Impact of psychosocial comorbidities on clinical outcomes after liver transplantation: Stratification of a high-risk population.
Liver transplantation
Non-compliance
Psychosocial decompensation
Recidivism
Transplant psychiatry
Journal
World journal of hepatology
ISSN: 1948-5182
Titre abrégé: World J Hepatol
Pays: United States
ID NLM: 101532469
Informations de publication
Date de publication:
27 Aug 2019
27 Aug 2019
Historique:
received:
20
03
2019
revised:
23
05
2019
accepted:
16
07
2019
entrez:
19
9
2019
pubmed:
19
9
2019
medline:
19
9
2019
Statut:
ppublish
Résumé
Liver transplantation is the accepted standard of care for end-stage liver disease due to a variety of etiologies including decompensated cirrhosis, fulminant hepatic failure, and primary hepatic malignancy. There are currently over 13000 candidates on the liver transplant waiting list emphasizing the importance of rigorous patient selection. There are few studies regarding the impact of additional psychosocial barriers to liver transplant including financial hardship, lack of caregiver support, polysubstance abuse, and issues with medical non-compliance. We hypothesized that patients with certain psychosocial comorbidities experienced worse outcomes after liver transplantation. To assess the impact of certain pre-transplant psychosocial comorbidities on outcomes after liver transplantation. A retrospective analysis was performed on all adult patients from 2012-2016. Psychosocial comorbidities including documented medical non-compliance, polysubstance abuse, financial issues, and lack of caregiver support were collected. The primary outcome assessed post-transplantation was survival. Secondary outcomes measured included graft failure, episodes of acute rejection, psychiatric decompensation, number of readmissions, presence of infection, recidivism for alcohol and other substances, and documented caregiver support failure. For the primary outcome, there were no differences in survival. Patients with a history of psychiatric disease had a higher incidence of psychiatric decompensation after liver transplantation (19% Patients with certain psychosocial comorbidities had worse outcomes following liver transplantation. Further prospective and multi-center studies are warranted to properly determine guidelines for liver transplantation regarding this high-risk population.
Sections du résumé
BACKGROUND
BACKGROUND
Liver transplantation is the accepted standard of care for end-stage liver disease due to a variety of etiologies including decompensated cirrhosis, fulminant hepatic failure, and primary hepatic malignancy. There are currently over 13000 candidates on the liver transplant waiting list emphasizing the importance of rigorous patient selection. There are few studies regarding the impact of additional psychosocial barriers to liver transplant including financial hardship, lack of caregiver support, polysubstance abuse, and issues with medical non-compliance. We hypothesized that patients with certain psychosocial comorbidities experienced worse outcomes after liver transplantation.
AIM
OBJECTIVE
To assess the impact of certain pre-transplant psychosocial comorbidities on outcomes after liver transplantation.
METHODS
METHODS
A retrospective analysis was performed on all adult patients from 2012-2016. Psychosocial comorbidities including documented medical non-compliance, polysubstance abuse, financial issues, and lack of caregiver support were collected. The primary outcome assessed post-transplantation was survival. Secondary outcomes measured included graft failure, episodes of acute rejection, psychiatric decompensation, number of readmissions, presence of infection, recidivism for alcohol and other substances, and documented caregiver support failure.
RESULTS
RESULTS
For the primary outcome, there were no differences in survival. Patients with a history of psychiatric disease had a higher incidence of psychiatric decompensation after liver transplantation (19%
CONCLUSION
CONCLUSIONS
Patients with certain psychosocial comorbidities had worse outcomes following liver transplantation. Further prospective and multi-center studies are warranted to properly determine guidelines for liver transplantation regarding this high-risk population.
Identifiants
pubmed: 31528246
doi: 10.4254/wjh.v11.i8.638
pmc: PMC6717712
doi:
Types de publication
Journal Article
Langues
eng
Pagination
638-645Déclaration de conflit d'intérêts
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
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