Adriana R. Vasquez

Seligman's theory of attributional style: optimism, pessimism, and quality of life after heart transplant.

Context— Posttransplant quality of life can be significantly affected by personality characteristics identified before transplant. Objective— Although overall quality of life in heart transplant patients improves after transplant, many studies reveal poorer mental health outcomes after transplant. We aimed to determine whether transplant recipients with an optimistic explanatory style had improved quality of life, fewer depressive symptoms, and increased survival. Design— We reviewed 68 patients who had completed a Minnesota Multiphasic Personality Inventory a mean of 2 years before transplant and examined associations between scores on the Optimism-Pessimism scale, survival rates, and results from the Health Status Questionnaire nearly 4 years after transplant. Results— Optimism was significantly associated with higher quality of life even after age (at the time of transplant), sex, depression score before transplant, time from the personality inventory to transplant, and time from transplant to the Health Status Questionnaire were controlled for. Furthermore, a pessimistic explanatory style was significantly associated with self-reported depressive symptoms, even after depression before transplant was adjusted for. Neither optimism nor pessimism was associated with length of survival. Conclusions— Pretransplant patients with a pessimistic explanatory style reported depressive symptoms nearly 5 years later. Furthermore, over the same time span, patients with an optimistic explanatory style described a significantly higher quality of life than the pessimists described.

Pretransplant Psychiatric and Substance Use Comorbidity in Patients with Cholangiocarcinoma Who Received a Liver Transplant

BACKGROUND Psychopathology has been commonly observed in liver transplant candidates, and up to 40% have comorbid psychiatric disorders. This illness burden may negatively impact quality of life and transplant outcome. Liver transplantation for cholangiocarcinoma remains uncommon due to the complex treatment protocol. We assessed for pretransplant psychopathology and substance use disorders in liver transplant recipients with cholangiocarcinoma to better characterize this patient group. METHODS We retrospectively reviewed the records of 143 liver transplant recipients who completed pretransplant psychological screening with the PAS, BDI-FS, BSI-18, and the SAAST between 2000 and 2004. The majority completed an evaluation by a transplant psychiatrist. Rates of pretransplant psychiatric and substance use symptoms and disorders were compared between 26 patients with cholangiocarcinoma and 117 other liver recipients using χ(2) or Fishers exact tests. RESULTS Of the total cohort, 35% had a pretransplant psychiatric diagnosis, 35% had a substance use disorder, and 43% were current or former smokers. The cholangiocarcinoma cohort had significantly lower scores on the PAS, BDI-FS, and the BSI-18. On interview, the cholangiocarcinoma group was less likely to have an alcohol use disorder (P = 0.03) or any substance use disorder (P = 0.04), but the two groups did not differ significantly in the likelihood of having a psychiatric disorder or smoking history. CONCLUSIONS This study suggests that patients with cholangiocarcinoma have lower rates of alcohol and drug use disorders than other liver transplant recipients. They do not differ in rates of psychiatric disorders or smoking. Psychosocial assessment and support are recommended throughout the transplant process.

Psychosocial Risk Impacts Mortality in Women After Liver Transplantation

BACKGROUND Liver transplant candidates undergo psychosocial assessment as a component of their pretransplant evaluation. Global psychosocial assessment scales, including the Psychosocial Assessment of Candidates for Transplantation (PACT), capture and quantify these psychiatric and social variables. OBJECTIVE Our primary aim was to assess for an association between global PACT score and survival in liver transplant recipients. METHODS This retrospective cohort study examined records of all liver recipients at one U.S. Transplant Center from 2000 to 2012 with outcomes monitoring until 07/01/2016. We investigated for associations between the following variables and mortality: PACT score, age, gender, marital status, race, alcoholic liver disease (ALD), and body mass index (BMI). Statistical methods included Students t-test, Wilcoxon rank sum test, chi-square, Fishers exact test, Kaplan-Meier curve, and Cox proportional hazard models. RESULTS Of 1040 liver recipients, 538 had a documented PACT score. Among these, PACT score was not associated with mortality. In women, a lower PACT score was associated with mortality (p = 0.003) even after adjustments for age, marital status, and BMI. Women with ALD had a 2-fold increased hazard of death (p = 0.012). Increasing age was associated with increased risk of death for the cohort as a whole (p = 0.019) and for men (p = 0.014). In men, being married and BMI were marginally protective (p = 0.10 and p = 0.13, respectively). CONCLUSIONS Transplant psychosocial screening scales, specifically the PACT, identify psychosocial burden and may predict post-transplant outcomes in certain populations. In female liver recipients, lower PACT scores and ALD were associated with a greater risk of post-transplant mortality.

Impact of psychiatric comorbidities on outcomes of elderly liver transplant recipients

OBJECTIVES This study evaluated the impact of psychiatric comorbidities in liver transplant (LT) recipients aged ≥65 years (elderly) on length of hospital-stay (LOS), death, and a composite outcome of graft loss or death. METHODS This retrospective study assessed impact of psychiatric comorbidities in 122 elderly LT recipients and a matched group of 122 LT recipients aged <65 years (younger). Associations were assessed using adjusted multivariable regression models. RESULTS Among elderly, median age at LT was 68 years, most were males (62%), white (85%) and 61.7% had a history of any psychiatric diagnosis. Among younger, median age was 55, most were males (67.2%), white (77.5%) and 61.5% had any psychiatric diagnosis. Median LOS was 8 days for both groups. Among elderly, after a median follow-up of 5 years, 25.4% died and 29.5% experienced graft loss or death. History of adjustment disorder, history of depression, past psychiatric medication use, and pain prior to LT were associated with an increased risk of death or the composite graft loss or death. Perioperative use of SSRIs and lack of sleeping medication use were associated with longer LOS. Among aged <65, after median follow-up of 4.7 years, 21 patients (17%) died and 25 (20%) experienced graft loss or death; history of depression, perioperative SSRIs or sleeping medications use was associated with increased mortality and graft-loss or death. CONCLUSION Six out of 10 patients among both elderly and younger cohorts had pre-LT psychiatric comorbidities, some of which adversely affected outcomes after LT.