Mental Problems After Liver Transplant

Date:

Characteristics Of Organ Transplant Recipients

Living With Your Transplant – Psychosocial Risks & Emotional Issues

Table 1 presents the characteristics of the organ transplant recipients in this study. Participants were 196 males and 109 females, with a mean age of 43.1 years. A total of 248 were kidney transplant recipients, 39 were heart transplant recipients, and 18 were liver transplant recipients. The median post-operative time was 17.1 months. The participants tended to be of Han ethnic group , be married , have an educational level of less than undergraduate , live in an urban area , live with others , worry about infection , and have comorbidities .

Table 1. Characteristics of organ transplant recipients.

When A Match Is Found

Waiting for a liver transplant is a long process, but the surgery coordination happens quickly once you have a match. The liver can come from a deceased donor who had a healthy liver. Sometimes a donated liver may be used for two recipients. The right side of the donated organ is more often used in adult recipients, while the smaller left side is more often used for children.

Its possible that a living donor can donate a portion of their liver as well. However, the living donor must be a good match in terms of blood type and other factors.

Drinking After A Liver Disease Diagnosis

The researchers found a higher risk of death and resumption of drinking among transplant patients who continued drinking after a liver disease diagnosis. However, three-year survival rates were still high in both groups: 78% for those with a history of continued drinking after liver disease diagnosis, versus 85% for those with sudden liver failure. Most patients in both groups were able to stop drinking completely after transplant.

These survival rates are similar to those of patients transplanted for liver cancer, who account for 25% of total liver transplant recipients in the United States.

We know that these patients are sick enough that if they werent transplanted, only 30% would have survived three months, said Dukewich. The study supports the idea that liver transplant, even in this patient population that was deemed high-risk, is life-saving, has merit, and should be studied further.

USC is the coordinating center for ACCELERATE-AH, the American Consortium of Early Liver Transplantation for Alcohol-Associated Hepatitis. The consortium of 12 centers, started by Lee and colleague Norah Terrault, chief of the Division of GI and Liver at Keck Medicine of USC, is the largest longitudinal cohort of patients transplanted for alcohol-associated hepatitis without mandated sobriety.

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Psychological Distress And Its Association With Quality Of Life In Organ Transplant Recipients During Covid

  • 1Nursing Office, Renmin Hospital of Wuhan University, Wuhan, China
  • 2Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
  • 3The Nephrology Division and Dialysis Transplant Center, Renmin Hospital of Wuhan University, Wuhan, China
  • 4Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, China
  • 5Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China

Objectives: The coronavirus disease 2019 pandemic may have an impact on the psychological distress of organ transplant recipients. We aimed to assess the status of psychological distress and its association with quality of life in organ transplant recipients during the COVID-19 pandemic.

Materials and Methods: A cross-sectional survey was carried out with 305 organ transplant recipients during March 30 and April 2, 2020, in Wuhan. Psychological distress comprised depression, anxiety, insomnia, and post-traumatic stress disorder , which were assessed using the Patient Health Questionnaire-9, the seven-item Generalized Anxiety Disorder questionnaire, the Insomnia Severity Index, and Impact of event scale-revised. QoL was assessed using the Chinese version of the short Form 36-item health survey.

Limitation: The cross-sectional study design limited us to make causal conclusion and the influence of potential confounders cannot be ruled out.

Recovering From A Liver Transplant

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Getting the transplant is just a part of the process of getting a new liver. According to the National Institute of Diabetes and Digestive and Kidney Diseases, a three-week hospital stay is common after a transplant. During this time, your doctor will evaluate the success of your operation, as well as determine your needs for home care.

It may take up to one year until you feel healthier. Let your doctor know what your mental and emotional health needs are before youre discharged.

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Side Effects From Immunosuppressants

Aside from an increased number of infections, immunosuppressant medications may also cause:

  • persistent cough
  • cold-like symptoms

Its important to take all your medications as prescribed. Dont stop taking immunosuppressants because of side effects without speaking with a doctor first.

You should also ask a healthcare professional before taking any new drugs or supplements to prevent interactions with your current treatment plan.

A doctor will also tell you to schedule follow-up appointments. These will involve physical exams as well as blood testing to ensure that your liver and kidneys are functioning well.

The Facts About Liver Transplant

Liver transplant

A liver transplant, also called a hepatic transplant, can help save your life when your liver no longer works. The treatment involves surgical removal of your entire liver. Its then replaced with all, or part, of a healthy donor liver. This may come from a living or deceased donor.

Having a healthy liver is essential to longevity because your liver is responsible for filtering blood and removing toxins from your body. Liver transplant is a last-resort measure for chronic liver diseases and severe acute liver diseases.

75 percent . Sometimes the transplanted liver can fail, or the original disease may return.

Its important that your doctor monitors your recovery long after the transplant to detect any problems. Youll likely need regular blood tests. According to Johns Hopkins, youll also need to take antirejection medications for the rest of your life.

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Life After A Liver Transplant

Your symptoms should improve soon after the transplant, but most people will need to stay in hospital for up to 2 weeks.

Recovering from a liver transplant can take a long time, but most people will gradually return to many of their normal activities within a few months.

You’ll need regular follow-up appointments to monitor your progress and you’ll be given immunosuppressant medication that helps to stop your body rejecting your new liver. These usually need to be taken for life.

Common Questions About Life After Liver Transplant

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Here are some common questions about life after liver transplant. Ask your transplant team if you have more.

  • Can I drink alcohol after liver transplant?

If you had a liver transplant because of alcohol-related liver disease, youll have committed to life-long abstinence from alcohol. A donor liver is likely to be more easily damaged by alcohol than your own liver. So even if you didnt have a liver transplant for this reason, you should still take care to only drink a little, if you decide to drink at all.

  • When can I have sex after liver transplant?

You can have sex again as soon as your wound has healed and you feel ready.

  • Can I have a baby after liver transplant?

Many women have successful pregnancies after a liver transplant. Its best to seek advice before you get pregnant.

Some medicines, such as mycophenolate, have been linked to problems with pregnancy when taken by the mother or father. So it is important to have safely changed to a different medicine first.

When you get pregnant you will need extra monitoring and specialist care.

  • Can I contact my donors family to thank them?

Yes, you can write a letter, which can go to your transplant centre, which will pass it on. Or the Donor Family Care Service team can do this for you.

  • Can I claim benefits?

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Assessment Of Psychological Distress

As described in our previous studies , symptoms of depression, anxiety, insomnia, and PTSD were assessed using the Patient Health Questionnaire-9 , 7-item Generalized Anxiety Disorder questionnaire , Insomnia Severity Index , and Impact of Event Scale-Revised , respectively. The cut-off scores for identifying major depression, anxiety, insomnia, and PTSD are 10, 10, 15, and 22, on the respective scales. The validity and reliability of these instruments have been confirmed in Chinese population .

Whats The Procedure Like For A Combined Liver And Kidney Transplant

A CLKT is done in a hospital. Before the procedure, youll need to have bloodwork done to ensure youre still a match for the donated organs. Youll also be placed under general anesthesia.

A kidney transplant involves the placement of a new donor kidney into your lower abdominal area and takes to complete. The new kidney is placed underneath your existing kidneys, which may be removed if theyre found to be cancerous or increase your risk of high blood pressure.

A liver transplant is done separately and takes

2 weeks . During this time, your healthcare team will monitor your condition to make sure your transplanted organs are working properly.

Youll also need to take medications to help lower the risk of organ rejection. These come in the form of immunosuppressants, which work by preventing your body from treating the new kidney and liver as foreign objects.

If possible, its important to avoid others who are sick. Taking immunosuppressants can weaken your immune system, making it harder to fight infections.

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Coping With Being On The Waiting List

Living with a serious liver condition can be strenuous enough, and the added anxiety of waiting for a liver to become available can make the situation even more difficult. This can have an effect on both your physical and mental health.

Contact your GP or the transplant centre for advice if you’re struggling to cope emotionally with the demands of waiting for a liver transplant.

You may also find it useful to talk to people in the same situation. The British Liver Trust website has a directory of support groups. You can also become a member of the HealthUnlocked liver disease community.

What To Tell Your Medical Team

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Let your transplant team know if there are any changes to your health or you get any new symptoms. These could be a warning sign of complications.

  • extreme tiredness
  • not peeing much, or at all, or very dark pee

Ask your transplant team what else to look out for.

Its important to tell them how you are recovering, and how you are getting on with taking all your medicines. The team is there to support you. If you had a liver transplant to treat alcohol-related liver disease and are finding it difficult not to drink, for example, its important to tell your team so they can give you the right help and support.

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Psychosocial Challenges Before And After Organ Transplantation

Accepted for publication 9 June 2015

4 August 2015Volume 2015:7 Pages 4558

Karl-Heinz Schulz,1,2 Sylvia Kroencke,1,2 1Department of Medical Psychology, 2University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Abstract: This review addresses psychosocial challenges before and after solid organ transplantation. Stressors, corresponding psychosocial changes of the recipient, and psychological interventions in the different phases of the transplant process are described. Furthermore, important aspects of the preoperative psychosocial evaluation are presented with a special focus on living donors and patients with alcoholic liver disease. For the postoperative period, adherence, quality of life, and return to work are highlighted. Finally, research and clinical implications are presented. Keywords: adherence, alcoholic liver disease, evaluation, living donation, quality of life, return to work

Introduction

Organ transplantation has become an established treatment in end-stage organ failure. Even though it is now a routine procedure in many countries worldwide, patients are faced with various challenges. This review addresses psychosocial challenges and relevant psychological aspects in the different phases of the transplant process.

Stressors before transplantation

Table 1 Generic course of a chronic disease before and after transplantation, patients coping demands, and psychological interventions

Stressors after transplantation

Adherence

Mental Health Affects The Quality Of Life And Recovery After Liver Transplantation

Lisa Renee Miller

Behavioral Health, Henry Ford Health System, Detroit, MI

Lisa Renee Miller

Behavioral Health, Henry Ford Health System, Detroit, MI

This study was supported in part by grants from Gift of Life Michigan and the Benson Ford Endowment of the Henry Ford Transplant Institute.

With respect to conflicts of interest, the authors have no relevant relationships to disclose.

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List Placement And Waiting For A Match

Where youre placed on the list is in part decided by a Model of End-Stage Liver Disease score. This score is based on blood tests, such as:

  • measuring your level of creatinine, which shows how well your kidneys are working
  • checking your international normalized ratio, which is a measure of how well your liver is making blood-clotting proteins

Those with the highest scores are sicker, and they are placed higher on the list. Regular blood tests are necessary to update your MELD score and position on the list. There is also a Pediatric End-Stage Liver Disease score for those younger than age 12. Transplant surgerys success also depends on a good match with a qualifying donor, so your wait time may also vary based on your body size and blood type.

Various factors determine whether a person receives a liver transplant. For instance, if two people with high MELD scores qualify for a liver transplant, the person who has been on the list the longest may receive a transplant sooner. In addition, a person high on the transplant list who has a rare blood type may be less likely to match with a donor.

A person experiencing acute liver failure may be placed near the top of the list because their risk of death could be more imminent compared to someone with a chronic condition.

Look After Your Mental Health

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Its important to keep yourself mentally healthy. Some patients find that they miss the people and staff that they spent lots of time with prior to their transplant. Others find sex or other relationships difficult after a transplant. Getting back to work can be difficult for some patients. You dont need to suffer alone. Please speak to your transplant team or your GP if you think that you need more support.

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Personality Traits Of Donors

The assessment of personality traits is an essential step in the donation procedure it may be helpful in explaining whether the donor might be inherently more prone to a psychological sequel or whether the stress of the operation increases the risk of such complications.

Our findings indicate that the personality trait assessment may be helpful to provide necessary psychological support to help donors cope appropriately with the post-surgical stressful situation. Supporting this view, various studies emphasized the importance of assessing the personality of the potential donors prior to the individuals decision-making to donate some potential donors with high trait anxiety tended to decide to donate in a postponement pattern than a deliberate pattern.

Relationships Between Mental Health And Qol

Predicting Pretransplant QOL From Pretransplant Mental Health

Pretransplant anxiety independently predicted pretransplant QOL outcomes for the Physical Functioning and Mental Health domains, the Physical Composite Score, and the Mental Health Composite Score . Pretransplant depression independently predicted pretransplant outcomes for all of the QOL domains , the Physical Composite Score, and the Mental Health Composite Score . Patients reporting higher levels of anxiety or depression typically reported worse outcomes for these QOL domains. Unexpectedly, those with higher anxiety reported better outcomes for Physical Functioning and the Physical Composite Score.

Pretransplant QOL

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Role Of The Pharmacist

Pharmacists play a major role in the multidisciplinary transplant team. In the U.S., UNOS administers the Organ Procurement and Transplantation Network it is responsible for setting standards for all U.S. transplant programs, and it requires that all transplant programs identify at least one pharmacist to be accountable for providing pharmaceutical care to solid-organ transplant recipients.28

Pharmacists have an integral role in monitoring drug therapy, given that transplant patients generally have complex drug regimens. Transplant clinical pharmacists have expertise in patient education, detecting major drug adverse events and interactions, and in developing strategies to improve adherence to immunosuppressants, antimicrobials, and other essential posttransplant medications.28

Getting Help After Organ Transplantation

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As you adjust to an organ transplant, some of these feelings may bother you less. Part of living with a transplant is accepting uncertainty.

Experts say it’s important to stay optimistic while at the same time accepting that it’s impossible to know exactly what’s going to happen.

But while living with some uncertainty is necessary, you should never accept depression or constant anxiety as inevitable. If you feel that you’re becoming depressed or chronically anxious, talk to your health care provider. Get help.

Many people also find that support groups can make a big difference. In everyday life, you don’t run into many people who have had a transplant. By joining a support group, you get to talk to people who are going through the same things that you are. Just meeting people in your position can make a big difference.

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Psychiatric Morbidity Among Egyptian Living Donor Liver Transplantation

There are few data describing long-term psychiatric complications in living liver donor post donation . The infrequent recording of such problems was explained by the absence of careful donor monitoring during long-term follow-up visits.

On the contrary, some studies reported that liver donors reached improved mental well-being in the long-term follow-up period . Other findings reported that donors had an increased rate of psychiatric complications, including depression, anxiety, bipolar disorder, and substance abuse .

In the current study using SCID-I for diagnosis of psychiatric disorders according to DSM-IV criteria, 3months after donation revealed that 15% of the Egyptian actual donors had an Axis-I diagnosis. Our results were consistent with previous findings, which found that the occurrence of post donation depression rates ranged between 0.2 and 15% among donors . Moreover, Gokce and coworkers found that 12.5% of donors had low mood and 6.3% were in need for pharmacological and psychotherapeutic interventions. Other studies showed a lower prevalence reported in Germany and Japan . Different results could be attributed to the socio-cultural quality of living confounding factors and the difference in sampling and methods of assessment.

On the other hand, a lower rate of clinical depression was recorded by other investigators with a range from only 3 to 4.9% . These discrepancies may reflect cultural and methodological differences.

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