title: Neurocognitive status is associated with all-cause mortality among psychiatric, high-risk liver transplant candidates and recipients.
abstract: OBJECTIVE
  Judicious selection of potential liver transplant candidates and close monitoring of progress are essential to successful outcomes. Pretransplant psychosocial evaluations are the norm, but the relationship between psychosocial (and neurocognitive status) and longer term medical outcomes is understudied. This exploratory study sought to examine the relationship between objective measures of pretransplant psychosocial and neurocognitive status and service utilization, transplant status, and all-cause mortality.
  
  
  METHODS
  This retrospective chart review examined outcomes among 108 psychiatric, high-risk liver transplant candidates up to four years following initial evaluation. Predictor variables of outcomes included demographic, medical, neurocognitive, psychological, and mental health treatment variables.
  
  
  RESULTS
  Transplant status and neurocognitive functioning were independently associated with all-cause mortality. None of the other variables were associated with outcomes.
  
  
  CONCLUSIONS
  Better neurocognitive functioning in high-risk liver transplant candidates may allow for greater involvement in medical care and/or compliance with treatment recommendations. More aggressive assessment and management of neurocognitive dysfunction may improve outcomes. Objective measures identified significant psychopathology typical of liver transplant candidates but were not associated with outcomes; engagement in specialized mental health care may have attenuated this relationship. Further study is needed to better understand the relationship between psychosocial functioning and outcomes.
authors.affiliation: The Menninger Clinic, Houston, TX, USA Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA amadan@menninger.edu.
authors.forename: A
authors.initials: A
authors.lastname: Madan
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Borckardt
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: W E
authors.initials: WE
authors.lastname: Balliet
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Barth
authors.affiliation: Department of Psychology, East Tennessee State University, Johnson City, TN, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Delustro
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Malcolm
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: D
authors.initials: D
authors.lastname: Koch
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: I
authors.initials: I
authors.lastname: Willner
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: P
authors.initials: P
authors.lastname: Baliga
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: A
authors.initials: A
authors.lastname: Reuben
mesh_terms: D000328:Adult; D002423:Cause of Death; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000401:mortality / Q000523:psychology*; D008875:Middle Aged
keywords: Liver transplantation; executive function; memory; mortality; outcomes research; psychosocial factors