Mental Disorders and Quality of Life in Patients Awaiting Liver Transplantation

Abstract

BACKGROUND: Liver transplantation is the main therapeutic alternative for patients with advanced liver disease. These patients have high prevalence of psychiatric comorbidities that may negatively interfere in clinical outcomes and quality of life. It is not clear in the literature whether the different etiologies of hepatic disease have the same prevalence of psychiatric disorders. OBJECTIVE: The aim of this study was to investigate whether patients in the liver transplant list showed differences in psychiatric characteristics, medical variables and quality of life among different etiological groups. METHODS: This is a cross-sectional study that evaluates quality of life, psychiatric and clinical comorbidities through the application of validated questionnaires and instruments in 248 patients who were on transplant waiting list from 2010 to 2014, assisted in a University Hospital and in a Private Hospital in Salvador/Bahia, Brazil. The patients were evaluated through the Mini International Neuropsychiatric Interview (M.I.N.I. PLUS 5.0) and Medical Outcomes Short-Form Health Survey (SF-36). RESULTS: The etiology of the most prevalent liver disease was hepatitis C virus. A prevalence of 50.8% of at least one mental disorder was identified. When alcohol abuse/dependence was excluded, the prevalence was 25.8%. Mental health did not show a statistically significant difference in the diverse etiological groups, but a higher prevalence of psychiatric comorbidities was detected among women and younger than 40 years. No cases of psychotic disorders were detected, possibly by exclusion prior to listing. There was no difference in the quality of life domains in the different liver etiological groups. CONCLUSION: A high-prevalence of psychiatric disorders was found among all clinical conditions most associated with indication for liver transplantation. Attention is drawn to the absence of patients with psychotic disorders, which suggests that transplantation may not have been indicated for this group of patients. For these reasons, professionals caring for liver transplant candidates should be highly vigilant for the presence of mental disorders, regardless of the etiology of liver disease. Specialized care is recommended to minimize the early exclusion of patients with no other therapeutic possibilities, as well as care of all people with mental disorders.

Perspectivas da fila de espera por um transplante hepático no Paraná: uma revisão de literatura

“…Ademais, a ascensão do transplante hepático também teve uma contribuição brasileira, ocorrida em 1988, quando uma equipe liderada pelo cirurgião Silvano Raia realizou o primeiro transplante hepático de doador vivo da história, aumentando, assim, as perspectivas dos pacientes que aguardavam por um fígado 16 . À vista disso, o transplante hepático se consolidou como padrão-ouro de tratamento em doenças hepáticas terminais, agudas e crônicas, assim como em alguns tipos de câncer hepático 5,32,34 .…”