Psychological outcome and quality of life following liver transplantation: A prospective, national, single-center study

Abstract

Liver transplantation is a well-established treatment for liver failure. Prolongation in survival is accepted, but long-term effects of liver transplantation on cognitive and psychological outcome are unclear. In the present study, psychological data were prospectively collected for 164 patients who were assessed for liver transplantation. Memory impairment, psychomotor slowing, anxiety, and depression were commonly observed. Severity of liver disease at assessment was significantly associated with slowing of reaction time. Memory impairment distinguished those who were not listed for transplantation because of illness severity. One year posttransplantation, follow-up data from transplant recipients showed significant improvement in most psychological domains relative to both healthy comparison participants and patients with chronic liver disease who did not undergo transplantation. Immunosuppression (cyclosporine versus tacrolimus) did not have differential effects on quality of life, fatigue, or affective status, although those administered cyclosporine showed greater improvements at 1-year follow-up on simple and choice reaction times. Elevated levels of anxiety and neuroticism at pretransplantation assessment were associated with worse psychosocial outcome at 1 year posttransplantation. Severity of liver disease was not related to psychological outcome at 1 year. Good psychological outcome at 1 year was maintained at the 3-year follow-up. (Liver Transpl 2003;9:712-720.)

Estudo preliminar sobre a qualidade de vida e sintomatologia depressiva de pacientes em fase pré e pós-transplante hepático

“…Na literatura internacional, os vários estudos encontrados apontam para melhora da qualidade de vida desses pacientes, mas também para muitas dificuldades advindas das complicações clínicas e dos problemas emocionais adquiridos com o sofrimento na fase crônica da doença. Estes estudos também mostram que a depressão pode ter um papel importante na compreensão desses prejuízos da qualidade de vida [3][4][5][6][7][8][9][10][11][12][13] .…”

“…Na prática clínica, verificava-se que estes pacientes apresentavam boa recuperação da sua capacidade física, mas também eram observados sintomas depressivos e dificuldades em retornar para suas atividades diárias habituais. A literatura 4,7,9 refere que a gravidade da doença, por trazer experiências emocionais difíceis para o paciente, está intimamente associada à quadros de humor deprimido e à prejuízos na qualidade de vida, sendo comum que os sintomas depressivos dificultem a percepção de melhoras na qualidade de vida 10 .…”

“…Assim, este estudo teve como objetivos avaliar e comparar a qualidade de vida, a prevalência de sintomas depressivos e o grau de dependência física de pacientes portadores de doença hepática crônica, transplantados e não transplantados de fígado, em lista de espera 4,7,9 . Tabela 2 -Valores descritivos e resultado da ANOVA para as escalas do SF-36 e para o IBD em cada categoria do CTP (A, B e C) Escalas CTP A (n = 10) CTP B (n = 14) CTP C (n = 6) p Média ± dp Média ± dp Média ± dp Os pacientes transplantados apresentaram escores para depressão maior que os não-transplantados, em números absolutos, mas não houve significância estatística.…”

Neuropsychological Aspects of Liver Disease and its Treatment

“…These results suggest that while marked neuropsychological recovery is observed at 1 year posttransplant, this recovery is incomplete, i.e. liver transplantation does not fully "normalise" cognitive performance, and that some residual degree of cognitive impairment remains [52]. It is often assumed that any cognitive impairment that is observed in liver disease is attributable to the neurotoxic effects of alcohol, however, the majority of participants in this study had a non-alcoholic aetiology (the most common diagnosis was primary biliary cirrhosis).…”

“…For a three-year period (1996-1999) all patients who were evaluated for possible liver transplantation in Scotland underwent detailed psychological assessment by a trained psychologist [52]. The assessment covered the domains of mood, fatigue, cognitive functioning and quality of life (QoL).…”