title: Pretransplant psychiatric and substance use comorbidity in patients with cholangiocarcinoma who received a liver transplant.
abstract: BACKGROUND
  Psychopathology has been commonly observed in liver transplant candidates, and up to 40% have comorbid psychiatric disorders. This illness burden may negatively impact quality of life and transplant outcome. Liver transplantation for cholangiocarcinoma remains uncommon due to the complex treatment protocol. We assessed for pretransplant psychopathology and substance use disorders in liver transplant recipients with cholangiocarcinoma to better characterize this patient group.
  
  
  METHODS
  We retrospectively reviewed the records of 143 liver transplant recipients who completed pretransplant psychological screening with the PAS, BDI-FS, BSI-18, and the SAAST between 2000 and 2004. The majority completed an evaluation by a transplant psychiatrist. Rates of pretransplant psychiatric and substance use symptoms and disorders were compared between 26 patients with cholangiocarcinoma and 117 other liver recipients using χ(2) or Fisher's exact tests.
  
  
  RESULTS
  Of the total cohort, 35% had a pretransplant psychiatric diagnosis, 35% had a substance use disorder, and 43% were current or former smokers. The cholangiocarcinoma cohort had significantly lower scores on the PAS, BDI-FS, and the BSI-18. On interview, the cholangiocarcinoma group was less likely to have an alcohol use disorder (P = 0.03) or any substance use disorder (P = 0.04), but the two groups did not differ significantly in the likelihood of having a psychiatric disorder or smoking history.
  
  
  CONCLUSIONS
  This study suggests that patients with cholangiocarcinoma have lower rates of alcohol and drug use disorders than other liver transplant recipients. They do not differ in rates of psychiatric disorders or smoking. Psychosocial assessment and support are recommended throughout the transplant process.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic Rochester, MN, USA. schneekloth.terry@mayo.edu
authors.forename: Terry D
authors.initials: TD
authors.lastname: Schneekloth
authors.forename: Sheila G
authors.initials: SG
authors.lastname: Jowsey
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Biernacka
authors.forename: M Caroline
authors.initials: MC
authors.lastname: Burton
authors.forename: Adriana R
authors.initials: AR
authors.lastname: Vasquez
authors.forename: Thomas
authors.initials: T
authors.lastname: Bergquist
authors.forename: Maureen S
authors.initials: MS
authors.lastname: Drews
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Gores
mesh_terms: D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D010552:Personality Assessment; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology