Undergoing a liver transplant is a stressful and major life event. A significant portion of the Dutch liver transplant patients experience, therefore, psychological problems such as symptoms of anxiety, depression, and posttraumatic stress (PTS), both before and after the transplant.
A prospective study among 260 patients of all Dutch liver transplant centers, shows that of the waiting-list patients 49% experience symptoms of anxiety, 34% depressive symptoms, and 32% symptoms of PTS. Moreover, patients who once show symptoms of anxiety or depression remain anxious or depressed throughout the waiting-list period. In the first two years after the transplant, 23% of the patients show persistent symptoms of anxiety, 29% of depressive symptoms, and 15% of symptoms of PTS. These patients also report poorer results regarding medication adherence and quality of life.
Besides this, a cross-sectional study among 281 patients who underwent a liver transplant at the University Medical Center Groningen between 1979 and 2009 shows that psychological problems are not only present in the short term but also the long-term after transplantation. Over 35% of the patients who had been transplanted longer than 10 years ago reported psychological problems, in particular anxiety (33%) and depression (23%).
Important risk factors associated with psychological problems are individual factors, such as sense of control and coping style, and transplant-related factors, such as severity of liver disease symptoms and side-effects of the immunosuppressive medication.
Our results emphasize the importance of psychosocial screening and support in the care of liver transplant patients throughout the transplant process.