Psychosocial evaluation for liver transplantation: A brief guide for gastroenterologists

García-Alanís, Mario; Toapanta‐Yanchapaxi, Liz; Vilatobá, Mario; Cruz-Martínez, Rodrigo; Contreras, Alan G.; López-Yáñez, S.; Flores-García, Nayelli C; Márquez-Guillén, Ernesto; García‐Juárez, Ignacio

doi:10.1016/j.rgmxen.2020.12.001

Cited by 3 publications

(1 citation statement)

References 83 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many recent studies have demonstrated similar outcomes regarding relapse rates and short-term survival for patients who remained abstinent for 6 + months and patients who remained abstinent for less than 6 months [8][9][10][11]. These studies strongly suggest that the 6-month rule should not be a determining factor for LT eligibility for ALD patients, but that a more comprehensive psychosocial assessment should be utilized instead [12,13]. On the contrary, research also showed that the lack of a 6-month abstinence period can be associated with higher risk of relapse and higher rates of alcohol consumption in ALD patients seeking LT [14,15].…”

Section: General Concepts Of Ald As Candidates For Ltmentioning

confidence: 95%

How does the 6-month abstinence period fare for patients seeking Liver transplantation? Lessons Learned from Game Theoretic Analysis

Andhavarapu

Saposnik

Swistak

2022

Preprint

View full text Add to dashboard Cite

Background Patients with alcoholic liver disease are often required to demonstrate a period of abstinence before being eligible for liver transplant. This is known as the 6-month rule. Early liver transplant has shown comparable outcomes in carefully selected patients, yet the 6-month rule is still used in transplant centers worldwide. We applied game theory to evaluate whether the 6-month rule is effective in distinguishing a relapsing patient from a non-relapsing patient during decisions for liver transplant for alcoholic liver diseases. Methods We used game theory to model the interactions between alcoholic liver disease patients and transplant physicians. We assumed that patients are either curable or refractory, but the physician does not know which. Patients can either abstain for 6 months or not, thereby signaling their type to the physician. We solved this model for the equilibria under different payoff assumptions. Results The equilibria for the models for both patient types resulted in the same equilibria, indicating that the 6-month rule is ineffective in separating the two types of patients. This finding held true for all probabilities of patient relapse and all payoff structures except the unlikely scenario where the cost of abstinence outweighs the benefits of transplant. Limitations Our model is based on assumptions, though these assumptions reflect real world preferences and scenarios. We also elected not to analyze other critical factors in the decision-making process for liver transplantation such as the patient’s clinical profile or the physician’s pre-existing biases. Conclusions Our game theoretic framework offers a mathematical explanation on why the 6-month abstinence criterion, although seemingly intuitive, is not an effective strategy for identifying LT candidates who would develop an alcohol relapse.

show abstract

Section: General Concepts Of Ald As Candidates For Ltmentioning

confidence: 95%

How does the 6-month abstinence period fare for patients seeking Liver transplantation? Lessons Learned from Game Theoretic Analysis

Andhavarapu

Saposnik

Swistak

2022

Preprint

View full text Add to dashboard Cite

show abstract

Optimizing strategies to reduce alcohol consumption and relapses, improving abstinence in liver transplant recipients

Legáz¹,

Muro²

2022

Hepatobiliary Surg Nutr

View full text Add to dashboard Cite

We have read with great attention and special interest the paper by Carrique and collaborators entitled: Results of Early Transplantation for Alcohol-Related Cirrhosis: Integrated Addiction Treatment with Low Rate of Relapse (1). In this prospective study, the authors initiated a pilot program to challenge the paradigm of the "6-month rule" of abstinence for patients with alcohol-related liver disease (ALD) requiring a transplant (2).This study is the first trial in North America to admit patients with acute and chronic decompensated liver disease, regardless of abstinence length, and give comprehensive addiction treatment prior to and after liver transplantation (LT) to lower the risk of relapse. This interesting study involved an in-depth examination of patients' alcohol use, social support, and psychiatric comorbidity, as well as the provision of pre-and post-transplantation addiction treatment. In this sense, the authors report how their relapse prevention therapy was provided directly to all patients deemed to meet the program's inclusion criteria and how biomarker testing for alcohol was used pre and post-transplantation.The final cohort informed in this study was 703 individuals fulfilling the program's criteria, 101 patients (14%) were listed for transplantation, and 44 (6.2%) received transplants. The results of this study show that there were no significant differences in survival rates between those receiving transplants through the pilot program compared with a control group with more than six months of abstinence. Three patients returned to alcohol use during an average post-transplantation followup period of 339 days. Although the follow-up period was relatively brief, no post-transplant deaths were attributable to reverting to alcohol intake.A recently published study on causes of death and survival in alcoholic cirrhosis patients undergoing LT (3) showed that at ten years, sepsis was the leading cause of death, accounting for 21.3 percent of all deaths, followed by graft failure (18.9%) and multiorgan failure (15.6%). Furthermore, the authors analyzed how pre-transplant clinical problems, such as viral infections and encephalopathy, influence the age at which the transplanted patient develops multiorgan failure. According to the authors, multiorgan failure is the primary cause of sudden death, with increased mortality over the first year following transplantation, followed by sepsis and graft failure.Carrique et al.(1) show in their data that younger age

show abstract

The Effect of Neuro-Linguistic Programming on Depression, Anxiety and Stress in Liver Transplant Patients

Doğan

Bağci

2022

Medical Records

View full text Add to dashboard Cite

Aim: This study was conducted using a prospective randomized single-blind clinical trial model to examine the effect of neurolinguistic programming (NLP) on depression, anxiety, and stress in liver transplant patients. Materials and Methods: This study was conducted with liver transplant patients at a university's Liver Transplant Institute between June 2021 and December 2021. The sample size of the study was determined as 84 (Experimental group: 42, control group: 42). Personal information form and Depression, Anxiety, and Stress Scale (DASS-21) were used to collect data. The data obtained from the research were evaluated with SPSS 25.Results: In the experimental group, the mean score of DASS-21 was found to be 38.95 ± 11.96 before the NLP application and 25.21 ± 5.43 after the NLP application. It was found statistically significant that the value obtained in the second measurement was lower than the value obtained in the first measurement (p<0.05). It was determined that NLP application significantly decreased all parameters of depression, anxiety, and stress (p<0.05). In the control group, the mean score of DASS-21 was determined as 51.05 ± 7.53 in the first measurement and 52.57 ± 7.92 in the second measurement. It was found statistically significant that the value obtained in the second measurement was higher than the value obtained in the first measurement (p<0.05). Conclusion:This study found that NLP reduced depression, anxiety, and stress in liver transplant patients. In line with this result, it can be suggested that nurse's benefit from NLP practice and receive training on NLP in managing the depression, anxiety, and stress experienced by liver transplant patients.

show abstract

Psychosocial evaluation for liver transplantation: A brief guide for gastroenterologists

Cited by 3 publications

References 83 publications

How does the 6-month abstinence period fare for patients seeking Liver transplantation? Lessons Learned from Game Theoretic Analysis

How does the 6-month abstinence period fare for patients seeking Liver transplantation? Lessons Learned from Game Theoretic Analysis

Optimizing strategies to reduce alcohol consumption and relapses, improving abstinence in liver transplant recipients

The Effect of Neuro-Linguistic Programming on Depression, Anxiety and Stress in Liver Transplant Patients

Contact Info

Product

Resources

About