Body Image in Liver Transplantation Recipients

Investigating Body Image and Self-Esteem in Kidney Transplant Patients: A Qualitative Study

BACKGROUND

Kidney transplantation is one of the life-saving therapies for patients with end-stage renal disease, which affects a person's psychological, social, and physical well-being. How transplanted patients perceive their illness and their body can affect their physical and psychological recovery.

AIM

This qualitative study was designed to evaluate self-esteem and body image in kidney transplant patients.

METHODS

The study involved 16 female renal transplanted patients. Data were collected using a two-part interview form developed by the investigators in accordance with the literature. We used Lundman's method to transcribe the interviews and coded the data from the interviews. The results of the study were discussed using the themes. The first three interviews were entered into MAXQDA, and then, additional interviews were analyzed.

RESULTS

Six main themes and 15 subthemes were generated based on the thematic analysis of the interviews with participants about body image and self-esteem. Themes included body acceptance, changes in body image, deterioration of social relationships, changes in self-esteem, spousal concerns, and organ perceptions. This study collected detailed data on body image, self-esteem, social relationships, and spouse/partner relationships after kidney transplantation.

CONCLUSION

The change in participants' body image and self-esteem after kidney transplantation caused having negative feelings regarding sexual life, relationships, and social life and feeling unfamiliar with the transplanted organ.

Determination of body image and self-efficacy levels in patients after cornea transplantation

PURPOSE

The study aimed to determine body image and levels after surgery in cornea transplant patients.

MATERIALS AND METHODS

The population of this cross-sectional study was composed of 383 patients presented to the Eye Bank unit of a University Hospital after corneal transplantation. Sample size of 193 patients was calculated with 0.5 power, a margin of error of 5%, representing 95% of the universe. The data were collected through face-to-face interviews with the patients by the researcher and the study was completed with 178 patients in September-November 2022. The data were collected using a Patient Information Form, the Body Image Scale, and the General Self-Efficacy Scale. Parametric tests, Pearson Correlation, Student's t-test, and One-Way Analysis of Variance tests were performed were used in the data analysis.

RESULTS

It was determined that the mean Body Image Scale score of the transplant patients participating in the study was 159.41 ± 36.99 and the mean Self-Efficacy Scale score was 30.37 ± 8.31. When the comparison of the mean scores was examined, the difference between the mean scores of gender, marital status, occupation, and body image scale was statistically significant (p < .05), while the difference between the self-efficacy mean scores was not statistically significant (p > .05). There was a positive, moderately strong significant relationship between body image and the self-efficacy of the patients (p < .01) (r = .57).

CONCLUSION

It was found that the patient's body image and self-efficacy levels were high, and self-efficacy increased as the body image increased.

Neuropsychiatric sequelae after liver transplantation and their possible mechanism via the microbiota-gut-liver-brain axis

Patients after liver transplantation are often impacted by mental and even neuropsychiatric disorders, including depression, sleep disorders, anxiety, and post-traumatic stress disorder. Neuropsychiatric sequelae have an adverse impact on rehabilitation and can even incapacitate people, reducing their quality of life. Despite screening tools and effective treatments, neuropsychiatric sequelae after liver transplantation (NSALT) have not been fully diagnosed and treated. Current research suggests that NSALT may be partly related to intestinal microbial variation, but the detailed mechanism remains unclear. In this review, we describe the clinical and diagnostic features, prevalence, prediction, clinical course and outcome, management, and treatment of NSALT; we also summarize their mechanisms through the microbiota-gut-liver-brain axis. Finally, we propose to improve NSALT on the basis of adjusting the gastrointestinal flora, immune inflammation or vagus nerve (VN), providing a novel strategy for clinical prevention and treatment.

Incidence and prevalence of depressive, anxiety, and insomnia symptoms among adult liver transplant recipients: A systematic review and meta-analysis

OBJECTIVE

Psychological morbidity among transplant recipients may negatively impact post-transplantation outcomes. Our objectives were to compute pooled incidence and prevalence estimates for depressive, anxiety, and insomnia symptoms among adults who underwent liver transplant.

METHODS

Electronic searches of MEDLINE, PubMed Central, CINAHL, and Google Scholar were carried out from inception to October 2022 to identify observational studies conducted among adult liver transplant recipients which measured depression, anxiety, and/or insomnia. We used the Joanna-Briggs tool for study quality appraisal.

RESULTS

Sixty-five studies (pooled N = 12,183) provided data for meta-analysis. The one-year pooled point prevalence rate for depressive symptoms was 25% (95% Confidence Intervals [CI]: 20% to 30%; I² = 94%; 37 studies; N = 6088) while that of anxiety and insomnia symptoms were 29% (95% CI: 21% to 38%; I² = 96%; 28 studies; N = 4016) and 28% (95% CI: 16% to 43%; I² = 98%; 14 studies; N = 1834), respectively. The findings remained robust across subgroup and sensitivity analyses. Most included studies had low or moderate risk of bias.

CONCLUSIONS

Depressive, anxiety, and insomnia symptoms are commonly prevalent following liver transplantation. Our findings, though limited by high heterogeneity across analyses, have important implications for screening, management, and prevention of psychological morbidity in this group.

SYSTEMATIC REVIEW REGISTRATION

This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD 42021276008).

Psychosocial Characteristics of Patients Evaluated for Kidney, Liver, or Heart Transplantation

OBJECTIVE

Psychosocial parameters play a pivotal role in organ recipient evaluation before wait-listing for transplantation because of their impact on organ and patient outcome. Patients in need of heart (HTx), liver (LTx), or kidney transplantation (KTx) face distinct physical and psychological challenges. This study compares the psychosocial characteristics and preferences for additional therapy for patients undergoing assessment for these three types of organ transplantation to optimize patient-tailored psychological, social, and other supportive interventions.

METHODS

We conducted a cross-sectional, observational study with 1110 potential transplantation candidates (LTx, n = 544; KTx, n = 330; HTx, n = 236), psychosocial status was determined for depressive symptoms (Patient Health Questionnaire Depression Scale), anxiety symptoms (seven-item Generalized Anxiety Disorder Screener), health-related quality of life (36-Item Short Form Health Survey), perceived social support (Perceived Social Support Questionnaire), sense of coherence (SoC; short form of the Sense of Coherence Scale), self-efficacy (General Self-Efficacy Short Scale), and body image (German Body Image Questionnaire-20). Preferences for additional supportive therapy were assessed dichotomously. Data were analyzed using multivariate analysis of covariance and χ2 tests.

RESULTS

Patient groups differed significantly regarding depression ( F (2,1107) = 35.283, p < .001, partial η2 = 0.01), anxiety ( F (2,1107) = 15.027, p < .001, partial η2 = 0.03), health-related quality of life (physical: F (2,1107) = 96.772, p < .001, partial η2 = 0.15; mental: F (2,1107) = 11.442, p < .001, partial η2 = 0.02), perceived social support ( F (2,1107) = 20.813, p < .001, partial η2 = 0.04), SoC ( F (2,1107) = 12.920, p < .001, partial η2 = 0.02), self-efficacy ( F (2,1107) = 17.308, p < .001, partial η2 = 0.03), and body image (rejecting body evaluation: F (2,1107) = 5.006, p = .007, partial η2 = 0.01; vital body dynamics: F (2,1107) = 40.216, p < .001, partial η2 = 0.07). Patients evaluated for HTx showed the highest psychosocial impairment and the highest inclination regarding additional supportive therapy.

CONCLUSIONS

Patients evaluated for HTx, LTx, and KTx have distinct psychosocial characteristics and treatment preferences. HTx patients display the highest psychosocial impairment. We suggest psychocardiological treatment structures for optimal outcome.

Psychosocial considerations in the combined bariatric surgery and organ transplantation population: a review of the overlapping pathologies and outcomes

PURPOSE OF REVIEW

This review highlights the salient data of the psychosocial concerns that influence outcomes of bariatric surgery and organ transplantation.

RECENT FINDINGS

Bariatric surgery has emerged as an important intervention with data supporting substantial and sustained weight loss, enhanced quality of life, remission of obesity-related medical comorbidities, and improved long-term patient and graft survival in transplant patients. Depression, suicide, anxiety, posttraumatic stress disorder, alcohol use, adherence, and psychopharmacology considerations can influence outcomes of both these surgeries.

SUMMARY

Obesity is increasingly prevalent among patients pursuing transplantation surgery, and it is often a factor in why a patient needs a transplant. However, obesity can be a barrier to receiving a transplant, with many centers implementing BMI criteria for surgery. Furthermore, obesity and obesity-related comorbidities after transplant can cause poor outcomes. In this context, many transplant centers have created programs that incorporate interventions (such as bariatric surgery) that target obesity in transplant candidates. A presurgery psychosocial assessment is an integral (and required) part of the process towards receiving a bariatric surgery and/or a transplantation surgery. When conducting a dual (bariatric and transplantation surgery) psychosocial assessment, it is prudent to understand the overlap and differentiation of specific psychosocial components that influence outcomes in these procedures.

Postoperative Nursing Care of a Deceased Donor Tracheal Transplant Recipient

INTRODUCTION

Certain airway disorders, such as tracheal stenosis, can severely affect the ability to breathe, reduce quality of life, and increase morbidity and mortality. Treatment options for long-segment tracheal stenosis include multistage tracheal replacement with biosynthetic material, autotransplantation, and allotransplantation. These interventions have not demonstrated long-term dependable results because of lack of adequate blood supply to the organ and ciliated epithelium. A new transplant program featuring single-stage long-segment tracheal transplant addresses this concern.

CLINICAL FINDINGS

The patient was a 56-year-old woman with a history of obesity, type 2 diabetes, hypertension, hyperlipidemia, liver sarcoidosis, 105-pack-year smoking history, and asthma. A severe asthma exacerbation in 2014 required prolonged intubation, and she subsequently developed long-segment cricotracheal stenosis. In 2015 she underwent an unsuccessful tracheal resection followed by failed attempts at tracheal stenting and dilation procedures. These attempts at stenting resulted in a permanent extended-length tracheostomy and ultimately ventilator dependency.

INTERVENTIONS

The patient underwent a single-stage long-segment deceased donor tracheal transplant. Important nursing considerations included hemodynamic monitoring, airway management and securement, graft assessment, stoma and wound care, nutrition, medication administration, and patient education.

CONCLUSION

High-quality nursing care postoperatively in the intensive care unit is critical to safe and effective treatment of the tracheal transplant recipient and success of the graft. To effectively treat these patients, nurses need relevant education and training. This article is the first documentation of postoperative nursing care following single-stage long-segment tracheal transplant.

Perceived body image and distress after liver tansplantation in recipients

OBJECTIVES

This study's aim was to determine the relationship between the perception of self-body image and the level of distress in patients who had liver transplantation surgery.

METHOD

This study was performed as a descriptive and cross-sectional study with the attendance of 120 liver transplant patients hospitalized in the liver transplant center of a training and research hospital. Self-body image was measured based on the Body Image Questionnaire (BIQ) on a scale of 40 (lowest) to 200 (highest) with the optimal BIQ score of 135-200. The level of distress was evaluated by the Distress Thermometer (DT) on a scale of 0 (None) to 10 (High). The data analysis was performed with the IBM Statistical Package for the Social Sciences Statistics 25.

RESULTS

According to the data attained, 35.8% of the patients were 55 years old or older, 56.7% were male, and 61.7% were married. The mean BIQ score among all tested patients was 81.85 ± 27.31, and this was considered as a low level of self-image. The mean DT score of the patients was 5.45 ± 2.72, which indicated relatively high levels of distress in the transplant recipients. Comparing these two values together (BIQ + DT) by regression analysis, we found a moderate negative relationship between self-body image (BIQ) and distress (DT) in the patients (r: -0.391, p < 0.001). Accordingly, when the distress levels of the patients decreased, their perceptions of self-body image increased.

CONCLUSION

Even if their liver transplant operation is successful, the problems of the recipients after transplantation do not completely disappear. Liver transplant recipients should be helped in coping with their condition effectively. Patients undergoing liver transplantation should be provided with psychosocial and emotional support.

Effects of Illness Perception on Self-Care Agency and Hopelessness Levels in Liver Transplant Patients: A Descriptive Cross-Sectional Study

Individuals with liver transplantation (LT), hopelessness, and lack of self-care may occur and change in the illness perceptions; however, no study has examined the effects of the illness perceptions on self-care agency and hopelessness levels in individuals with LT. This study was conducted to examine the effects of the illness perceptions of patients who had received LT surgery on their self-care agency and hopelessness levels. A descriptive cross-sectional study with a convenience sample (N = 120) was conducted at a center in eastern Turkey. The data were collected by using the "Brief Illness Perception Questionnaire" (B-IPQ), "Self-Care Agency Scale" (SCAS), "Beck Hopelessness Scale" (BHS). In the study, the mean total B-IPQ, SCAS, BHS scores was found as 57.50 ± 3.61, 83.83 ± 9.43, 10.19 ± 3.81, respectively. There was a positive and significant relationship between the B-IPQ and BHS total scores.

Physical Function, Physical Activity, and Quality of Life After Liver Transplantation

Robust physical activity after liver transplantation is an important determinant of longterm health, similar in its importance to the value of pretransplant activity for withstanding the immediate stress of transplantation. Although transplantation normally enables rapid recovery of liver synthetic and metabolic functions, the recovery of physical capacity and performance to normal levels is delayed and often incomplete. Anatomic measurements of sarcopenia and the physical performance indicators of frailty both tend to improve slowly, and they may, in fact, decrease further in the posttransplant period, especially when the common extrahepatic drivers of muscle loss, such as the elements of the metabolic syndrome, persist or intensify after transplantation. Posttransplant exercise improves fitness, which is a conclusion based on 2 observational studies and 3 randomized trials that assessed endpoints of strength testing, energy expenditure in metabolic equivalents, and peak or maximal oxygen uptake. Importantly, 1 controlled trial found that exercise also improved quality of life (QOL) measured by the Short Form 36 survey, consistent with multiple reports of the value of social support and engagement in sports activity for improving posttransplant QOL. Developing evidence-based standards for post-liver transplant physical activity baseline testing and sustainment of intensity and quality is a key unmet need in transplant hepatology. At present, it is reasonable for transplant teams to assess fitness and design a tailored exercise program when a recipient is first discharged, to record and reinforce progress at all posttransplant visits, and to set realistic longterm performance goals that will often achieve recommended standards for the healthy general population.