Predictors of psychiatric disorders in liver transplantation candidates: Logistic regression models

Abstract

This study has two goals. The first goal is to assess the prevalence of psychiatric disorders in orthotopic liver transplantation (OLT) candidates by means of standardized procedures because there has been little research concerning psychiatric problems of potential OLT candidates using standardized instruments. The second goal focuses on identifying predictors of these psychiatric disorders. One hundred sixty-five elective OLT candidates were assessed by our unit. O rthotopic liver transplantation (OLT) is an accepted standard of care for end-stage liver disease. The pre-OLT period is marked by declining physical function, adjustment-related anxiety and depression, and development of organic brain deficits. [1][2][3][4] Although several psychiatric follow-up studies are available for recipients and donors after OLT, [5][6][7] there are few studies concerning the psychiatric status of potential OLT candidates before OLT. There is heterogeneity in the results of these studies, and the findings need to be interpreted with caution because psychiatric diagnoses were determined by means of psychometric scales and only in few cases by a comprehensive clinical interview. 7,[8][9][10][11][12] Reported prevalence rates of psychiatric disorders among OLT candidates vary from 15% to 50%. [8][9][10][11][12] Another recent study describing psychological characteristics of a large sample of OLT candidates reports that more than half the patients presented at least mild levels of depression, and more than one third were affected by clinically elevated levels of anxiety, suggesting a greater incidence of depression and anxiety than previously reported. 13

Assessment of depression and anxiety in patients with chronic liver disease

“…However, it remains unclear why up to 50% of patients with noncirrhotic CLD have these disorders long before the occurrence of cirrhosis 25 . Although this psychiatric comorbidity is common in all CLD, most of the published studies are based on an estimate of depression and anxiety in liver transplant candidate or patients after liver transplatation 7,29,14,15,27 , and patients with chronic viral hepatitis [28][29][30] . As reported in the literature, there is no difference in the level of depression and anxiety among candidates for liver transplantation and patients with liver disease who are not on the list for transplantation 24 , and therefore we estimate that the scores for depression and anxiety between these two groups of patients are comparable 15 .…”

“…Most of the previous studies have been focused on depression in CLD 4,6,7,12,[14][15][16][17] , while only a few have been devoted to anxiety in these patients 6,14,16,17 . Published studies data were heterogenic, both in terms of study population, different diagnostic criteria and assessment instruments that were used for the diagnosis of depression and anxiety.…”

Quality of life and psychiatric disorders before and one year after liver transplantation

“…In our study, we found adjustment disorder as the most common psychiatric disorder among pretransplantation patients. In a larger sample of LT candidates, Rocca et al [8] similarly pointed out that 33% of their patients waiting for LT had adjustment disorder as the most common psychiatric disorder. They also found the prevalence of psychiatric disorders in their LT candidates as 43%.…”

“…In one study approximately half of the patients who were candidates for heart or liver transplantation had at least one psychiatric disorder, and candidates for liver transplantation were found to have the highest psychiatric comorbidity prevalence [7]. Rocca et al [8] reported that 43% of their LT candidates had a current psychiatric diagnosis and Child-Pugh score and previous psychiatric diagnosis were found as significant independent predictors of depressive disorders. Among psychiatric disorders in their LT candidates, adjustment disorder was found particularly prevalent.…”

Cognitive performance and mood in patients on the waiting list for liver transplantation and their relation to the model for end-stage liver disease

“…A number of studies have shown that the severity of the liver diseases is an important predictor of the severity of psychiatric disorders. The Child-Pugh classification 8 is one reliable predictor for the occurrence of depression and other symptoms such as, sleep and sexual disorders, fatigue and history of psychiatric diseases 1,9 . This instrument provides a prognostic classification made from two clinical data: ascites and hepatic encephalopathy, and three laboratory findings: levels of total bilirubin, albumin and activity of prothrombin.…”