Psychosocial Status of Liver Transplant Candidates in Iran and Its Correlation with Health-Related Quality of Life and Depression and Anxiety

Abstract

Objectives. The study was aimed at providing a psychosocial profile for Iranian liver transplant candidates referred to an established liver transplantation program. Material and Methods. Patients assessed for liver transplant candidacy in Imam Khomeini Hospital (Tehran, Iran) between March 2013 and September 2014 were included. The following battery of tests were administered: Psychosocial Assessment of Candidates for Transplant (PACT), the Short-Form health survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). Results. Psychosocial assessment in 205 liver transplant candidates revealed significant impairments in several SF-36 domains; social functioning was the least and physical functioning was the most impaired domains. The prevalence of cases with probable anxiety and depressive disorders, according to HADS, was 13.8% and 5.6%, respectively. According to PACT, 24.3% of the assessed individuals were considered good or excellent candidates. In 11.2%, transplantation seemed poor candidate due to at least one major psychosocial or lifestyle risk factor. Poor candidate quality was associated with impaired health-related quality of life and higher scores on anxiety and depression scales (p < 0.05). Conclusions. Transplant programs could implement specific intervention programs based on normative databases to address the psychosocial issues in patients in order to improve patient care, quality of life, and transplant outcomes.

Figure 1

Association between liver transplant candidate quality and Health-related quality of life (a, b) and between liver transplant candidate quality and anxiety and depression (c). (a, b) Scores in SF-36 domains linearly increase when moving from poor to good/excellent candidate quality categories. Physical functioning (F = 7.287, p = 0.008), physical role functioning (F = 8.663, p = 0.004), bodily pain (F = 6.042, p = 0.015), general health (F = 11.478, p = 0.001), vitality (F = 17.616, p < 0.001), social functioning (F = 4.455, p = 0.036), emotional role functioning (F = 18.148, p < 0.001), and mental health (F = 19.341, p < 0.001). (c) HADS anxiety and depression scores linearly decrease when moving from poor to good/excellent candidate quality categories. Anxiety (F = 17.526, p < 0.001), depression (F = 11.673, p = 0.001). Abbreviations: SF-36, Short-Form health survey; HADS, Hospital Anxiety and Depression Scale.