Mental health status after living donor hepatectomy

Abstract

Donor safety and preservation of donor health after living liver donation are of paramount importance. In addition, the preoperative mental state of a donor is an important factor in determining the psychological impact of donor hepatectomy. Thus, we aimed to explore the mental health status of living liver donors after hepatectomy. We enrolled 60 donors who were scheduled to undergo living donor hepatectomy during the period January 2014 to March 2015 at a single medical center. Mental health status was measured before and 3 months after surgery using 3 self-report questionnaires, namely the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depressive symptoms, the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire to measure quality of life, and the Chinese Health Questionnaire (CHQ) to screen for minor psychiatric disorders. A comparison of the pre- and postdonation CES-D scores revealed a significant reduction in depressive symptoms after surgery (P = .031). There were significant improvements in the physical health domain (P = .031), the psychological health domain (P = .005), the social relationships domain (P = .005), and the environmental health domain (P = .010) of the WHOQOL-BREF. There were no significant changes in CHQ scores after donor hepatectomy (P = .136). All donors reported that they would donate again if required. Approximately one-third (33.3%) of donors experienced more pain than they had anticipated in the immediate postoperative period, and 20.0% of donors had complications after donor hepatectomy. Donor mental health status tended to improve as donors regained physical function during the 1st 3 months of recovery. Long-term monitoring of living donors’ mental health is needed to minimize the adverse psychological outcomes of living liver donation.

Clinical Features and Long-Term Outcomes of Living Donors of Liver Transplantation Who Developed Psychiatric Disorders

“…In LDLT donors, age and sex, relationship with recipient, ambivalence and motivation to be LDLT donor, feeling for donation, and hospitalization have all also been reported to be associated with psychiatric complications [8,25]. Our observations were consistent with previous reports that suggested that the development of postoperative psychiatric complications was associated with postoperative physical complications [5,6,26,27]. As such, it seems to be important to minimize physiological complications to prevent the development of psychiatric complications in LDLT donors.…”

“…In fact, approximately 1-10% of LDLT donors have been reported to develop psychiatric complications after donor surgery [5][6][7][8][9]. Interestingly, in many existing studies, it is unclear whether psychiatric complications were diagnosed and treated by a psychiatrist [5,6,8]. Moreover, little is discussed about the long-term outcomes of LDLT donors who develop psychiatric complications.…”

Complications and outcomes of 890 living liver donor hepatectomies at a single center: risks of saving loved one’s life

“…Though donors were informed about postoperative pain, onethird of them reported that post-procedure pain was greater than anticipated in the immediate postoperative period (37). Our clinical experience also matches up with this.…”

“…Although LDLT has helped to resolve the problems of many patients, donors themselves gain no medical benefits, but incur the risks of surgical complications, sometimes with negative psychosocial consequences. Reports have shown that 40% of the living liver donors report psychological distress after surgery (12,37,(43)(44)(45). Our experience shows that donor complications and negative recipient outcomes are major causes of psychological distress.…”

“…Eight of our donors reported pain as their main problem, without any other complications during the first days after the procedure. Studies have shown that most donors return to their job after a mean duration of 3 to 4 months, and most donors report that they would donate again if necessary (37)(38)(39). We focused on the psychosocial effects of the donation with the limited number of donors in our previous reports (40)(41)(42), and a clinical study is currently under way at our center which focuses on these questions.…”