Psychological Risk Factors for Graft Rejection Among Liver Transplant Recipients

doi:10.1016/j.transproceed.2011.01.159

Transplantation Proceedings

Volume 43, Issue 4, May 2011, Pages 1123-1127

https://doi.org/10.1016/j.transproceed.2011.01.159 Get rights and content

Abstract

The purpose of this prospective study was to find psychological risk factors predicting acute, chronic, and psychological rejection in patients undergoing liver transplantation using Cognitive Behavioural Assessment (CBA-2.0). The primary scale included an assessment of fears, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression. We prospectively recruited 44 patients undergoing orthotopic liver transplantation (OLT). Exclusion criteria were: education level below secondary school, unstable clinical situation in an out-patient setting, fulminant hepatitis, psychotic disorders, neurocognitive deficits, dementia, serious mental retardation, current alcohol or drug abuse, recent ideation of or attempted suicide, and non-adherence to therapy. CBA-2.0 primary scale series of questionnaires were handed out to patients immediately after the medical examination, which had been performed to ascertain eligibility for OLT. Rejection (acute and/or chronic) was diagnosed according to clinical and histopathological criteria. Psychological rejection was diagnosed when patients declared, after transplantation, a refusal of the new organ which caused psychiatric symptoms requiring medical treatment and/or psychotherapy. Analysis of variance and logistic regression of psychological variables was performed to detect possible risk factors for each type of rejection. A greater fear of repulsive animals was able a predictor for an acute rejection episode (odds ratio = 1.1; P < .05). No other psychological pretransplant predictor was noted for chronic or psychological rejection. In patients undergoing OLT, preoperative emotions of fear could predict an acute graft rejection episode. These findings imply that pre-OLT screening should include psychological factors in addition to traditional medical criteria with intervention in selected cases.

Section snippets

Methods

After ethical committee approval, 44 candidates listed for OLT were asked to participate in the study to undergo psychological evaluation before transplantation. Inclusion criteria were a stable clinical condition in an out-patient setting, a minimum of a secondary school education, and written informed consent. We excluded patients with fulminant hepatitis, psychotic disturbances, neurocognitive deficits, dementia, serious mental retardation (IQ <50), current alcohol or drug abuse, recent

Results

Table 1 shows the demographic and medical characteristics of patients who experienced various types of rejection. Patients suffering from versus free of acute graft rejection displayed a greater fear of repulsive animals score (10.2 ± 8.7 versus 5.1 ± 6.0; P < .05; Table 2). Obsessive behavior concerning hygiene (1.2 ± 1.2 versus 2.6 ± 1.6; P < .05) was lower among patients with versus without chronic graft rejection (Table 3). Analysis of variance Anova CBA 2.0 variables did not reveal any

Discussion

We prospectively demonstrated, for the first time, that fear for repulsive animals and neuroticism were associated with acute and chronic graft rejection, respectively. A higher fear for repulsive animals score was able to predict acute graft rejection episodes.It is well-known that pre-transplantation and posttransplantation psychological status affect the quality of life among posttransplant patients.11, 12

A relationship between hormone levels and immunomodulation is well known.¹⁵ Some

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Cited by (24)

Psychological graft-rejection: A need to understand the construct in transplant scenarios
2023, Asian Journal of Psychiatry
Psychosocial treatment on psychological symptoms, adherence, and physiological function on transplanted patients: A systematic review and metanalysis
2022, Journal of Psychosomatic Research
Citation Excerpt :
Psychosocial interventions to the transplanted recipients could be important in order to achieve the reduction of psychosocial distress, and the improvement of personal functioning and the general perception of health [9,10]. Psychosocial interventions, that comprise interventions focused on psychological or social support, can be helpful in all transplantation stages enabling patients to better manage this extraordinarily stressful situation, as well as to promote and improve a good adherence in dialysis [11,12], to the medical cares, and to the adequate lifestyle indications [13,14]. Moreover, applying psychosocial interventions in all stages of the transplantation process (pre- and -post transplant) could allow to identify possible risk factors, and to prevent negative outcome of the surgery [3].
Transplantation represents an important source of hope for the candidates and produces an intense emotional effect. Psychosocial interventions can be helpful in all transplantation stages to better manage this extraordinarily stressful situation. Aim of the work is to verify the effects of the psychosocial interventions on recipients on psychological symptoms, medical adherence and transplanted solid organ functioning.
This work adhered to PRISMA, STROBE, Cochrane and New Castle Ottawa bias scales and it is registered in PROSPERO. Inserting “Transplant” and “Psychological intervention” as key words in PubMed, Psycinfo, Cochrane database resulted 977 studies from 2001 to 2021. A systematic review and metanalyses were processed on nineteen randomized controlled trials and observative prospective cohort studies. The difference between pre- and post- psychosocial intervention assessment on the psychological variables, medical adherence, and organ functioning outcome was processed.
Main findings showed that the psychosocial interventions were effective on depression (0.62; CI: 0.32–0.92) and anxiety on kidney recipients (0.49; CI: 0.17–0.81), and on anxiety on heart recipients, mainly when administrated after the surgery (0.68; CI: 0.30–1.06). Moreover, the findings showed a lack of studies on the effectiveness of the psychosocial intervention on organ functioning.
The work highlighted the effectiveness of the psychosocial interventions on psychological outcome, particularly after the surgery and the need to address the research on the evaluation of the effectiveness of the psychosocial interventions on the organ functioning. The findings suggest to integrate the transplantation procedures with psychosocial interventions considering the different needs of recipients in relation to the specific transplanted organ.
Perceived body image and distress after liver tansplantation in recipients
2021, Transplant Immunology
This study's aim was to determine the relationship between the perception of self-body image and the level of distress in patients who had liver transplantation surgery.
This study was performed as a descriptive and cross-sectional study with the attendance of 120 liver transplant patients hospitalized in the liver transplant center of a training and research hospital. Self-body image was measured based on the Body Image Questionnaire (BIQ) on a scale of 40 (lowest) to 200 (highest) with the optimal BIQ score of 135–200. The level of distress was evaluated by the Distress Thermometer (DT) on a scale of 0 (None) to 10 (High). The data analysis was performed with the IBM Statistical Package for the Social Sciences Statistics 25.
According to the data attained, 35.8% of the patients were 55 years old or older, 56.7% were male, and 61.7% were married. The mean BIQ score among all tested patients was 81.85 ± 27.31, and this was considered as a low level of self-image. The mean DT score of the patients was 5.45 ± 2.72, which indicated relatively high levels of distress in the transplant recipients. Comparing these two values together (BIQ + DT) by regression analysis, we found a moderate negative relationship between self-body image (BIQ) and distress (DT) in the patients (r: −0.391, p < 0.001). Accordingly, when the distress levels of the patients decreased, their perceptions of self-body image increased.
Even if their liver transplant operation is successful, the problems of the recipients after transplantation do not completely disappear. Liver transplant recipients should be helped in coping with their condition effectively. Patients undergoing liver transplantation should be provided with psychosocial and emotional support.
Evaluation of the SIPAT instrument to assess psychosocial risk in heart transplant candidates: A retrospective single center study
2017, Heart and Lung: Journal of Acute and Critical Care
Citation Excerpt :
Furthermore, the need for psychosocial assessment is widely recognized by core professional agencies which establish best practices in heart transplantation.3,4 Published data suggest that there is an association between pre-transplant psychosocial risk and post-transplant outcomes.5–13 Common pre-transplant psychological variables associated with a greater hazard of post-transplant mortality include previous suicide attempts, poor adherence to medical recommendations, past history of substance abuse, current depressive disorders, psychosocial functioning, and social support.14–18
We evaluated the reliability of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in heart transplant (HT) recipients and explored its usefulness in predicting post-transplant outcomes.
Pre-transplant psychosocial and behavioral risk is associated with post-transplant clinical outcomes. SIPAT is a risk assessment tool created for pre-transplant psychosocial evaluation.
Via retrospective chart review, three examiners applied the SIPAT to 51 adult HT recipients. Examiners blinded to SIPAT scores extracted data and interviewed clinicians for one-year post-transplant outcomes. Analysis included Intra-class correlation coefficient (ICC), Pearson's correlation coefficient and Chi-square.
SIPAT demonstrated strong inter-rater reliability (ICC = 0.89, 95% CI = 0.76–0.96). Compared to those with SIPAT ratings of “Excellent/Good”, the “Minimally Acceptable Candidate/High Risk” group was more likely to miss clinic visits (p = 0.004).
The SIPAT tool had strong IRR. Less favorable SIPAT ratings were associated with nonadherence to clinic visits. Further study is warranted to determine association of SIPAT ratings to clinical outcomes.
Utility of pretransplant psychological measures to predict posttransplant outcomes in liver transplant patients: A systematic review
2016, General Hospital Psychiatry
Citation Excerpt :
Two other studies found no significant relationship between pre-LT depression score and graft rejection [24–26]. As with the survival outcome, all four studies that examined pre-LT anxiety symptoms reported no association with graft rejection [22,24–26]. Depression before transplant predicted decreased general life satisfaction after transplant (beta =− 0.30, P = .01), whereas pre-LT anxiety predicted greater general life satisfaction after transplant (beta = 0.37, P = .01) in study by Goetzmann et al. [21].
Evaluation of liver transplant (LT) candidacy involves psychosocial evaluation to ensure appropriate organ allocation. However, the utility of pre-LT psychiatric and neuropsychological factors in predicting posttransplant outcomes remains uncertain. We reviewed current evidence on the prognostic value of pre-LT psychological factors for outcomes after LT.
We conducted a systematic review of studies with adult LT recipients that investigate the relationship between pre-LT psychiatric and neuropsychological variables and posttransplant outcomes. We searched Ovid, MEDLINE, PsycINFO, EMBASE/Scopus, Cochrane Controlled trials register and Web of Science (January 1975 to May 2015) for longitudinal, peer-reviewed studies of at least 20 subjects and written in English.
The 19 studies included in this review are heterogeneous in population, prognosis and duration of follow-up (from 20 days to more than 3 years). Findings on the prognostic value of pre-LT depression or anxiety on post-LT outcomes are mixed, though depression appears to predict lower quality of life (QOL). Pre-LT suicidal thoughts in particular are associated with post-LT depression. High submissiveness may predict rejection within 20 days of LT, and low conscientiousness is associated with greater nonadherence. Whereas pre-LT cognitive performance has not been shown to predict survival, poorer performance may predict poorer QOL after LT.
Further studies are needed to examine this important element of LT candidacy evaluation. Studies should evaluate psychiatric factors in large samples, include systematic evaluations by mental health clinicians and explore broader neuropsychological domains in predicting posttransplant outcomes.
Externally Oriented Thinking Predicts Phosphorus Levels in Dialyzed Patients
2016, Transplantation Proceedings
The aim of the present study was to investigate the association between alexithymia scores and biological markers of adherence in dialyzed patients. The hypothesis was that higher scores of alexithymia would be associated with lower adherence to treatment.
Fifty-four adult dialyzed patients were enrolled during a follow-up visit. Participants were asked to complete a self-report questionnaire, namely, the Toronto Alexithymia Scale (TAS-20). Moreover, biological markers levels of adherence to treatment (phosphorus, creatinine, and serum uric acid) were measured.
A positive correlation was found between phosphorous levels and TAS-F2 (r = 0.28; P = .04) and TAS-F3 (r = −0.31; P = .02). Stepwise regression with TAS-F2 and TAS-F3 as predictors of adherence to treatment showed a significant model, adjusted R² = 0.08, F(1,52) = 5.4; P < .02, where only TAS-F3 was able to predict phosphorous levels (P = .02).
Findings showed that external oriented thinking was able to predict a biological marker of adherence to treatment in dialyzed patients.

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LiverOutcomePsychological Risk Factors for Graft Rejection Among Liver Transplant Recipients

Abstract

Section snippets

Methods

Results

Discussion

Psychosomatics

Transplant Proc

Psychosomatics

Psychosomatics

Transplant Proc

Psychosomatics

J Heart Lung Transplant

Brain Behav Immun

Psychiatry Res

Liver
Outcome
Psychological Risk Factors for Graft Rejection Among Liver Transplant Recipients