Liver Transplant—Psychiatric and Psychosocial Aspects

Abstract

Liver transplantation is a life saving surgical procedure that is associated with improved longevity and enhanced quality of life. The number of successful liver transplants is growing worldwide. The procedure requires a dedicated and trained team of experts. A psychiatrist plays an important role in such a team. Psychiatric and psychosocial assessment is considered imperative to evaluate the candidate's suitability as a transplant recipient. Many psychiatric disorders may lead to the need for liver transplant, and if kept unchecked can adversely affect outcomes. Psychiatric problems arising in the post-transplant period may also require intervention of the psychiatrist. The donor too needs to be evaluated adequately to assess for psychological fitness for the procedure. This article provides broad overview of the various psychiatric and psychosocial issues pertaining to liver transplantation.

Knowledge and Daily Living Activities of Post Liver Transplant Clients

“…[45] Regarding stress management, many psychiatric disorders have been seen to be present subsequent to liver transplantation. [46] The present study revealed that most of the LT clients did not have knowledge about stress management. This comes in accordance with a study conducted at Kaohsiung Chang Gung Memorial Hospital on 30 post liver transplant clients by Chiu et al, (2009) who reported that up to 70% of the clients had psychiatric disorders in the post transplantation period as well as anxiety, depression and delirium were the major reasons for referral to a psychiatrist/mental health professionals.…”

Psychologic Evaluation in Liver Transplantation: Assessment of Psychologic Profile of End-Stage Liver Disease Patients Before and After Transplant

“…Existing evidence suggests that the need for life-long lifestyle modifications could evoke persistent anxiety. 5 Patient age, family monthly income, and mental health of close relatives have also been associated with anxiety and depression in patients after transplant. 37,41 Others have suggested a positive correlation between physical and mental health-related quality of life in posttransplant patients.…”

“…4 Patients with ESLD have different psychologic, emotional, cognitive, physical, and social challenges before, during, and after transplant. [5][6][7][8][9][10] The chronic nature of the disease itself, 11 the wait and anticipation for an organ donor, 12 donor shortage, 13 the stressful pretransplant evaluation process, 14 transplant procedures, need for life modifications after transplant, 5 and the strict adherence to the treatment regimen, 15 as well as social isolation, 14 negatively affect the patient's quality of life. 14 It is not surprising that transplant candidates show high levels of anxiety 13 and depression, 16 which compels addressing the psychologic needs of candidates.…”

Hepatobiliary Quiz-5 (2013)

“…17 Psychiatric contraindications to liver transplantation include severe personality disorders, active substance use, active psychosis, severe neuro-cognitive disorders, suicidality, absent or inadequate psychosocial supports, demonstrated poor adherence and factitious disorder. 18 Delirium is the most common neuropsychiatric problem after the transplant surgery. 19,20 It is characterized by confusion, disorientation, fluctuation in consciousness and agitation, and poses as a management difficulty in the intensive care unit.…”