The resilience and coping abilities of patients who’ve had liver transplants vary and alter over time and are sometimes linked to sociodemographic aspects including income, race, and education, a study led by UT Southwestern Medical Center researchers shows. The findings could lead on to tailored interventions to optimize clinical and patient-centered outcomes amongst liver transplant recipients.

Once we deal with patients who’ve undergone this life-changing surgery, recovery really evolves over time. We do not fully understand or capture that with current metrics that give attention to mainly clinical outcomes similar to survival. The aim of this project was to get a more in-depth view of novel patient-reported concepts at different stages of survivorship.”

Sarah R. Lieber, M.D., M.S.C.R., Transplant Hepatologist, Assistant Professor of Internal Medicine and a member of the Division of Digestive and Liver Diseases

Dr. Lieber led the study published in Liver Transplantation, working with UTSW mentor Amit G. Singal, M.D., M.S., Professor of Internal Medicine, a member of the Division of Digestive and Liver Diseases and the Harold C. Simmons Comprehensive Cancer Center, Medical Director of the Liver Tumor Program, and Chief of Hepatology.

Transplantation offers the prospect for a cure for 1000’s of patients within the U.S. every 12 months with diseases or trauma that affect the liver. Although greater than 70% who receive this surgery survive no less than five years, Dr. Lieber said, their recovery might be stuffed with physical, emotional, and psychological challenges. Liver transplant survivors must adapt to a latest life that features strict medication adherence, frequent clinical monitoring, and unanticipated complications.

To higher understand what aspects influence survivorship, Dr. Lieber and colleagues emailed surveys to a whole lot of patients who received liver transplants between January 1990 and November 2019 and were followed on the University of North Carolina Liver Transplant Center.

The surveys collected sociodemographic information similar to age, sex, race, ethnicity, education level, and income; pre-transplant characteristics similar to reason for transplantation, waitlist time, and psychiatric history; and post-transplant characteristics including length of hospital stay, employment status, and whether patients had a caregiver. Additionally they included survey questions validated for other chronic conditions to evaluate the patients’ abilities to positively cope in addition to their level of post-traumatic growth (the flexibility to adapt and grow after a traumatic event), resiliency, and symptoms of hysteria and depression.

The researchers received 191 accomplished surveys from patients with a broad span of survival periods starting from lower than a 12 months post-transplant to greater than 10 years. A majority of respondents were male (about 64%) and Caucasian (about 84%) and ranged from 28 to 83 years old.

The surveys showed that although 85% within the early survival period (one 12 months or less) had high post-traumatic growth, only about 15% of late survivors (between five and 10 years) had the identical characteristic. High resilience was reported in just about 33% of survivors and was related to relatively high income.

Lower resilience was seen amongst patients with longer hospital stays and later survival stages. Patients who reported a lower ability to manage after transplant were more more likely to be 65 or older, non-Caucasian, have less education, or needed a transplant for nonviral liver disease. Dr. Lieber said about 25% of liver transplant survivors had clinically significant anxiety and depression, more frequent amongst early survivors and ladies with pre-transplant mental health disorders.

These characteristics could help predict clinical outcomes, she said. For instance, anxiety and depression, the flexibility to manage, and resilience have been shown to predict how well a patient can self-manage care and interact effectively with the health system for other chronic diseases, and are essential predictors for quality of life and functioning, similar to the flexibility to return to work and interact in every day activities. Dr. Lieber and her colleagues plan to proceed to review other facets of survivorship in liver transplant patients, similar to how these variables change over time, which could help researchers develop tailored interventions to enhance clinical outcomes and quality of life.

“High-quality care of patients after liver transplant includes treating the entire person,” Dr. Lieber said. “Survivorship research informs how we develop and implement interventions to assist our transplant community.”

Alvaro Noriega Ramirez, a Clinical Research Assistant within the Division of Digestive and Liver Diseases, also contributed to this study.

This research was funded by the UT Southwestern Fund to Retain Clinical Scientists (UT-FOCUS), the American Heart Association (923721), the Doris Duke Charitable Foundation COVID-19 Fund to Retain Clinical Scientists, and the American College of Gastroenterology Junior Faculty Development Award.

Dr. Singal is a Dedman Family Scholar in Clinical Care and holds the Willis C. Maddrey, M.D. Distinguished Chair in Liver Disease.

Source:

UT Southwestern Medical Center

Journal reference:

Lieber, S. R., et al. (2023). Energetic coping, resilience, post-traumatic growth, and psychiatric symptoms amongst early and late liver transplant survivors. Liver Transplantation. doi.org/10.1097/lvt.0000000000000009.