1
|
Zimbrean PC, Rubman S, Andacoglu O, Bakhai D, Clifton E, Deng Y, Doshi M, Emamaullee J, Gan G, Holmes R, Jaber L, Jackson WE, Joyce M, Kalil R, Kumar V, Laflen J, Lentine KL, Prashar R, Winder GS, Yadav A, Liapakis A. Psychosocial evaluation of living liver donors-State of current practices in the United States. Liver Transpl 2024; 30:505-518. [PMID: 37861339 DOI: 10.1097/lvt.0000000000000288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
We surveyed living donor liver transplant programs in the United States to describe practices in the psychosocial evaluation of living donors focused on (1) composition of psychosocial team; (2) domains, workflow, and tools of the psychosocial assessment; (3) absolute and relative mental health-related contraindications to donation; and (4) postdonation psychosocial follow-up. We received 52 unique responses, representing 33 of 50 (66%) of active living donor liver transplant programs. Thirty-one (93.9%) provider teams included social workers, 22 (66.7%) psychiatrists, and 14 (42.4%) psychologists. Validated tools were rarely used, but domains assessed were consistent. Respondents rated active alcohol (93.8%), cocaine (96.8%), and opioid (96.8%) use disorder, as absolute contraindications to donation. Active suicidality (97%), self-injurious behavior (90.9%), eating disorders (87.9%), psychosis (84.8%), nonadherence (71.9%), and inability to cooperate with the evaluation team (78.1%) were absolute contraindications to donation. There were no statistically significant differences in absolute psychosocial contraindications to liver donation between geographical areas or between large and small programs. Programs conduct postdonation psychosocial follow-up (57.6%) or screening (39.4%), but routine follow-up of declined donors is rarely conducted (15.8%). Psychosocial evaluation of donor candidates is a multidisciplinary process. The structure of the psychosocial evaluation of donors is not uniform among programs though the domains assessed are consistent. Psychosocial contraindications to living liver donation vary among the transplant programs. Mental health follow-up of donor candidates is not standardized.
Collapse
Affiliation(s)
- Paula C Zimbrean
- Departments of Psychiatry and Surgery (Transplant), Yale School of Medicine, New Haven, Connecticut, USA
| | - Susan Rubman
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Oya Andacoglu
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Darshit Bakhai
- Department of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin Clifton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Yanhong Deng
- Yale Center for Analytical Sciences, New Haven, Connecticut, USA
| | - Mona Doshi
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Juliet Emamaullee
- Department of Surgery, Keck Medicine of USC/Children's Hospital-Los Angeles, Los Angeles, California, USA
| | - Geliang Gan
- Yale Center for Analytical Sciences, New Haven, Connecticut, USA
| | - Rachel Holmes
- Department of Psychiatry, Indiana University, Indianapolis, Indiana, USA
| | - Lana Jaber
- Department of Surgery, California Pacific Medical Center, San Francisco, California, USA
| | - Whitney E Jackson
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, Colorado, USA
| | - Michael Joyce
- Department of Social Work, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Roberto Kalil
- Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Vineeta Kumar
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennie Laflen
- Department of Surgery, St. Louis University School of Medicine, St. Louis, Missouri, USA
| | - Krista L Lentine
- Department of Internal Medicine, SM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Rohini Prashar
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Gerald S Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Anju Yadav
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
2
|
Fan Y, Nashan B, Wu X, Zhang H, Shi Y. Prevalence and factors associated with depression and anxiety in living liver donors: A systematic review and meta-analysis. J Psychosom Res 2023; 173:111443. [PMID: 37562147 DOI: 10.1016/j.jpsychores.2023.111443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/03/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE This study aimed to systematically review the prevalence and factors associated with depression and anxiety in living liver donors after liver transplantation. METHODS Five English language electronic databases and four Chinese language electronic databases were searched from inception to February 2023. Two investigators independently extracted the data and assessed the study quality. The pooled prevalence was calculated using STATA software (version 14.0). We performed a narrative review to summarize the factors associated with depression and anxiety in living liver donors after liver transplantation. The protocol of this study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database, registration number: CRD42021290071. RESULTS This study included 39 articles involving 18,577 participants. The pooled prevalence was 6.3% [95% confidence interval (CI) (4.1-8.9%)] for depression in living liver donors, and 10.0% [95% CI (4.0-18.1%)] for anxiety. Prevalence of clinically significant depressive or anxiety symptoms was higher (15.7% and 17.4%) compared with disorders (2.7% and 2.2%). The prevalence of depression and anxiety was highest within 3 months post-donation. Specifically, female donors, serious postoperative complications, and recipients' poor health/death have been reported as factors having a negative influence on depression and anxiety. CONCLUSIONS Collected evidence showed that the overall prevalence of depression or anxiety of living liver donors was high. Therefore, early detection and timely treatment of psychological disorders are crucial to promote positive psychiatric health outcomes and ensure the quality of life of living liver donors.
Collapse
Affiliation(s)
- Yaru Fan
- School of Nursing, Peking University, Beijing, China.
| | - Björn Nashan
- Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
| | - Xiaxin Wu
- School of Nursing, Peking University, Beijing, China.
| | - Haiming Zhang
- National Clinical Research Center for Digestive Diseases and Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Yuexian Shi
- School of Nursing, Peking University, Beijing, China.
| |
Collapse
|
3
|
Zimbrean PC. Depression in transplantation. Curr Opin Organ Transplant 2022; 27:535-545. [PMID: 36227755 DOI: 10.1097/mot.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To review and summarize the literature published between 1 January 2020 and 30 June 2022, on the prevalence, risk factors and impact of depression in transplant population. RECENT FINDINGS Depression is common in transplantation candidates and recipients, with a prevalence up to 85.8% in kidney recipients. Multiple studies have indicated after transplantation depression correlates with increased mortality and with higher healthcare utilization. Social risk factors for posttransplant depression include financial difficulties and unemployment, while less is understood about the biological substrate of depression in this population. There is evidence that dynamic psychotherapy is effective for depression in organ transplant recipients, while cognitive behavioral therapy or supportive therapy did not lead to improvement of depression in transplant recipients. For living organ donors, the rates of depression are similar to the general population, with financial factors and the clinical status of the recipient playing a significant role. SUMMARY Depression is a common finding in transplant population. More research is needed to understand the biological substrate and risk factors and to develop effective treatment interventions.
Collapse
Affiliation(s)
- Paula C Zimbrean
- Departments of Psychiatry and Surgery (Transplantation), Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|