G. Rupolo

The impact of liver disease and medical complications on quality of life and psychological distress before and after liver transplantation.

BACKGROUND/AIM The impact of liver disease and medical complications on quality of life (QOL) and psychological distress before and after orthotopic liver transplantation (OLT) is a matter of growing interest. METHODS Perceived QOL (LEIPAD Quality of Life test) and psychological distress (Brief Symptom Inventory, BSI) were assessed in 40 cirrhotic patients listed for OLT (Group A) and in 101 liver transplant recipients (Groups B to G=0-6, 7-12, 13-24, 25-36, 37-48, 49-60 months post-OLT). Patients were also evaluated for medical complications, blood levels of immunosuppressive agents and recurrence of liver disease. RESULTS QOL and psychological distress were significantly better in most of the post-OLT groups than in cirrhotic patients. Among post-OLT patients, a significantly worse QOL was perceived at 13-24 months (Life Satisfaction: Group D vs G, p=0.024; Cognitive Functioning: Group D vs F, p=0.024), while significantly greater psychological distress was detected at 7-12 months (Anxiety and Interpersonal Sensitivity: Group C vs Group B, p=0.032 and p=0.023, respectively). Medical complications and immunosuppressive therapy did not influence QOL or psychological distress after OLT. Within 6 months after OLT, patients with HCV recurrence showed significantly greater Depression (p=0.023), Anxiety (p=0.038), Phobic Anxiety (p=0.001), and Paranoid Ideation (p=0.033) than anti-HCV negative patients. CONCLUSIONS Liver transplantation improves psychological distress and most, but not all, QOL domains. Recurrent HCV infection is associated with greater psychological distress.

Nonadherent Behaviors After Solid Organ Transplantation

BACKGROUND AND AIM The effectiveness of any treatment depends not only on the choice of therapy, but also, to a large extent, on the patients active cooperation. Adherence to medical prescriptions and particularly to immunosuppressive therapy is crucial to prevent medical complications that negatively influence graft function and patient survival after organ transplantation. The aim of this study was to assess, among patients who underwent solid organ transplantation, nonadherent behaviors (NAB) to immunosuppressive therapy, to correct lifestyle, and to general medical prescriptions. MATERIALS AND METHODS We evaluated patients who underwent solid organ transplantation from March 2008 to June 2009. All participants completed an anonymous 15-item questionnaire to assess NAB. RESULTS We enrolled 218 organ transplant patients: 103 liver, 50 kidney, 52 heart, and 13 lung. There were 152 men and the overall age was 52.2 ± 0.8 years (mean ± standard deviation [SD]) time from transplantation, 83.6 ± 4.5 months (mean ± SD). Overall 37.9%, 38.8%, and 12.8% of patients reported nonadherence to immunosuppressive therapy, to correct lifestyle, and to general medical prescriptions, respectively. Considering nonadherence to immunosuppressive therapy and to general prescriptions, the percentage of kidney transplant patients who referred NAB was significantly lower compared with other organ transplant patients (P = .008 and P = .04, respectively). Nonadherent patients to immunosuppressive therapy and to general medical prescriptions displayed a longer interval from transplantation compared with adherent patients (P = .02 and P = .03, respectively). Among patients nonadherent to the correct lifestyle, the rates of men and of patients with disability pension were significantly higher compared to adherent patients (P = .001 and P = .002, respectively). CONCLUSIONS Poor adherence to medical prescriptions and to adequate lifestyle is common among organ transplant patients, especially those who have undergone liver transplantation. Psychoeducational interventions for transplanted patients and their families are needed to improve adherence.

Experience of donation and quality of life in living kidney and liver donors

Italian guidelines on living donation demand that we ascertain the donor’s free and informed consent. Assessments to do so have to be conducted by an independent ‘third party’ who has nothing to do with the medical team treating the recipient. From February 2002 to December 2006, the Veneto Regional Authority’s Third Party Commission evaluated 201 living liver and kidney donors. A sample of these were contacted after their surgery to assess their living donation experience and quality of life (QoL); 81 were eligible for the assessment and 69 (85.2%) responded. All donors involved in the study completed an anonymous document that included the SF‐36 and a questionnaire on their donation experience. The majority (96%) of the sample expressed a positive global opinion of the experience. We concluded that the donation had positive effects on their QoL and that family support had a fundamental influence on their general well‐being, and their psychic balance in particular. Some crucial issues emerged, however, i.e. 11% of donors judged the information received before the operation inadequate, 17% reported a subjective perception of bodily changes after the operation and 14% were concerned about their current health: these findings emphasize the importance of informing potential donors thoroughly before they submit to surgery.

The effect of recurrence of HCV infection of life after liver transplantation

Abstract The present study evaluated the quality of life (QOL) of adult cirrhotic patients before orthotopic liver transplantation (OLT), the effect of OLT on QOL in the long‐term and the effect of HCV recurrence within medical complications on QOL. Three groups of patients were studied: 19 pre‐OLT, 33 during the first year post‐OLT and 41 1 to 5 years post‐OLT. The patients completed questionnaires on QOL and underwent liver function tests, immunosuppressive drug blood level determinations and medical complications evaluation. Somatization and depression and anxiety scores improved significantly during the first year post‐OLT compared with pre‐OLT, but they worsened again during the 1–5‐year period post‐OLT. Physical functioning and life satisfaction scores improved significantly during the first year post‐OLT compared with pre‐OLT and the improvement persisted 1–5‐year during the period post‐ OLT. Patients with HCV recurrence compared with patients without HCV recurrence during the first year post‐OLT showed a significant worsening of most of the domains of QOL. In conclusion, OLT improved most of the domains of QOL by the end of the first post‐transplant year, though the improvements did not all persist in the long‐term. Recurrence of HCV infection plays a major role in the impairment of QOL after OLT.

Personality, psychophysical stress and myopia progression. A prospective study on 57 university students.

Personality profile, psychophysical stress and cycloplegic refraction were evaluated at the baseline (TO) and after 12 months (T1) in 57 university students comprising 39 myopes and 18 emmetropes/hyperopes (controls) whose age, sex distribution and academic results were comparable. At TO, a tendency toward a higher degree of anxiety, somatization and inadequacy was found in myopes in comparison with controls; however, only the anxiety state was different (Wilcoxon signed-rank testP<0.001). Personality profiles, psychophysical stress and blood levels of cortisol, ACTH, GH, prolactin were similar in myopes and controls. The myopes were classified at T1 as either well-corrected (if their lenses corresponded to refractometer values of ± 0.50 D and were worn full-time) or undercorrected (if their lenses were ≥ 0.75 D with respect to refractometric values and/or were worn part-time). When the spherical cycloplegic values at TO and T1 were compared, a myopic shift was revealed only in the undercorrected myopes (P< 0.001 in both eyes). These findings suggest that personality profile and psychophysical stress do not play a primary pathogenetic role in myopia. Undercorrection seems to accelerate the progression of myopia.

Failed suicide by Amanita phalloides (Mycetismus) and subsequent liver transplant: Case report

The case described is a serious parasuicide (failed suicide) by voluntary ingestion of a considerable amount of highly poisonous mushrooms (Amanita phalloides). The liver transplant performed straight afterwards enabled the patient to survive, but after a period of relative well-being in the immediate postoperative period, her pervasive suicidal ideation returned to the fore in all its dramatic ambivalence. The difficulties involved in managing the case and the decision to transplant a living organ in an individual who has just attempted suicide are discussed.

223 COST-EFFECTIVENESS OF A NEW MODEL OF SPECIALISTIC CAREGIVING FOR OUTPATIENTS WITH CIRRHOSIS AND ASCITES; A PROSPECTIVE STUDY

223 COST-EFFECTIVENESS OF A NEW MODEL OF SPECIALISTIC CAREGIVING FOR OUTPATIENTS WITH CIRRHOSIS AND ASCITES; A PROSPECTIVE STUDY F. Morando, G. Maresio, S.S. Piano, S. Fasolato, M. Cavallin, A. Romano, S. Rosi, E. Gola, A. Sticca, A.C. Frigo, M. Stanco, C. Destro, G. Rupolo, D. Mantoan, P. Angeli, A. Gatta. Department of Medicine, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical Direction, University and General Hospital of Padova, Direction of Health System of Veneto Region, Department of Medicine, Unit of Hepatic Emergencies and Liver Transplantation, University of Padova, Padova, Italy E-mail: filippo.morando@alice.it

Medical Complications after Liver Transplantation (OLT): Impact on Quality of Life (QOL)

OLT is indicated as a procedure for patients with end-stage liver disease to restore not only liver function, but also a good QOL. Few data assessing correlation between medical complications and QOL after OLT are available. The aim of this cross-sectional study was to evaluate the effect of OLT on QOL in adult liver transplant recipients.