title: A biopsychosocial approach to liver transplant evaluation in two patients with Wilson's disease.
abstract: Wilson's disease (WD) is characterized by hepatic, neurological, and/or psychiatric disturbances. In some cases, liver transplantation is indicated. Because psychologists and other health care workers play an increasing role in the evaluation of individuals presenting for transplant, an understanding of the heterogeneous phenotype of WD is important for mental health professionals working in medical settings. This article reviews two cases of patients with WD (one probable, one confirmed) presenting for liver transplantation and a biopsychosocial assessment approach is demonstrated. Patients are presented in terms of medical, psychiatric, and psychosocial history, neuropsychological examination results, and the subsequent indications for liver transplantation. Both patients exhibited neurocognitive and psychiatric symptoms. One patient was determined to be a marginally suitable candidate for transplantation, whereas the other was considered at high risk for negative outcome post-transplant. This article demonstrates the importance of considering phenotypic presentation, neurocognitive function, psychiatric status, and psychosocial circumstances in assessing transplant readiness in patients with WD. A comprehensive and integrative biopsychosocial assessment approach is appropriate for evaluating patients with WD presenting for liver transplantation.
authors.affiliation: Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA. abbe.boeka@vanderbilt.edu
authors.forename: Abbe G
authors.initials: AG
authors.lastname: Boeka
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Solomon
authors.forename: Kristine
authors.initials: K
authors.lastname: Lokken
authors.forename: Brendan M
authors.initials: BM
authors.lastname: McGuire
authors.forename: J Steve
authors.initials: JS
authors.lastname: Bynon
mesh_terms: D000328:Adult; D003072:Cognition Disorders; D005260:Female; D006527:Hepatolenticular Degeneration / Q000503:physiopathology*; D006801:Humans; D016031:Liver Transplantation / Q000523:psychology*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009483:Neuropsychological Tests; D018579:Patient Selection; D010641:Phenotype