A meta‐analysis on the incidence of donor‐related depression after liver transplant

Abstract

Summary Living donor liver transplantation (LDLT) is increasing, yet gaps exist in the understanding of psychological wellbeing of donors after liver transplant. This meta‐analysis seeks to evaluate the incidence and risk factors for donor‐related depression after liver transplantation. A search was conducted on Medline and Embase database. Articles assessing incidence of depression in LDLT donors were included. Incidence was pooled after Freeman–Turkey double‐arcsine transformation. For risk factors, dichotomous variables were analyzed with generalized linear model, while a conventional meta regression with logit transformation was conducted for continuous variables. Of 1069 abstracts, 40 articles underwent full‐text review. Seventeen articles were included. The pooled incidence of depression among 1888 LT donors was 7.66% (CI: 4.47–12.80%). Depression rates were significantly higher in Asian compared to Western studies (RR: 1.73, CI: 1.19–2.52, P = 0.0039). Female gender (P < 0.001), Caucasian ethnicity (P = 0.047), employment status (P < 0.001) and lower education levels (P = 0.044) were significantly associated with depression. Donor relationship with recipients was not a significant risk factor. LDLT remains a core aspect of the treatment of end‐stage liver disease. However, the high depression rates after LT suggest that there remains room for improvement in the care of donors’ mental health post‐transplant.

The incidence of adverse outcome in donors after living donor liver transplantation: A meta-analysis of 60,829 donors

“…This is particularly concerning as the incidence of psychological complications is likely to be underestimated owing to the cultural stigma associated with mental health in the Asian context. [27,28] Moreover, previous studies have estimated the prevalence of suicide and suicide attempts among living liver donors at 0.25%. [29][30][31] Notably, only 2 studies in this meta-analysis reported data regarding suicide among living liver donors.…”

“…To date, several risk factors have been identified as potential predictors of poorer psychosocial outcomes in liver donors, including female sex, recipient death, employment status, and lower education levels. [34,35] The eligibility of donors at risk of psychological issues post-liver donation should be reconsidered to protect these vulnerable individuals and potentially reduce the incidence of post-organ donation suicide rate. Beyond pre-donation assessment and counselling, the establishment of a lifelong follow-up program with regular psychiatric evaluations using validated tools and the provision of dedicated psychosocial support services are vital to mitigate the risk of psychological complications and its repercussions.…”

“…In this study, the incidence of psychological complications was the highest, highlighting the considerable health burden posed by psychological complications in living liver donors. This is particularly concerning as the incidence of psychological complications is likely to be underestimated owing to the cultural stigma associated with mental health in the Asian context 27,28 . Moreover, previous studies have estimated the prevalence of suicide and suicide attempts among living liver donors at 0.25% 29–31 .…”

Depression in transplantation

“…Depression was significantly higher in Asian compared with western populations (RR: 1.73, CI 1.19-2.52, P ¼ 0.0039), while being female, Caucasian, unemployed and with lower education level were factors associated with depression. The level of depression was not influenced by the relationship with the recipient [65]. A metanalysis of 15 articles reporting on mental status of kidney donors found that depression decreased after transplantation [66].…”

Crosstalk between Depression and Breast Cancer via Hepatic Epoxide Metabolism: A Central Comorbidity Mechanism

“…As mentioned above, with the increase in depression exploration, extracerebral pathological alterations have been paid more and more attention. As the main organ of lipid metabolism, especially the metabolism of epoxide, the liver has been proposed to have an unexpected connection with brain functions [ 101 , 102 , 103 , 104 , 105 ]. The pathogenesis of Alzheimer’s disease (AD) is believed to be closely related to depression [ 106 , 107 ].…”