title: Utility of pretransplant psychological measures to predict posttransplant outcomes in liver transplant patients: a systematic review.
abstract: Evaluation of liver transplant (LT) candidacy involves psychosocial evaluation to ensure appropriate organ allocation. However, the utility of pre-LT psychiatric and neuropsychological factors in predicting posttransplant outcomes remains uncertain. We reviewed current evidence on the prognostic value of pre-LT psychological factors for outcomes after LT.
  
  
  
  We conducted a systematic review of studies with adult LT recipients that investigate the relationship between pre-LT psychiatric and neuropsychological variables and posttransplant outcomes. We searched Ovid, MEDLINE, PsycINFO, EMBASE/Scopus, Cochrane Controlled trials register and Web of Science (January 1975 to May 2015) for longitudinal, peer-reviewed studies of at least 20 subjects and written in English.
  
  
  
  The 19 studies included in this review are heterogeneous in population, prognosis and duration of follow-up (from 20days to more than 3 years). Findings on the prognostic value of pre-LT depression or anxiety on post-LT outcomes are mixed, though depression appears to predict lower quality of life (QOL). Pre-LT suicidal thoughts in particular are associated with post-LT depression. High submissiveness may predict rejection within 20days of LT, and low conscientiousness is associated with greater nonadherence. Whereas pre-LT cognitive performance has not been shown to predict survival, poorer performance may predict poorer QOL after LT.
  
  
  
  Further studies are needed to examine this important element of LT candidacy evaluation. Studies should evaluate psychiatric factors in large samples, include systematic evaluations by mental health clinicians and explore broader neuropsychological domains in predicting posttransplant outcomes.
authors.affiliation: Department of Psychiatry, School of Medicine, Yale University, 300 George Street, New Haven, CT, U.S.A., 06519.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Fineberg
authors.affiliation: Department of Psychiatry, School of Medicine, Yale University, 300 George Street, New Haven, CT, U.S.A., 06519.
authors.forename: Adrienne
authors.initials: A
authors.lastname: West
authors.affiliation: Department of Psychiatry, School of Medicine, Yale University, 300 George Street, New Haven, CT, U.S.A., 06519.
authors.forename: Peter Jongho
authors.initials: PJ
authors.lastname: Na
authors.affiliation: Department of Psychiatry, School of Medicine, Yale University, 300 George Street, New Haven, CT, U.S.A., 06519.
authors.forename: Mark
authors.initials: M
authors.lastname: Oldham
authors.affiliation: Department of Medicine, Yale University Medical Center, 333 Cedar Street, LMP 1080, New Haven, CT, 06520; Department of Surgery, Yale University Medical Center, 333 Cedar Street, LMP 1080, New Haven, CT, 06520.
authors.forename: Michael
authors.initials: M
authors.lastname: Schilsky
authors.affiliation: Department of Psychiatry, School of Medicine, Yale University, 300 George Street, New Haven, CT, U.S.A., 06519.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Hawkins
authors.affiliation: Department of Psychiatry, School of Medicine, Yale University, 300 George Street, New Haven, CT, U.S.A., 06519. Electronic address: Hochang.lee@yale.edu.
authors.forename: Hochang Benjamin
authors.initials: HB
authors.lastname: Lee
mesh_terms: D006801:Humans; D016031:Liver Transplantation / Q000523:psychology* / Q000706:statistics & numerical data*; D008603:Mental Health / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000592:standards / Q000706:statistics & numerical data*
keywords: Liver transplantation; Neuropsychological testing; Pretransplant evaluation; Psychiatric evaluation; Systematic review