Impact of psychosocial status on liver transplant process

Golfieri, Lucia; Gitto, Stefano; Vukotic, Ranka; Andreone, Pietro; Marra, Fabio; Morelli, Cristina; Cescon, Matteo; Grandi, Silvana

doi:10.1016/j.aohep.2019.06.011

Cited by 28 publications

(22 citation statements)

References 53 publications

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“…In recent years, organ demand exceeds supply by tens of thousands. LT is considered the only option for end-stage liver disease, whereas many patients still face death because of the shortage of liver donor sources [42]. The application of immunosuppressive agents has unexpectedly adverse effects on patients with liver allografts.…”

Section: Discussionmentioning

confidence: 99%

Gastrodin Ameliorates Acute Rejection via IRE1α/TRAF2/NF-κB in Rats Receiving Liver Allografts

Yuan

et al. 2019

BioMed Research International

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Background Liver transplantation (LT) is currently an effective treatment for end-stage liver disease, but the occurrence of acute rejection (AR) is still the main problem to be solved. The present study aimed to evaluate the effect of gastrodin (GAS) on LT. Methods Rat transplant models were established and divided into SHAM, LT, GAS-L (50 mg/kg GAS), and GAS-H (100 mg/kg GAS) groups. The liver function, inflammatory factors, liver histopathology, survival of rats, number of M2-type macrophages, liver cell apoptosis, and pathway proteins were assayed at 7 days and 14 days after the operations. Results With increasing GAS concentrations, liver function, expression of proinflammatory factors in the liver, and expression of M2-type molecules in macrophages were significantly improved, and the survival time of rats was significantly prolonged (P < 0.05). All rats treated with low or high doses of GAS were judged to have nondeterministic acute rejection. Flow cytometry showed that liver cell apoptosis was decreased significantly in the GAS-L and GAS-H groups after GAS administration compared with apoptosis and differentiation in the LT group (P < 0.05). Expression levels of Caspase-3, Bad, and Bax proteins were decreased, and the expression of the antiapoptotic protein Bcl-2 was increased in the GAS-L and GAS-H groups (P < 0.05). Mechanistically, the ERS-related IRE1α/TRAF2/NF-κB pathway was suppressed by GAS, and GAS acted mainly on intrahepatic macrophages to affect AR and reduce ROS production (P < 0.05). Conclusion GAS ameliorated AR by inhibiting the IRE1α/TRAF2/NF-κB pathway in LT.

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Section: Discussionmentioning

confidence: 99%

Gastrodin Ameliorates Acute Rejection via IRE1α/TRAF2/NF-κB in Rats Receiving Liver Allografts

Yuan

et al. 2019

BioMed Research International

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“…In general, a multidisciplinary transplant team should include an expert psychologist and psychiatrist for early diagnosis and effective treatment of pre-transplant mental illness [135]. Particularly in the specific setting of AUD, the multidisciplinary team should perform a quick and effective evaluation of social support, adequate training about the LT process and an early psychological/psychiatric diagnosis.…”

Section: Behavioral Interventionsmentioning

confidence: 99%

“…Particularly in the specific setting of AUD, the multidisciplinary team should perform a quick and effective evaluation of social support, adequate training about the LT process and an early psychological/psychiatric diagnosis. The multidisciplinary team should favor the development of mechanisms, such as active coping, that improve the overall clinical outcome [135].…”

Section: Behavioral Interventionsmentioning

confidence: 99%

“…No study has proposed a specific psychological approach for the LT setting. However, as we have recently reported [135], the following suggestions are suitable for the design of further studies: (1) any psychological approach beneficial for achieving an active coping strategy; (2) family therapy might be beneficial; (3) group or self-help group therapy seem to be beneficial for patients with a history of illicit drug use or AUD; indeed, also in the transplant context, these kinds of therapies might determine positive outcomes.…”

Section: Behavioral Interventionsmentioning

confidence: 99%

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Alcohol use disorder and liver transplant: new perspectives and critical issues

Gitto

Aspite

Golfieri

et al. 2020

Korean J Intern Med

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Alcoholic liver disease is a consolidated indication for liver transplantation, but many unsolved issues can be highlighted. Patients with alcohol use disorder develop peculiar comorbidities that can become contraindications for transplantation. Moreover, a number of social and psychological patterns should be evaluated to select candidates with a low risk of alcohol relapse and adequate post-transplant adherence. In this context, the 6-month rule is too rigid to be widely applied. A short period of abstinence (1 to 3 months) is useful to estimate recovery of liver function and, possibly to avoid transplant. Cardiovascular disorders and extra-hepatic malignancies represent the main clinical issues after transplant. Patients transplanted due to alcoholic disease are a major risk for other liver diseases. Severe corticosteroid-resistant alcoholic acute hepatitis is a debated indication for transplant. However, available data indicate that well-selected patients have excellent post-transplant outcomes. Behavioral therapy, continued psychological support and a multidisciplinary team are essential to achieve and maintain complete alcohol abstinence during the transplant process. Alcoholic liver disease is an excellent indication for a liver transplant but patients with alcohol use disorder deserve a personalized approach and dedicated resources.

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“…End-stage liver disease patients can develop encephalopathy with memory loss and diminished cognitive ability (Montagnese & Bajaj, 2019). Patients are told that, without a liver transplant, they may die making the wait for a donor even more intolerable (Larson, 2015).The waiting period for a liver transplant is difficult, fraught with uncertainty and associated with significant morbidity and mortality (Golfieri et al, 2019;Pérez-San-Gregorio et al, 2012). Patients reported the waiting period as the most stressful time of their lives (Teixeira et al, 2016).…”

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confidence: 99%

Illness Uncertainty in Patients Awaiting Liver Transplant

2020

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Illness uncertainty is prevalent in patients awaiting liver transplant. We described high levels of illness uncertainty in these patients and examined relationships between uncertainty and person factors and the antecedents of uncertainty. Mishel uncertainty in illness scale was used to measure illness uncertainty. We used modes and interquartile range (IQR) to describe illness uncertainty levels in 115 patients. Multiple logistic and linear regression models estimated the associations of uncertainty with hypothesized antecedents. High total illness uncertainty score was reported by 15.6% of the patients. After adjusting for all variables, illness uncertainty was associated with two antecedents of uncertainty, low social well-being (OR = 0.816; p = .025) and low self-efficacy (OR = 0.931; p = .013). Complexity was negatively associated with social well-being; ambiguity and inconsistency were negatively associated with self-efficacy. One in seven patients experienced high illness uncertainty. Social well-being and self-efficacy were negatively related to illness uncertainty.

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Impact of psychosocial status on liver transplant process

Cited by 28 publications

References 53 publications

Gastrodin Ameliorates Acute Rejection via IRE1α/TRAF2/NF-κB in Rats Receiving Liver Allografts

Gastrodin Ameliorates Acute Rejection via IRE1α/TRAF2/NF-κB in Rats Receiving Liver Allografts

Alcohol use disorder and liver transplant: new perspectives and critical issues

Illness Uncertainty in Patients Awaiting Liver Transplant

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