Risk factors and impact on outcomes of trajectories of anxiety and depression after liver transplantation: a prospective cohort study

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C. Annema, G. Drent, P.F. Roodbol, R.E. Stewart, H.J. Metselaar, B. van Hoek, R.J. Porte, A.V. Ranchor

Chair(s): M.J. Wessels & J.M. Wierdsma

Thursday 9 march 2017

9:00 - 9:12h at Willem Pijperzaal

Categories: Parallel - Verpleegkundig

Parallel session: Parallelsessie X – Verpleegkundig

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Background:
Although the burden of psychological problems among liver transplant recipients is recognized, little is known about the course of symptoms of anxiety and depression over time. The aim of this study was to examine whether distinct trajectories of anxious and depressive symptoms are present among adult liver transplant recipients from before transplantation up until to two years after transplantation; to identify demographic, clinical, and individual characteristics associated with the distinct trajectories; and to examine the influence of distinct trajectories on outcomes.

Methods:
Data were retrieved by questionnaire before and at 3, 6, 12, and 24 months after transplantation. Clinical data were retrieved by medical record review. Latent Class Growth Analysis was used to identify distinct trajectories and General Linear Mixed Models analysis was used to identify associated variables.

Results:
Three distinct trajectories for symptoms of anxiety and depression were identified: “no symptoms,” “resolved symptoms,” and “persistent symptoms.” The trajectory of persistent symptoms of anxiety comprised 23% of the transplant recipients. The trajectory of persistent depressive symptoms 29% of the transplant recipients. Several clinical and individual variables were found to be associated with the trajectories of persistent symptoms of anxiety and depression: experiencing more side-effects from the immunosuppressive medication, a lower level of personal control, more use of emotional coping, less use of task-oriented coping, less disclosure about the transplant, and experiencing more stressful life events. Transplant recipients within the trajectories of persistent symptoms, reported significantly worse medication adherence (P < 0.02) and lower scores for all domains of health-related quality of life (P < 0.001).

Conclusion:
A significant subset of liver transplant recipients showed persistent symptoms of anxiety and depression. Our results emphasize the importance of psychological care in the transplant population. Assessment of risk factors early in the transplant process and continuous follow-up of psychological functioning are warranted. Based on these assessments appropriate interventions should be undertaken to enhance psychological functioning in liver transplant patients.