Background and aims For patients with end-stage liver disease commonly used indices of nutritional status (i.e. body weight and BMI) are often inflated due to fluid overload (i.e. ascites, peripheral edema) resulting in an underdiagnosis of malnutrition. As muscle is the largest protein reservoir in the body, an estimate of muscle mass may be a more reliable and valid estimate of nutritional status. Methods Therefore, we used pre-transplant computerized tomography data of 338 liver transplant (LTX) candidates to identify muscle and fat mass based on a specific abdominal transverse section commonly used in body composition analyses and investigated the contribution of this measure to specific post-LTX outcomes. Results We found the majority, 68%, of our patients could be defined as cachetic. For men muscle mass predicted many important post-transplant outcomes including intensive care unit (ICU) and total length of stay and days of intubation. Muscle mass was a significant predictor of survival and also predicted disposition to home vs another facility. For women muscle mass predicted lengths of ICU and total stay and days of intubation but the effect was modest. Muscle mass did not predict survival or disposition for women. Conclusions As pre-transplant muscle mass was associated with many important post-operative outcomes we discuss these findings in the context of possible pre-transplant interventions to either improve or sustain muscle mass before surgery.

Objective Anxiety disorders are prominent in chronic lung disease; lung transplant recipients may therefore also be at high risk for these disorders. We sought to provide the first prospective data on rates and risk factors for anxiety disorders as well as depressive disorders during the first two years after transplantation. Method 178 lung recipients, and a comparison group (126 heart recipients), received psychosocial and Structured Clinical Interview for DSM-IV assessments at 2-, 7-, 12-, 18-, and 24-months posttransplant. Survival analysis determined onset rates and risk factors. Results The panic disorder rate was higher (p<.05) in lung than heart recipients (18% v. 8%). Lung and heart recipients did not differ on rates of transplant-related post-traumatic stress disorder (15% v. 14%), generalized anxiety disorder (4% v. 3%), or major depression (30% v. 26%). Risk factors for disorders included pretransplant psychiatric history, female gender, longer wait for transplant, and early posttransplant health problems and psychosocial characteristics (e.g., poorer caregiver support, use of avoidant coping). Conclusions Heightened vigilance for panic disorder in lung recipients and major depression in all cardiothoracic recipients is warranted. Strategies to prevent psychiatric disorder should target recipients based not only on pretransplant characteristics but early posttransplant characteristics as well.

Body Mass Index is a commonly used but likely inexact measure of body composition for patients with end-stage liver disease. For this reason, we examined whether body composition measurements from direct visualization on computerized tomography (CT) scans provide new insights both into the degree of malnutrition and also discordant combinations such as obesity with muscle mass loss. This technology is widely used in other medically ill populations but not yet in liver transplantation. Methods We examined actual body composition using abdominal CT scan data and software designed to measure fat and muscle compartments. Results In 234 liver transplant candidates we found BMI was highly and significantly correlated to subcutaneous and visceral fat. However we additionally found that even among obese patients, cachexia, as defined by muscle mass, was common with 56% of those with BMIs over 30 being cachexic. We also found that patients with non-alcoholic steatohepatitis, compared to other types of liver diseases, were significantly more likely to have larger amounts of visceral fat while also having less muscle. In an exploratory analysis muscle mass corrected for height was a significant predictor of post-transplant survival. Conclusions Body composition by CT scan data provides a specific method to identify obesity and muscle wasting for end-stage liver disease patients. Whether these data can aid in the prognostication of outcomes and survival requires further investigation.

There are no evidence-based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single-site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e., lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education), or (c) standard care only before donation. Ambivalence was reassessed post-intervention (before donation). Primary trial outcomes—psychosocial variables in somatic, psychological, and family interpersonal relationship domains—were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p=.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p=.038), lower rates of fatigue (p=.021) and pain (p=.016), shorter recovery times (p=.041), and fewer unexpected medical problems (p=.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p=.046) and fewer unexpected family-related problems (p=.045). They did not differ on depression, feelings about donation, or family relationship quality. The findings suggest the intervention merits testing in a larger, multisite trial.

Background In contrast to standard donor retention strategies (e.g., mailings, phone calls, text messages), we developed a brief telephone interview, based on motivational interviewing principles, which encourages blood donors to reflect upon their unique motivators and barriers for giving. The present study examined the effect of this motivational interview, combined with action and coping plan components, on blood donor motivations. Study Design and Methods The design was to randomly assign blood donors to receive either a telephone-delivered motivational interview with action and coping plan components or a control call approximately six weeks after their most recent donation. Participants completed a series of surveys related to donation motivation approximately 3 weeks before telephone contact (pre-call baseline) and then repeated these surveys approximately one week after telephone contact (post-call). Results The sample was 63% female, included a majority (52.6%) first-time blood donors, and had a mean age of 30.0 years (SD = 11.7). A series of ANOVAs revealed that, relative to controls (n=244), donors in the motivational interview group (n=254) had significantly larger increases in motivational autonomy (p=0.001), affective attitude (p=0.004), self-efficacy (p=0.03), anticipated regret (p=0.001), and intention (p=<0.001), as well as larger decreases in donation anxiety (p=0.01), from pre-call baseline to post-call assessment. Conclusion This study supports motivational interviewing with action and coping planning as a novel strategy to promote key contributors to donor motivation.