Mingo Beckmann

Quality of Life and Psychiatric Complications After Adult Living Donor Liver Transplantation

We investigated the psychosocial effects of a right hepatectomy on donors for adult living donor liver transplantation (ALDLT). Questionnaires were sent to 66 actual donors, who had undergone ALDLT between August 1998 and September 2003, as well as to 139 potential donors, who had been examined as possible candidates for ALDLT; the latter had been excluded and had not undergone surgery. All actual donors reported full recovery within an average period of 14.41 (standard deviation = 8.86) weeks; all had returned to their preoperative employment. In preparation for ALDLT, they had received significantly more support from their families in the decision‐making process than the potential donors had (t = 2.02; degree of freedom = 79; P = 0.047); they also felt better informed about donation than the potential donors (t = 2.04; df = 64; P = 0.045). Psychiatric problems occurred in 6 (14%) female donors in the perioperative period, mostly in connection with unrealistic outcome expectations. Donors with severe postoperative complications (n = 3) demonstrated higher scores of psychiatric symptoms (chi‐square = 6.39; df = 2; P = 0.041). When we compared potential and actual donors, a significant difference in emotional quality of life was not demonstrated (t = 0.41; df = 76; P = 0.684), and it corresponded to that of the normative sample. For donors, perceived emotional quality of life did not depend on the course of recovery of the recipients. Six to 9 months after donation, potential donors reported a significantly higher physical quality of life than actual donors (t = 2.20; df = 56; P = 0.032). In conclusion, female donors, donors with their own major complications, or donors with unrealistic outcome expectations should be provided with adequate psychosocial care. With regard to the psychosocial outcome, ALDLT is a safe intervention for the donor. Liver Transpl 12:1782–1790, 2006.

Mental and physical quality of life in actual living liver donors versus potential living liver donors: A prospective, controlled, multicenter study

In a quasi‐experimental design, we investigated the quality of life (QOL) in actual liver donors (n = 43) and potential liver donors (n = 33) before and 3 months after liver transplantation. This is the first study in this field combining a prospective design with an adequate control group. Potential donors served as a control group because they also had a relative in need of a liver transplant and were as emotionally involved with the recipient as actual donors, but they were not subjected to the donor operation. Groups did not differ in age, gender, marital status, donor‐recipient relationship, urgency of transplantation, or recipient group (adult versus child). Actual donors showed decreased physical QOL, whereas potential donors were not affected. However, for both groups, a decrease in anxiety was found. Furthermore, actual donors showed a better mental QOL postoperatively than potential donors. The recipients of these 2 groups did not differ with respect to postoperative complications. Furthermore, the groups did not report a different caregiver burden, but actual donors showed higher self‐esteem. Because of the surgery, the worsening of physical symptoms in actual donors was expected. It is remarkable, however, that although actual donors still showed a limited physical QOL 3 months after the operation, in both groups, a similar reduction in anxiety could be observed, and actual donors even demonstrated a better mental QOL postoperatively than potential donors. The latter might be due to a psychological benefit that actual donors derived from the fact that they were able to help the recipients. Liver Transpl 15:1676–1687, 2009.

Selection of Donors for Adult Living-Donor Liver Donation : Results of the Assessment of the First 205 Donor Candidates

Psychosomatic assessment for living liver donors for adults has as yet not been described in detail. Between August 1998 and September 2003, 205 donor candidates were admitted for psychosomatic evaluation; 13.2% of whom (N=27) were excluded. Mental disturbances, especially when accompanied with social stress, were frequent reasons for exclusion. Selected donors had higher social status with regard to education and employment rate than other donor candidates. Candidates with better psychosocial resources are selected in the psychosomatic evaluation, and this contributes to the good psychosocial outcome of living donors.

Depression and protective factors of mental health in people with hepatitis C: A questionnaire survey

BACKGROUND Most studies investigating the effects of chronic hepatitis C (HCV) infection on the central nervous system have focused on cognitive impairment or on the health-related quality of life, but only few on depression. OBJECTIVES This study investigated depression in HCV-infected people. Sense of coherence and social support were surveyed as protective factors of mental health. METHODS In a cross-sectional study-design, 81 HCV-infected people with mild liver disease, who were not receiving antiviral therapy, were surveyed by validated measures. Anxiety (HADS), depression (BDI), psychopathological symptoms (SCL-90-R), social support (F-SozU) and resilience (SOC) were assessed. RESULTS Higher levels of depression than normal controls (p=.001) and a wide range of psychological symptoms were associated with HCV infection. Women, single participants, and persons with a shorter interval after first diagnosis exhibited significantly higher scores of depression. Gender and sense of coherence predicted depression scores in HCV people (R(2)=.42, p<.001). CONCLUSIONS The expression of depression in HCV-infected people is modulated not only by biological but also by psychological factors of mental health. Sense of coherence as a protective factor has a significant impact on the degree of depression. Furthermore, the high prevalence of depression and anxiety among persons not receiving antiviral therapy justifies psychosocial screening and support for HCV people independent of antiviral therapy.

Sense of coherence and social support predict living liver donors’ emotional stress prior to living-donor liver transplantation

Abstract:  The protection of the donors from physical or emotional harm has been a fundamental principle in living‐donor liver donation from the beginning. Psychosomatic donor evaluation aims at the selection of eligible donors and the screening and exclusion of psychiatrically vulnerable donors. As clinical interviews may include subjective biases, efforts should be made to establish objective criteria for donor assessment. In recent research, protective factors have been reported to be a significant force behind healthy adjustment to life stresses and can be investigated as possible predictors of donors’ eligibility. Being the central construct of Antonovsky’s theory of salutogenesis, the sense of coherence is one of the most surveyed protective factors and a good predictor of individuals’ stability when experiencing stress. Furthermore, family support has been shown to be a valuable protective resource in coping with stress. This study surveyed whether sense of coherence and social support predict donors’ emotional strain prior to transplantation. Seventy‐one donor candidates were included in the study during the donor evaluation prior to living‐donor liver transplantation. Sense of coherence proved to be a significant predictor for all criterion variables, namely anxiety, depression and mental quality of life. In addition to this, donor candidates who were classified as eligible for donation in the psychosomatic interview had significantly higher values on sense of coherence total scores compared with rejected donors. In a multiple regression analysis, sense of coherence and social support together yielded a prediction of depression with an explained variance of 22% (R2 = 0.22). Sense of coherence and social support can be implemented as self‐rating instruments in the psychosomatic selection of donors and would help to further objectify donors’ eligibility.

Anxiety, posttraumatic stress, and fear of cancer progression in patients with melanoma in cancer aftercare.

Background: Several studies have described mental distress and anxiety in patients with melanoma. The findings of these studies varied from patients with a quality of life similar to the general population and those with increased mental distress. In the present study, we investigated anxiety, posttraumatic stress, and fear of cancer progression to gain a detailed picture of the burdens of these patients. Patients and Methods: 70 patients with malignant melanoma who attended cancer aftercare were surveyed using the psychometric instruments Hospital Anxiety and Depression Scale (HADS), Posttraumatic Symptom Scale (PTSS-10), and Fear of Progression Questionnaire (FoP-Q). The questionnaires were evaluated and an analysis of the single items carried out. Results: The scores for the three anxiety parameters were low, but 7% of the patients presented an increased HADS score, and 17% an increased PTSS-10 value. An analysis of the items showed that patients feared physical disabilities more than mental distress or lack of social support. Conclusion: Most of the patients perceived themselves as stable, and relied on the assistance of their families. However, a small group of patients suffered from clinically relevant anxiety; these patients should be given the support indicated for their specific distress.

Influence of kinship on donors' mental burden in living donor liver transplantation

In the context of living donor liver transplantation (LDLT), German transplantation law stipulates that donor candidates should primarily be relatives of the recipients or persons with distinct and close relationships. In this study, we investigated the influence of the relationship between the donor and the recipient on the donors emotional strain before transplantation. Donors were categorized according to the following subgroups: (1) parents donating for their children, (2) children donating for their parents, (3) siblings, (4) spouses, (5) other relatives, and (6) nonrelatives. The sample consisted of 168 donor candidates. Anxiety (F = 2.8, P = 0.02), depression (F = 2.6, P = 0.03), and emotional quality of life (F = 3.1, P = 0.01) differed significantly according to the relationship between the donor and the recipient. In comparison with healthy controls, parents donating for their children were significantly less stressed before LDLT and demonstrated fewer anxiety (P < 0.01) and depression symptoms (P < 0.05). Adult children donating for their parents demonstrated the highest mental burden and the lowest emotional quality of life. However, this was not due to the responsibility of these children for their own families because differences between donors with children and donors without children could not be ascertained. This group should be given special attention before LDLT and during follow‐up visits, and psychological help should be provided when it is necessary. Liver Transpl, 2012.

Psychosomatic aspects of living donor liver transplantation

ZusammenfassungDie Methode der Leberlebendspende bietet die Möglichkeit, der Organknappheit und der damit verbundenen Wartelistenmortalität entgegen zu wirken. Das zentrale ethische Problem der Leberlebendspende liegt in der Gefährdung eines gesunden Spenders mit dem Ziel der Verbesserung der Lebensqualität des Empfängers. Um die psychische Gesundheit des Spenders nicht zu gefährden, sollte eine psychosomatische Evaluation der Spender stattfinden, die neben der Bewältigungsfähigkeiten und der Stabilität des Spenders auch dessen Freiwilligkeit feststellt. Hierfür ist eine ausführliche Aufklärung des Spenders über das Verfahren notwendig. Realistische Erwartungen an die Leberlebendspende, familiäre Beziehungen, die nicht extreme Konflikte beinhalten, eine ausreichende Autonomie in der Spender-Empfänger-Beziehung sowie eine soziale und familiäre Unterstützung werden als Prädiktoren für ein günstiges psychosoziales Outcome für den Spender angesehen. Die Lebensqualität vor und nach der Spende ist ähnlich oder besser als die der Allgemeinbevölkerung; bei einer Gruppe von etwa 13% der Spender können psychische Komplikationen auftreten. Weibliche Spender, Spender mit eigenen chirurgischen Komplikationen oder unrealistischen Ergebniserwartungen sollten unbedingt eine psychotherapeutische Unterstützung erhalten, bevor diese zur Spende zugelassen werden. Die dringliche Spendeindikation beim akuten Leberversagen und die Spende der erwachsenen Kinder für ihre Eltern stellen besondere Belastungsfaktoren dar. Diese Konstellationen sollten, wenn möglich, zum Schutz des potenziellen Spenders vermieden werden.AbstractLiving donor liver transplantation (LDLT) offers the option to reduce organ scarcity and thereby waiting list mortality. The crucial ethical problem of LDLT is the fact that the well being of a donor is being jeopardized for the improvement of quality of life of the recipient. To preserve mental health of the donors, psychosomatic evaluation should be conducted including examination of the coping capacity, the mental stability of the donor and the voluntary nature of the donation. Thus a comprehensive disclosure of information to donors is necessary. Realistic outcome expectations, family relationships without extreme conflicts, sufficient autonomy of the donor-recipient relationship and social and familiar support are predictors facilitating a favorable psychosocial outcome for the donor. Before and after LDLT the health-related quality of life of the donors is similar or increased in comparison to the general population. Psychiatric complications following LDLT can occur in 13% of the donors. Female donors, donors who have surgical complications themselves and donors with unrealistic outcome expectations should be given psychotherapeutic support before they are admitted to living liver donation. Urgent indications in the case of acute liver failure and the donation by adult children for their parents are particular stress factors. For the safety of the donor, these combinations should be avoided whenever possible.Living donor liver transplantation (LDLT) offers the option to reduce organ scarcity and thereby waiting list mortality. The crucial ethical problem of LDLT is the fact that the well being of a donor is being jeopardized for the improvement of quality of life of the recipient. To preserve mental health of the donors, psychosomatic evaluation should be conducted including examination of the coping capacity, the mental stability of the donor and the voluntary nature of the donation. Thus a comprehensive disclosure of information to donors is necessary. Realistic outcome expectations, family relationships without extreme conflicts, sufficient autonomy of the donor-recipient relationship and social and familiar support are predictors facilitating a favorable psychosocial outcome for the donor. Before and after LDLT the health-related quality of life of the donors is similar or increased in comparison to the general population. Psychiatric complications following LDLT can occur in 13% of the donors. Female donors, donors who have surgical complications themselves and donors with unrealistic outcome expectations should be given psychotherapeutic support before they are admitted to living liver donation. Urgent indications in the case of acute liver failure and the donation by adult children for their parents are particular stress factors. For the safety of the donor, these combinations should be avoided whenever possible.

Psychosomatic evaluation of patients awaiting lung transplantation.

Levels of psychosocial functioning were assessed according to Transplantation Evaluation Rating Scale (TERS) in 113 patients prior to lung transplantation. The prevalence of mental disorders was 20%; in addition impaired mental status was observed in 12 (11%) patients. The most frequent diagnoses were dependence on tobacco (9%), adjustment disorders (4%), and dependence on alcohol (2%). In the clinical interview, 87 patients (77%) were assessed as eligible, 20 (18%) as risky, and 6 (5%) as high-risk candidates. The TERS total scores between the eligibility groups differed significantly (F = 19.5; df = 112; P < .001). There were no significant effects of gender and age. Significant inverse correlations were estimated between the TERS score and educational status (r = -.291; P = .002). TERS allows a standardized evaluation of lung transplant candidates with good discrimination into eligibility groups. General psychosocial adaptation is mainly based on the educational level, a factor that should be examined in psychosomatic assessments.

Psychosomatische Aspekte der Leberlebendspende

ZusammenfassungDie Methode der Leberlebendspende bietet die Möglichkeit, der Organknappheit und der damit verbundenen Wartelistenmortalität entgegen zu wirken. Das zentrale ethische Problem der Leberlebendspende liegt in der Gefährdung eines gesunden Spenders mit dem Ziel der Verbesserung der Lebensqualität des Empfängers. Um die psychische Gesundheit des Spenders nicht zu gefährden, sollte eine psychosomatische Evaluation der Spender stattfinden, die neben der Bewältigungsfähigkeiten und der Stabilität des Spenders auch dessen Freiwilligkeit feststellt. Hierfür ist eine ausführliche Aufklärung des Spenders über das Verfahren notwendig. Realistische Erwartungen an die Leberlebendspende, familiäre Beziehungen, die nicht extreme Konflikte beinhalten, eine ausreichende Autonomie in der Spender-Empfänger-Beziehung sowie eine soziale und familiäre Unterstützung werden als Prädiktoren für ein günstiges psychosoziales Outcome für den Spender angesehen. Die Lebensqualität vor und nach der Spende ist ähnlich oder besser als die der Allgemeinbevölkerung; bei einer Gruppe von etwa 13% der Spender können psychische Komplikationen auftreten. Weibliche Spender, Spender mit eigenen chirurgischen Komplikationen oder unrealistischen Ergebniserwartungen sollten unbedingt eine psychotherapeutische Unterstützung erhalten, bevor diese zur Spende zugelassen werden. Die dringliche Spendeindikation beim akuten Leberversagen und die Spende der erwachsenen Kinder für ihre Eltern stellen besondere Belastungsfaktoren dar. Diese Konstellationen sollten, wenn möglich, zum Schutz des potenziellen Spenders vermieden werden.AbstractLiving donor liver transplantation (LDLT) offers the option to reduce organ scarcity and thereby waiting list mortality. The crucial ethical problem of LDLT is the fact that the well being of a donor is being jeopardized for the improvement of quality of life of the recipient. To preserve mental health of the donors, psychosomatic evaluation should be conducted including examination of the coping capacity, the mental stability of the donor and the voluntary nature of the donation. Thus a comprehensive disclosure of information to donors is necessary. Realistic outcome expectations, family relationships without extreme conflicts, sufficient autonomy of the donor-recipient relationship and social and familiar support are predictors facilitating a favorable psychosocial outcome for the donor. Before and after LDLT the health-related quality of life of the donors is similar or increased in comparison to the general population. Psychiatric complications following LDLT can occur in 13% of the donors. Female donors, donors who have surgical complications themselves and donors with unrealistic outcome expectations should be given psychotherapeutic support before they are admitted to living liver donation. Urgent indications in the case of acute liver failure and the donation by adult children for their parents are particular stress factors. For the safety of the donor, these combinations should be avoided whenever possible.Living donor liver transplantation (LDLT) offers the option to reduce organ scarcity and thereby waiting list mortality. The crucial ethical problem of LDLT is the fact that the well being of a donor is being jeopardized for the improvement of quality of life of the recipient. To preserve mental health of the donors, psychosomatic evaluation should be conducted including examination of the coping capacity, the mental stability of the donor and the voluntary nature of the donation. Thus a comprehensive disclosure of information to donors is necessary. Realistic outcome expectations, family relationships without extreme conflicts, sufficient autonomy of the donor-recipient relationship and social and familiar support are predictors facilitating a favorable psychosocial outcome for the donor. Before and after LDLT the health-related quality of life of the donors is similar or increased in comparison to the general population. Psychiatric complications following LDLT can occur in 13% of the donors. Female donors, donors who have surgical complications themselves and donors with unrealistic outcome expectations should be given psychotherapeutic support before they are admitted to living liver donation. Urgent indications in the case of acute liver failure and the donation by adult children for their parents are particular stress factors. For the safety of the donor, these combinations should be avoided whenever possible.