The biopsychosocial approach in liver and multi-organ transplantation: assessment of the outcome predictors

Introduction: During all phases of Liver Transplant (LT) process patients tend to develop psychological distress. Aims of the present study were to evaluate psychological variables at the time of evaluation for listing for LT (T0) and enter in the waitlist for LT (T1). Methods: We prospectively enrolled patients admitted at the Bologna Transplant Center between 2017 and 2018. Patients were compared with an age- and gender- matched control group. Significant differences between variables were estimated with non-parametric tests. χ2 or Fisher’s exact test was used for categorical variables while Mann-Whitney for continuous ones. Changes between T0 and T1 were analyzed with Wilcoxon Test. A p value less than 0.05 was pondered as noteworthy for all tests. Results: We enrolled 50 patients mainly males (68%) with mean age of 57±7 years. A DSM 5 diagnosis was present in one fifth of patients and DCPR syndrome in 44%. Enrolled subjects at T0 showed anxiety, depression and somatic symptoms. In comparison with control group, experimental one displayed lower scores in PCS and MCS of SF-12 (p=0.000, p=0.000, respectively), BC positive refraining, venting, instrumental support, humor, behavioural disengagement, emotional support, self-blame (all p<0.05) and in ISEL and PTG Scale (all p=0.000). Experimental group reported higher scores in the scale of SQ about anxiey, depression, somatic symptom and BC substance use score (all p<0.05). Twenty-five patients were admitted in the waitlist (T1). From T0 to T1, there was an increase of DSM-5 and DCPR diagnosis. At T1 in comparison with T0, we registered higher scores in SQ Hostility subscale (p=0.084) and BC Self distraction (p=0.079). Conclusions: Patients in screening for LT show many psychological disorders, often more pronounced than general population. From screening to enter into waitlist, many psychological patterns tend to worsen. Psychological support and multidisciplinary view might be useful during the transplant process.