Psychiatric and psychosocial outcome of orthotopic liver transplantation.
BACKGROUND
The study aimed to explore the prevalence of psychiatric disorders among orthotopic liver transplantation (OLT) recipients, and to investigate how psychiatric morbidity was linked to health-related quality of life (HRQOL).


METHODS
We recruited 75 patients who had undergone OLT a median of 3.8 years previously (range = 5-129 months). Psychiatric morbidity was assessed using the Structural Clinical Interview for the DSM-III-R. Psychometric observer-rating and self-rating scales were administered to evaluate cognitive functioning (SKT), depressive symptomatology (HAMD(17)), posttraumatic stress symptoms (PTSS-10), social support (SSS), and HRQOL (SF-36 Health Status Questionnaire). Treatment characteristics were obtained from medical records.


RESULTS
22.7% (n = 17) of our sample had a current or probable psychiatric diagnosis according to DSM-III-R: 2.7% full posttraumatic stress disorder (PTSD) (n = 2), 2.7% major depressive disorder (MDD) comorbid to full PTSD (n = 2), 1.3% MDD comorbid to partial PTSD (n = 1), and 16% partial PTSD (n = 12). Patients with PTSD symptoms demonstrated lower cognitive performance, higher severity of depressive symptoms and more unfavorable perception of social support. OLT-related PTSD symptomatology was associated with maximal decrements in HRQOL. The duration of intensive care treatment, the number of medical complications, and the occurrence of acute rejection were positively correlated with the risk of PTSD symptoms subsequent to OLT.


CONCLUSIONS
OLT-related PTSD symptomatology impairing HRQOL is a complication for a subgroup of OLT recipients. Health-care providers should be aware of the possible presence of PTSD in OLT survivors.
Department of Psychiatry, Ludwig-Maximilians University of Munich, Munich, Germany. rothenh@kons.med.uni-muenchen.de
Hans-Bernd
HB
Rothenhäusler
Sigrid
S
Ehrentraut
Hans-Peter
HP
Kapfhammer
Christina
C
Lang
Reinhart
R
Zachoval
Manfred
M
Bilzer
Gustav
G
Schelling
Alexander L
AL
Gerbes
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology*; D015897:Comorbidity; D003422:Critical Care / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000523:psychology; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010348:Patient Care Team; D011183:Postoperative Complications / Q000175:diagnosis / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D012803:Sick Role; D012917:Social Adjustment; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology*