | - Martina Sterneck
- Department of Medicine, University Medical Center Hamburg Eppendorf, 20251 Hamburg, Germany;
| | - Martin-Walter Welker
- Department of Internal Medicine I, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany;
| | - Silvio Nadalin
- Department for General, Visceral and Transplant Surgery, University Hospital Tuebingen, 72016 Tuebingen, Germany;
| | - Gabriele Kirchner
- Department of Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany;
- Innere Medizin I, Caritaskrankenhaus St. Josef, 93053 Regensburg, Germany
| | - Felix Braun
- Department for Transplantation Surgery, University Hospital Kiel, 24105 Kiel, Germany;
| | - Christina Malessa
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, 07747 Jena, Germany;
| | - Adam Herber
- Department of Gastroenterology and Rheumatology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum, Charité University Medicine Berlin, 13353 Berlin, Germany;
- Berlin Institute of Health, 13353 Berlin, Germany
| | - Karl Heinz Weiss
- Department of Internal Medicine, University of Heidelberg, 69120 Heidelberg, Germany;
- Department of Internal Medicine, Salem Medical Center, 69120 Heidelberg, Germany
| | - Elmar Jaeckel
- Integrated Research and Treatment Centre Transplantation (IFB-Tx), Hannover Medical School, 30625 Hannover, Germany;
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany
| | - Frank Tacke
- Department of Hepatology & Gastroenterology, Campus Charité Mitte/Campus Virchow-Klinikum, Charité University Medicine Berlin, 13353 Berlin, Germany
- Correspondence:
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29
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Wang B, Lu S, Zhang C, Zhu L, Li Y, Bai M, Xu E. Quantitative proteomic analysis of the liver reveals antidepressant potential protein targets of Sinisan in a mouse CUMS model of depression. Biomed Pharmacother 2020; 130:110565. [PMID: 32745909 DOI: 10.1016/j.biopha.2020.110565] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/17/2020] [Accepted: 07/26/2020] [Indexed: 12/12/2022] Open
Abstract
In traditional Chinese medicine, the role of the liver in depression is highly valued, and liver-relieving drugs, such as Sinisan, are often used to treat depression; however, the mechanism whereby these drugs work remains unclear. The present study aimed to reveal possible antidepressant mechanisms of Sinisan (SNS) by analyzing hepatic proteomics in chronic unpredictable mild stress (CUMS) mice. Using the CUMS mouse model of depression, the antidepressant effects of SNS were assessed by the sucrose preference test (SPT) and forced swimming test (FST). Hepatic differentially expressed proteins (DEPs) after SNS treatment were investigated by tandem mass tag (TMT) based quantitative proteomics analysis. Then, a bioinformatics analysis of DEPs was conducted through hierarchical clustering, Venn analysis, Gene Ontology (GO) annotation enrichment, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment. DEP genes were further validated by quantitative real-time polymerase chain reaction (qRT-PCR) analysis and western blotting. Behavioral results demonstrated that SNS significantly increased sucrose intake in SPT and shortened the immobility time in FST in model mice. Eighty-two DEPs were identified, including 37 upregulated and 45 downregulated proteins, between model and SNS groups. Enrichment analysis of GO annotations indicated that SNS primarily maintained cellular iron ion homeostasis by iron ion transportation and regulated expression of some extracellular structural proteins for oxidation-reduction processes. KEGG and Venn analysis showed that mineral absorption, steroid hormone biosynthesis and metabolism might be the principal pathways through which SNS acts on depression. Furthermore, several proteins involved in the biosynthesis and metabolism of steroid hormone pathways were significantly up/downregulated by SNS, including CYP2B19, CYP7B1 (validated by qRT-PCR) and HSD3b5 (validated by qRT-PCR and western blotting). Our results indicate that SNS plays important roles in antidepressant actions by restoring DEPs, resulting in the biosynthesis and metabolism of steroid hormones. The current results provide novel perspectives for revealing potential protein targets of SNS in depression.
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Affiliation(s)
- Baoying Wang
- Henan Key Laboratory for Modern Research on Zhongjing's Herbal Formulae, Academy of Traditional Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, China.
| | - Shuaifei Lu
- School of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, China
| | - Changjing Zhang
- School of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, China
| | - Leilei Zhu
- School of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yucheng Li
- Henan Key Laboratory for Modern Research on Zhongjing's Herbal Formulae, Academy of Traditional Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Ming Bai
- Henan Key Laboratory for Modern Research on Zhongjing's Herbal Formulae, Academy of Traditional Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, China.
| | - Erping Xu
- Henan Key Laboratory for Modern Research on Zhongjing's Herbal Formulae, Academy of Traditional Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, China.
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30
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Åberg F. Quality of life after liver transplantation. Best Pract Res Clin Gastroenterol 2020; 46-47:101684. [PMID: 33158471 DOI: 10.1016/j.bpg.2020.101684] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/31/2020] [Indexed: 01/31/2023]
Abstract
Liver transplantation (LT) enables rapid transition from critical illness and poor prognosis back to health. After LT, health-related quality of life (HRQoL) generally becomes comparable to that of the general population, although some deficits in mainly physical domains are frequent. However, recipients continue to have symptoms related to immunosuppression, complications, and other things, which impact HRQoL and the recipient's ability to regain independence and re-establish function in everyday life. Less than half of LT recipients return to work. Reportedly, HRQoL seems to deteriorate slightly over the long-term, but still remains satisfactory. Physical fatigue is common, but recent studies show that structured exercise programs improve both fatigue and HRQoL. Emerging evidence also suggests that continued patient information, structured psychosocial support systems, and caregiver involvement might further help improve long-term HRQoL. More research is needed to gain better understanding of the factors affecting long-term HRQoL, and how to best improve HRQoL.
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Affiliation(s)
- Fredrik Åberg
- Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki University, Helsinki, Finland; The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
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31
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Blumenthal JA, Smith PJ, Sherwood A, Mabe S, Snyder L, Frankel C, McKee DC, Hamilton N, Keefe FJ, Shearer S, Schwartz J, Palmer S. Remote Therapy to Improve Outcomes in Lung Transplant Recipients: Design of the INSPIRE-III Randomized Clinical Trial. Transplant Direct 2020; 6:e535. [PMID: 32195326 PMCID: PMC7056276 DOI: 10.1097/txd.0000000000000979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/21/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Impaired functional capacity and emotional distress are associated with lower quality of life (QoL) and worse clinical outcomes in post lung transplant patients. Strategies to increase physical activity and reduce distress are needed. METHODS The Investigational Study of Psychological Interventions in Recipients of Lung Transplant-III study is a single site, parallel group randomized clinical trial in which 150 lung transplant recipients will be randomly assigned to 3 months of telephone-delivered coping skills training combined with aerobic exercise (CSTEX) or to a Standard of Care plus Education control group. The primary endpoints are a global measure of distress and distance walked on the 6-Minute Walk Test. Secondary outcomes include measures of transplant-specific QoL, frailty, health behaviors, and chronic lung allograft dysfunction-free survival. RESULTS Participants will be evaluated at baseline, at the conclusion of 3 months of weekly treatment, at 1-year follow-up, and followed annually thereafter for clinical events for up to 4 years (median = 2 y). We also will determine whether functional capacity, distress, and health behaviors (eg, physical activity, medication adherence, and volume of air forcefully exhaled in 1 second (FEV1), mediate the effects of the CSTEX intervention on clinical outcomes. CONCLUSIONS Should the CSTEX intervention result in better outcomes compared with the standard of care plus post-transplant education, the remotely delivered CSTEX intervention can be made available to all lung transplant recipients as a way of enhancing their QoL and improving clinical outcomes.
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Affiliation(s)
- James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Stephanie Mabe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Laurie Snyder
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Courtney Frankel
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Daphne C. McKee
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Natalie Hamilton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Sheila Shearer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Jeanne Schwartz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Scott Palmer
- Department of Medicine, Duke University Medical Center, Durham, NC
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Zhu X, Ming Y, Liu J, Liu L, Cheng K, Mao P. Sleep Quality and Psychosocial Factors in Liver Transplant Recipients at an Outpatient Follow-Up Clinic in China. Ann Transplant 2020; 25:e920984. [PMID: 32066650 PMCID: PMC7047916 DOI: 10.12659/aot.920984] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Sleep disturbance is a common problem in liver transplant recipients, but few studies have confirmed the psychosocial factors associated with sleep quality in patients after liver transplantation. This study aimed to identify the psychosocial factors related to sleep quality among liver transplant patients during outpatient follow-up. Material/Methods A retrospective cross-sectional study was performed in 124 liver transplant patients during outpatient follow-up. All participants completed a general demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Generalized Anxiety Disorder-7 scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the perceived social support scale (PSSS). Results The mean global PSQI score was 6.57 (SD, 4.28), which was significantly higher than the mean score for people with normal sleep quality; 50 (40.3%) recipients were classified as having poor sleep quality (PSQI >7). Among the self-reported sleep problems, 62 (50.0%) participants reported that they had to go to the bathroom at night, 58 (43.5%) woke up in the middle of the night or early morning, 84 (67.7%) reported depression symptoms, and 116 (93.5%) had low-level social support. The global PSQI score was positively correlated with anxiety and depression scores, while the global PSSS score was negatively correlated with anxiety and depression scores (p<0.01). Multiple linear regression analysis showed that the length of the post-liver transplant period, the type of residence, BMI, depressive symptoms, and anxiety symptoms were important factors affecting sleep quality among liver transplant patients (p<0.05). Conclusions Our findings showed high prevalence and incidence of poor sleep quality in liver transplant recipients in outpatient follow-up, with significant correlations with anxiety, depression, and social support, and it was affected by multiple factors. This indicates a need for further research on the follow-up results of sleep and the benefits of comprehensive interventions involving psychosocial factors in liver transplant recipients in China.
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Affiliation(s)
- Xiao Zhu
- Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Affiliated Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Yingzi Ming
- Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Affiliated Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Jia Liu
- Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Affiliated Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Lifang Liu
- Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Affiliated Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Ke Cheng
- Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Affiliated Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Ping Mao
- Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Affiliated Hospital, Central South University, Changsha, Hunan, China (mainland).,Nursing School of Central South University, Changsha, Hunan, China (mainland)
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Erard-Poinsot D, Dharancy S, Hilleret MN, Faure S, Lamblin G, Chambon-Augoyard C, Donnadieu-Rigole H, Lassailly G, Boillot O, Ursic-Bedoya J, Guillaud O, Leroy V, Pageaux GP, Dumortier J. Natural History of Recurrent Alcohol-Related Cirrhosis After Liver Transplantation: Fast and Furious. Liver Transpl 2020; 26:25-33. [PMID: 31562696 DOI: 10.1002/lt.25647] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/10/2019] [Indexed: 12/13/2022]
Abstract
Alcohol-related liver disease (ALD) is one of the main indications for liver transplantation (LT). Severe alcohol relapse can rapidly lead to recurrent alcohol-related cirrhosis (RAC) for the graft. The aim of this study was to describe the natural history of RAC and the overall survival after LT and after an RAC diagnosis. From 1992 to 2012, 812 patients underwent primary LT for ALD in 5 French transplant centers. All patients with severe alcohol relapse and an RAC diagnosis on the graft were included. The diagnosis of cirrhosis was based on the analysis of liver biopsy or on the association of clinical, biological, radiological, and/or endoscopic features of cirrhosis. RAC was diagnosed in 57/162 patients (35.2%) with severe alcohol relapse, and 31 (54.4%) of those patients had at least 1 episode of liver decompensation. The main types of decompensation were ascites (70.9%), jaundice (58.0%), and hepatic encephalopathy (9.6%). The cumulative probability of decompensation was 23.8% at 5 years, 50.1% at 10 years, and 69.9% at 15 years after LT. During the follow-up, 36 (63.2%) patients died, the main cause of death being liver failure (61.1%). After diagnosis of cirrhosis, the survival rate was 66.3% at 1 year, 37.8% at 5 years, and 20.6% at 10 years. In conclusion, RAC is associated with a high risk of liver decompensation and a poor prognosis. Prevention of severe alcohol relapse after LT is a major goal to improve patient survival.
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Affiliation(s)
- Domitille Erard-Poinsot
- Fédération des Spécialités Digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Sébastien Dharancy
- Service de Chirurgie Digestive et Transplantation, Pôle Médico-Chirurgical Huriez, Hôpital Claude Huriez, Université Lille 2, Lille, France
| | - Marie-Noëlle Hilleret
- Clinique Universitaire d'Hépato-Gastroentérologie, Pole Digidune, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U823, Grenoble, France
| | - Stéphanie Faure
- Unité de Transplantation Hépatique, Pôle Digestif, Centre Hospitalier Universitaire de Saint-Eloi, Université Montpellier, Montpellier, France
| | - Géraldine Lamblin
- Service d'Hépatologie et Gastroentérologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Christine Chambon-Augoyard
- Fédération des Spécialités Digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Hélène Donnadieu-Rigole
- Unité de Transplantation Hépatique, Pôle Digestif, Centre Hospitalier Universitaire de Saint-Eloi, Université Montpellier, Montpellier, France
| | - Guillaume Lassailly
- Service de Chirurgie Digestive et Transplantation, Pôle Médico-Chirurgical Huriez, Hôpital Claude Huriez, Université Lille 2, Lille, France
| | - Olivier Boillot
- Fédération des Spécialités Digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - José Ursic-Bedoya
- Unité de Transplantation Hépatique, Pôle Digestif, Centre Hospitalier Universitaire de Saint-Eloi, Université Montpellier, Montpellier, France
| | - Olivier Guillaud
- Fédération des Spécialités Digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Vincent Leroy
- Clinique Universitaire d'Hépato-Gastroentérologie, Pole Digidune, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U823, Grenoble, France
| | - Georges-Philippe Pageaux
- Unité de Transplantation Hépatique, Pôle Digestif, Centre Hospitalier Universitaire de Saint-Eloi, Université Montpellier, Montpellier, France
| | - Jérôme Dumortier
- Fédération des Spécialités Digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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Nonterah CW, Marek RJ, Borckardt JJ, Balliet WE. Impact of Alexithymia on Organ Transplant Candidates' Quality of Life: The Mediating Role of Depressive Symptoms. Psychol Rep 2019; 123:1614-1634. [PMID: 31856644 DOI: 10.1177/0033294119896058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Solid organ transplant candidates who display alexithymia tend to report psychological distress with some displaying symptoms associated with depression which in turn has a negative impact on their quality of life. This study sought to examine the mediating role of depression on the relationship between alexithymia and physical and psychological quality of life. The sample comprised 707 patients who were under consideration for solid organ transplantation. Mediation models were used to examine the proposed hypotheses, specifically that alexithymia would predict quality of life, and that depression would mediate the relationship between alexithymia and physical and psychological quality of life. Findings revealed that alexithymia predicted both physical and psychological quality of life. Depression scores partially mediated the relationship between alexithymia and both physical and psychological quality of life. Transplant candidates with higher levels of alexithymia who report poor physical and psychological quality of life may be at increased risk for depression. Results highlight the need to assess alexithymia within this unique patient population, who may understate symptoms of depression due to attempts at positive impression management.
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Affiliation(s)
| | - Ryan J Marek
- University of Houston-Clear Lake, Houston, TX, USA
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35
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Insights Into the Experience of Liver Transplant Recipients With Alcoholic Liver Disease: A Descriptive Qualitative Study. Transplant Direct 2019; 5:e506. [PMID: 32095501 PMCID: PMC7004591 DOI: 10.1097/txd.0000000000000951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 09/21/2019] [Indexed: 12/01/2022] Open
Abstract
Background. Alcoholic liver disease (ALD) due to alcohol use disorder (AUD) is the primary cause of liver transplantation (LT) in the United States. Studies have found that LT recipients experience a range of physical and emotional difficulties posttransplantation including return to alcohol use, depression, and anxiety. The aim of this study is to better understand the experiences of LT recipients with ALD because they recovered posttransplant to inform the development of a patient-centered intervention to assist patients during recovery. Methods. Using qualitative methods, researchers conducted semi-structured interviews with 16 ALD LT recipients. The primary topics of the interview were physical recovery, mental health, substance use including alcohol and tobacco use, and financial experiences. Common patient themes were identified and coded. Results. Within the domain of physical health, patients stressed that undergoing LT was a near-death experience, they were helpless, changes in weight influenced their perception of their illness, and they have ongoing medical problems. In the domain of mental health, patients described cognitive impairments during their initial recovery, difficulty in processing the emotions of having a terminal condition, ongoing depression, anxiety, and irritability. The patients also described their perception of having AUD, the last time they used alcohol and their attitude to AUD treatment posttransplant. Patients also described their reliance on one member of their social support network for practical assistance during their recovery and identified one member of their medical team as being of particular importance in providing emotional as well as medical support during recovery. Conclusions. The patient’s description of their lived experience during the months following transplant informed the development of a patient-centered intervention that colocates behavioral health components with medical treatment that helps broaden their social network while addressing topics that emerged from this study.
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Trajectories of Anxiety and Depression After Liver Transplantation as Related to Outcomes During 2-Year Follow-Up: A Prospective Cohort Study. Psychosom Med 2019; 80:174-183. [PMID: 29112588 DOI: 10.1097/psy.0000000000000539] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aims of the study were to examine whether distinct trajectories of anxious and depressive symptoms are present among liver transplant recipients from before transplantation to 2 years afterward, to identify associated demographic, clinical, and individual characteristics, and to examine the influence of distinct trajectories on outcomes. METHODS A prospective, multicenter cohort study was performed among 153 liver transplant recipients. Data were retrieved using questionnaires administered before transplantation and at 3, 6, 12, and 24 months after transplantation. Clinical data were retrieved by medical record review. Latent class growth analysis was used to identify distinct trajectories. χ test, analyses of variance, and multinomial logistic regression were used to identify associated variables and the impact of the distinct trajectories on outcomes. RESULTS Three distinct trajectories for symptoms of anxiety (State-Trait Anxiety Inventory-short form) as well as depression (Center for Epidemiological Studies Depression Scale) were identified: "no symptoms," "resolved symptoms," and "persistent symptoms." The trajectories of persistent anxiety and depression comprised, respectively, 23% and 29% of the transplant recipients. Several clinical and individual variables were associated with the trajectories of persistent anxiety and/or depression: experiencing more adverse effects of the immunosuppressive medication, lower level of personal control, more use of emotion-focused coping, less disclosure about the transplant, and more stressful life events. The trajectories of persistent symptoms were associated with worse outcomes regarding medication adherence and health-related quality of life, but not with mortality. CONCLUSIONS A significant subset of transplant recipients showed persistent symptoms of anxiety and depression from before to 2 years after transplantation. These results emphasize the importance of psychosocial care in the transplant population.
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Kahl KG, Eckermann G, Frieling H, Hillemacher T. Psychopharmacology in transplantation medicine. Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:74-85. [PMID: 30018020 DOI: 10.1016/j.pnpbp.2018.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 06/07/2018] [Accepted: 07/05/2018] [Indexed: 12/18/2022]
Abstract
Organ transplantation has become a well-established treatment option in patients with end-stage organ diseases. Although quality of life has markedly improved, psychiatric disorders before and after transplantation are more frequent compared to the general population. Psychopharmacological treatment is recommended for almost all mental disorders according to current guidelines, but may pose particular problems in organ transplant patients. Changes in the metabolism and elimination of drugs during organ insufficiency, drug interactions, and overlapping side effects between psychopharmacological and immunosuppressive drugs are challenging problems in clinical management. Furthermore, questions frequently arise concerning the use of psychopharmacological treatment options for sleeping and anxiety disorders. This article reviews psychopharmacology in organ transplant patients, with particular attention to frequent psychiatric disorders observed in the disease course of end-stage organ diseases.
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Affiliation(s)
- Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School, Hannover, Germany; Section Polypharmacy, Working Group on Neuropsychopharmacology and Pharmacopsychiatry (AGNP), Germany.
| | - Gabriel Eckermann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School, Hannover, Germany; Section Polypharmacy, Working Group on Neuropsychopharmacology and Pharmacopsychiatry (AGNP), Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School, Hannover, Germany
| | - Thomas Hillemacher
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School, Hannover, Germany; Department of Psychiatry and Psychotherapy, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Germany
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38
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Niazi SK, Schneekloth TD, Vasquez AR, Keaveny AP, Davis S, Picco M, Heckman MG, Diehl NN, Jowsey-Gregoire SG, Rummans TA, Burcin Taner C. Impact of psychiatric comorbidities on outcomes of elderly liver transplant recipients. J Psychosom Res 2018; 111:27-35. [PMID: 29935751 DOI: 10.1016/j.jpsychores.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study evaluated the impact of psychiatric comorbidities in liver transplant (LT) recipients aged ≥65 years (elderly) on length of hospital-stay (LOS), death, and a composite outcome of graft loss or death. METHODS This retrospective study assessed impact of psychiatric comorbidities in 122 elderly LT recipients and a matched group of 122 LT recipients aged <65 years (younger). Associations were assessed using adjusted multivariable regression models. RESULTS Among elderly, median age at LT was 68 years, most were males (62%), white (85%) and 61.7% had a history of any psychiatric diagnosis. Among younger, median age was 55, most were males (67.2%), white (77.5%) and 61.5% had any psychiatric diagnosis. Median LOS was 8 days for both groups. Among elderly, after a median follow-up of 5 years, 25.4% died and 29.5% experienced graft loss or death. History of adjustment disorder, history of depression, past psychiatric medication use, and pain prior to LT were associated with an increased risk of death or the composite graft loss or death. Perioperative use of SSRIs and lack of sleeping medication use were associated with longer LOS. Among aged <65, after median follow-up of 4.7 years, 21 patients (17%) died and 25 (20%) experienced graft loss or death; history of depression, perioperative SSRIs or sleeping medications use was associated with increased mortality and graft-loss or death. CONCLUSION Six out of 10 patients among both elderly and younger cohorts had pre-LT psychiatric comorbidities, some of which adversely affected outcomes after LT.
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Affiliation(s)
- Shehzad K Niazi
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States; Department of Transplantation, Mayo Clinic, Jacksonville, FL, United States.
| | - Terry D Schneekloth
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN, United States
| | - Adriana R Vasquez
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States; Department of Transplantation, Mayo Clinic, Jacksonville, FL, United States
| | - Andrew P Keaveny
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, United States
| | - Susan Davis
- Mayo Clinic, Jacksonville, FL, United States
| | | | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, United States
| | - Nancy N Diehl
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, United States
| | - Sheila G Jowsey-Gregoire
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN, United States
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - C Burcin Taner
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, United States
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Elderly recipients of liver transplantation: impact of age and psychosocial variables on outcome. Curr Opin Organ Transplant 2018; 22:588-592. [PMID: 28914641 DOI: 10.1097/mot.0000000000000469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW With expanding experience and success of liver transplantation, increasing numbers of elderly candidates await and undergo liver transplantation. There is accumulating evidence that graft survival and mortality does not appear to differ significantly between the young and carefully selected elderly liver transplantation recipients. Although existing evidence suggests that psychosocial factors impact outcomes after liver transplantation in general, no such information is available specifically for elderly (age ≥65 years) liver transplantation recipients. We conducted a broad medical literature review of outcome studies of elderly liver transplantation recipients. In this review article, we summarize the findings and comment on psychosocial variables included in these studies. RECENT FINDINGS Ten outcome studies have reported on the impact of age on the liver transplantation outcomes. There is increasing evidence of favorable outcomes in elderly liver transplantation recipients. Few of these studies include measures of quality of life, functional improvement and other psychosocial variables. SUMMARY Very limited information is available about the impact of psychosocial factors on outcomes in elderly liver transplantation recipients. This dearth of information represents a critical gap in our knowledge and has implications for optimal candidate selection and outcomes after liver transplantation.
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Dhar VK, Kim Y, Graff JT, Jung AD, Garrett J, Dick LE, Harris J, Shah SA. Benefit of social media on patient engagement and satisfaction: Results of a 9-month, qualitative pilot study using Facebook. Surgery 2018; 163:565-570. [DOI: 10.1016/j.surg.2017.09.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/19/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
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Heo J, Noh OK, Oh YT, Chun M, Kim L. Psychiatric comorbidities among patients undergoing liver transplantation in South Korea: a nationwide population-based study. Hepatol Int 2018; 12:174-180. [PMID: 29442216 DOI: 10.1007/s12072-018-9849-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/29/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of this study was to analyze the prevalence of mental disorders in patients undergoing liver transplantation (LT) based on claims data from the Health Insurance Review and Assessment Service (HIRA) in South Korea. METHODS We confirmed mental disorders in a nationwide cohort of 3758 patients receiving LT between January 2010 and December 2014. We categorized the prevalence of mental disorders based on patient age at the time of LT. RESULTS A total of 288 patients for LT were diagnosed with a mental disorder 1 year before their cancer diagnosis. Of those patients, depression was present in 90 (31.25%) and anxiety in 92 (31.9%) patients at the first diagnosis. The overall frequency of mental disorders peaked just before LT, and substance abuse was the most prevalent mental disorder before LT. The risk of mental disorders after LT was significantly lower in those with hepatocellular carcinoma (HCC) than in those without HCC (hazard ratio = 1.70, p < 0.001). CONCLUSIONS Mental disorders in patients receiving LT showed different patterns of prevalence depending on age at the time of surgery and the nature of underlying diseases. Personalized intervention based on patient characteristics could improve the quality of life.
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Affiliation(s)
- Jaesung Heo
- Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - O Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, South Korea. .,Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea. .,Office of Biostatistics, Ajou University School of Medicine, Suwon, South Korea.
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Logyoung Kim
- Health Insurance Review and Assessment Service, Seoul, South Korea
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Serigado JM, Barboza KC, Marcus P, Sigal SH. Clinical Impact of Depression in Cirrhosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s11901-018-0386-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Burra P, Zanetto A, Germani G. Liver Transplantation for Alcoholic Liver Disease and Hepatocellular Carcinoma. Cancers (Basel) 2018; 10:E46. [PMID: 29425151 PMCID: PMC5836078 DOI: 10.3390/cancers10020046] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma is one of the main important causes of cancer-related death and its mortality is increasingly worldwide. In Europe, alcohol abuse accounts for approximately half of all liver cancer cases and it will become the leading cause of hepatocellular carcinoma in the next future with the sharp decline of chronic viral hepatitis. The pathophysiology of alcohol-induced carcinogenesis involves acetaldehyde catabolism, oxidative stress and chronic liver inflammation. Genetic background plays also a significant role and specific patterns of gene mutations in alcohol-related hepatocellular carcinoma have been characterized. Survival is higher in patients who undergo specific surveillance programmes than in patients who do not. However, patients with alcohol cirrhosis present a significantly greater risk of liver decompensation than those with cirrhosis due to other aetiologies. Furthermore, the adherence to screening program can be suboptimal. Liver transplant for patients with Milan-in hepatocellular carcinoma represents the best possible treatment in case of tumour recurrence/progression despite loco-regional or surgical treatments. Long-term result after liver transplantation for alcohol related liver disease is good. However, cardiovascular disease and de novo malignancies can significantly hamper patients' survival and should be carefully considered by transplant team. In this review, we have focused on the evolution of alcohol-related hepatocellular carcinoma epidemiology and risk factors as well as on liver transplantation in alcoholic patients with and without hepatocellular carcinoma.
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Affiliation(s)
- Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, 35128 Padua, Italy.
| | - Alberto Zanetto
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, 35128 Padua, Italy.
| | - Giacomo Germani
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, 35128 Padua, Italy.
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Rogal S, Shenai N, Kruckenberg K, Rosenberger E, Dew MA, DiMartini A. Post-transplant Outcomes of Persons Receiving a Liver Graft for Alcoholic Liver Disease. Alcohol Alcohol 2017; 53:157-165. [DOI: 10.1093/alcalc/agx100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022] Open
Affiliation(s)
- Shari Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA 15240, USA
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Neeta Shenai
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA
| | - Katherine Kruckenberg
- University Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA
| | - Emily Rosenberger
- Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Clinical and Translational Science Institute, 401 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA
- Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Clinical and Translational Science Institute, 401 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261
- Departments of Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, 4200 Fifth Avenue, Pittsburgh, PA 15260, USA
| | - Andrea DiMartini
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA
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Cahn-Fuller KL, Parent B. Transplant eligibility for patients with affective and psychotic disorders: a review of practices and a call for justice. BMC Med Ethics 2017; 18:72. [PMID: 29216883 PMCID: PMC5721543 DOI: 10.1186/s12910-017-0235-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The scarcity of human organs requires the transplant community to make difficult allocation decisions. This process begins at individual medical centers, where transplant teams decide which patients to place on the transplant waiting list. Each transplant center utilizes its own listing criteria to determine if a patient is eligible for transplantation. These criteria have historically considered preexisting affective and psychotic disorders to be relative or absolute contraindications to transplantation. While attitudes within the field appear to be moving away from this practice, there is no data to confirm that eligibility criteria have changed. MAIN BODY There are no nationwide guidelines detailing the manner in which affective and psychotic disorders should impact transplant eligibility. Individual transplant centers thus form their own transplant eligibility criteria, resulting in significant inter-institution variability. Data from the 1990s indicates that the majority of transplant programs considered certain psychiatric illnesses, such as active schizophrenia, to be absolute contraindications to transplantation. A review of literature reveals that no comprehensive data has been collected on the topic since that time. Furthermore, the limited data available about current practices suggests that psychiatric illness continues to be viewed as a contraindication to transplantation at some transplant centers. In light of this finding, we review psychiatric literature that examines the impact of affective and psychotic disorders on transplant outcomes and conclude that the presence of these disorders is not an accurate predictor of transplant success. We then discuss the requirements of justice as they relate to the creation of a just organ allocation system. CONCLUSION We conclude that transplant eligibility criteria that exclude patients with affective and psychotic disorders on the basis of their psychiatric diagnosis alone are unjust. Just listing criteria must incorporate only those factors that have a causative effect on posttransplant morbidity and mortality. Justice also demands that we eliminate current inter-institution practice variations in favor of national transplant eligibility criteria. Given the limited data available about current practices, we call for an updated study investigating the manner in which affect and psychotic disorders impact transplant eligibility determinations.
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Affiliation(s)
- Katherine L Cahn-Fuller
- NYU Langone Health, Division of Medical Ethics, New York, NY, USA. .,Columbia University Medical Center, New York, NY, USA.
| | - Brendan Parent
- NYU Langone Health, Division of Medical Ethics, New York, NY, USA
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Golfieri L, Gitto S, Morelli MC, Pinna AD, Grandi S, Andreone P. Impact of hepatitis C virus infection on health-related quality of life before and after liver transplantation: a multidisciplinary point of view. Expert Rev Anti Infect Ther 2017; 15:759-765. [PMID: 28756716 DOI: 10.1080/14787210.2017.1362334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis C negatively changes patient quality of life even in the absence of advanced liver disease. The specific patterns of quality of life of hepatitis C positive patients waiting for transplant or after surgery are not widely studied. Areas covered: A significant percentage of infected patients show cognitive impairment, fatigue, and/or a 'brain fog', that cannot be explained by the liver disease. Depression can be diagnosed in one third of hepatitis C positive patients. Conflicting data are available regarding the possible role of Model for End-Stage Liver Disease score as predictor of impaired quality of life. In the first period after liver transplant, quality of life tends to increase at the pre-transplant period but in the medium and long-term period, it declines. The recurrence of hepatitis C infection represents a strong predictor of morbidity and mortality and can significantly affect the global quality of life of patients. Expert commentary: Hepatologists, surgeons and psychologists should collaborate to support infected patients in all phases of transplant including the long-term period after surgery. Education and information should be implemented especially regarding the positive role of new direct antivirals.
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Affiliation(s)
- Lucia Golfieri
- a Dipartimento di Psicologia , Università di Bologna , Bologna , Italy
| | - Stefano Gitto
- b Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche , Università di Bologna , Bologna , Italy
- c Programma Dipartimentale Innovazione Terapeutica Epatopatie Croniche Virali (ITEC), Dipartimento Ospedaliero dell'Apparato Digerente , Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola , Bologna , Italy
| | - Maria Cristina Morelli
- d Medicina Interna per il trattamento delle gravi insufficienze d'organo , Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola , Bologna , Italy
| | - Antonio Daniele Pinna
- e Chirurgia Generale e Trapianti , Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola , Bologna , Italy
| | - Silvana Grandi
- a Dipartimento di Psicologia , Università di Bologna , Bologna , Italy
| | - Pietro Andreone
- b Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche , Università di Bologna , Bologna , Italy
- c Programma Dipartimentale Innovazione Terapeutica Epatopatie Croniche Virali (ITEC), Dipartimento Ospedaliero dell'Apparato Digerente , Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola , Bologna , Italy
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Abstract
Alcohol-related liver disease is the second most frequent indication for liver transplantation (LT), yet as many as 90% to 95% of patients with alcohol-related end-stage liver disease are never formally evaluated for LT. Furthermore, despite its significance as a cause of chronic liver disease and indication for LT, it has received little attention in recent years for several reasons, including the good posttransplant short-term results, and the lack of specific "drugs" used for this disease. A writing group, endorsed by the International Liver Transplant Society, was convened to write guidelines on Liver Transplantation for Alcoholic Liver Disease to summarize current knowledge and provide answers to controversial and delicate ethical as well as clinical problems. We report here a short version of the guidelines (long version available at www.ilts.org) with the final recommendations graded for level of evidence. The writing group membership is expected to remain active for 5 years, reviewing the guideline annually, and updating the online version when appropriate.
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Huang X, Liu X, Yu Y. Depression and Chronic Liver Diseases: Are There Shared Underlying Mechanisms? Front Mol Neurosci 2017; 10:134. [PMID: 28533742 PMCID: PMC5420567 DOI: 10.3389/fnmol.2017.00134] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/20/2017] [Indexed: 12/15/2022] Open
Abstract
The occurrence of depression is higher in patients with chronic liver disease (CLD) than that in the general population. The mechanism described in previous studies mainly focused on inflammation and stress, which not only exists in CLD, but also emerges in common chronic diseases, leaving the specific mechanism unknown. This review was to summarize the prevalence and risk factors of depression in CLD including chronic hepatitis B, chronic hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease, and to point out the possible underlying mechanism of this potential link. Clarifying the origins of this common comorbidity (depression and CLD) may provide more information to understand both diseases.
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Affiliation(s)
- Xiaoqin Huang
- Department of Psychiatry, The First Affiliated Hospital of Anhui Medical UniversityHefei, China
| | - Xiaoyun Liu
- Department of Psychiatry, The First Affiliated Hospital of Anhui Medical UniversityHefei, China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical UniversityHefei, China
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Craig JA, Miner D, Remtulla T, Miller J, Zanussi LW. Piloting a Coping Skills Group Intervention to Reduce Depression and Anxiety Symptoms in Patients Awaiting Kidney or Liver Transplant. HEALTH & SOCIAL WORK 2017; 42:e44-e52. [PMID: 28395080 DOI: 10.1093/hsw/hlw064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/26/2016] [Indexed: 06/07/2023]
Abstract
The authors evaluated the use of a coping skills group (CSG) therapy intervention to decrease depression and anxiety and increase healthy coping skills in a population of kidney and liver transplant candidates. The study, using a pre-posttest design, piloted a CSG with a convenience sample of 41 consenting participants on a waiting list or in workup for kidney or liver transplant. Two transplant social workers led five eight-week closed psychoeducational groups. Coping skills, depression symptoms, and anxiety symptoms were assessed preintervention, postintervention, and at follow-up one month later. Results suggest that the CSG group created significant changes in some coping areas, such as decreasing the use of denial and self-blame and increasing the use of acceptance, religion, and instrumental supports. In this study, instrumental supports are strategies such as seeking assistance, finding information, or asking for advice about what to do. The effects on instrumental supports did not sustain at the one-month follow-up. Anxiety and depression scores were significantly reduced, and these changes were sustained at one-month follow-up. This study supports the use of a group-based psychosocial intervention for the pretransplant population and will be most relevant to social workers practicing in the transplant field.
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Affiliation(s)
- Julie Anne Craig
- Forensic Adolescent Program, Alberta Health Services, Sunridge Professional Building, 2675 36th Street, NW, Calgary, Alberta, Canada
| | - Dee Miner
- Southern Alberta Transplant Program, Foothills Medical Centre, Alberta Health Services, Calgary, Canada
| | - Tasneem Remtulla
- Southern Alberta Transplant Program, Foothills Medical Centre, Alberta Health Services, Calgary, Canada
| | - Janet Miller
- Mount Royal University, Calgary, Alberta, Canada
| | - Lauren W Zanussi
- Department of Psychiatry, Foothills Medical Centre, and assistant professor, University of Calgary, Alberta, Canada
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Depression and Liver Transplant Survival. PSYCHOSOMATICS 2017; 58:64-68. [DOI: 10.1016/j.psym.2016.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 01/21/2023]
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