Psychosocial challenges before and after organ transplantation

Abstract

This review addresses psychosocial challenges before and after solid organ transplantation. Stressors, corresponding psychosocial changes of the recipient, and psychological interventions in the different phases of the transplant process are described. Furthermore, important aspects of the preoperative psychosocial evaluation are presented with a special focus on living donors and patients with alcoholic liver disease. For the postoperative period, adherence, quality of life, and return to work are highlighted. Finally, research and clinical implications are presented.

Depression, social support, and clinical outcomes following lung transplantation: a single-center cohort study

“…To our knowledge, the present manuscript is the first to examine the influence of perioperative outcomes on the association between pretransplant psychosocial characteristics and post‐transplant outcomes among lung transplant recipients. Although previous studies have examined the association between pretransplant psychosocial factors and long‐term outcomes , few have attempted to account for post‐transplant medical factors that may affect this association . For example, longer LOS following transplantation is a well‐known predictor of future clinical events due to the impact of acute infections, primary graft dysfunction, and other perioperative complications .…”

“…Psychosocial function is increasingly recognized as an important component of pretransplant evaluation . A comprehensive evaluation not only includes medical status (e.g., assessment of lung disease severity) but also typically assesses multiple areas of psychosocial functioning, one of the most common being the assessment of depressive symptoms.…”

Pretransplant depression in lung recipients - a lost battle?

“…Fear of death, internal conflicts, and the uncertainty of timely transplantation are the predominant emotional stressors at this stage of the disease. Before lung transplantation, depression appears to be predominant in 40% of patients, and lung transplant patients are more likely to suffer from anxiety disorders, particularly panic disorder .…”

“…Prior to transplantation, nonadherence is considered a contraindication to transplantation. It can be estimated that about 50% of late acute rejection and 15% of graft loss are associated with nonadherence . According to the immunosuppressive drug literature, nonadherence rates can reach up to 24–70% depending on the measurement method .…”

“…It can be estimated that about 50% of late acute rejection and 15% of graft loss are associated with nonadherence . According to the immunosuppressive drug literature, nonadherence rates can reach up to 24–70% depending on the measurement method . The best predictor of postoperative nonadherence seems to be the behavior of preoperative nonadherence.…”