The role of preoperative psychosocial counselling on the improvement of the recipient compliance and speed of recovery after liver transplantation – A systematic review of the literature and expert panel recommendations


Weiss E., Kabacam G., Gorvin L., Spiro M., Raptis D. A., KESKİN O., ...More

Clinical Transplantation, vol.36, no.10, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 36 Issue: 10
  • Publication Date: 2022
  • Doi Number: 10.1111/ctr.14632
  • Journal Name: Clinical Transplantation
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, EMBASE, MEDLINE
  • Keywords: abstinence, chronic pain, compliance, counselling, liver transplantation, pre - operative, psychological assessment, stress
  • Hacettepe University Affiliated: Yes

Abstract

This article is protected by copyright. All rights reserved.Background: Psychosocial disorders ranging from anxiety to severe psychiatric diseases and active alcohol/substance abuse are frequent in liver transplant candidates and potentially associated with worse post- transplant outcomes. Therefore, psychosocial evaluation is mandatory to optimize success after liver transplantation. However, how to carry out this evaluation, the type of intervention needed and its potential impact on patient outcome remain unclear. Objectives: 1. To investigate whether psychosocial assessment may help in predicting risks of poor outcome. 2 To investigate whether psychosocial interventions may mitigate these risks and improve posttransplant outcomes, in particular compliance and speed of recovery. Data sources: Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. Methods: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. The protocol was registered on PROSPERO CRD42021238361. Main outcomes assessed were mortality, alcohol relapse, rejection and medication compliance. Results: Fifteen studies were analysed including five observational comparative and ten observational non-comparative studies. Preoperative psychosocial evaluation of LT candidates was associated with higher concordance with the treatment plan (i.e., higher adherence to treatment and lower alcohol relapse) and lower rates of rejection. Psycho-social assessment tools were used in some studies to guide the evaluation, but their predictive ability remains debated, and they should not be used in isolation. Most of the interventions were studied in patients with alcohol related issues. In this context, support by specialized teams was associated with better posttransplant outcome, especially through a decrease in post-transplant alcohol relapse. Conclusions: Preoperative psychosocial assessment should be provided in order to detect patients at increased risk of poorer post-transplant outcome, in particular in terms of concordance to the treatment plan (Quality of Evidence; Low | Grade of Recommendation; Strong/For). The experts suggest that, when possible, provision of preoperative psychological assessment and concomitant interventions aimed at improving the concordance to treatment plan will positively impact the success of liver transplantation. (Quality of Evidence; Very Low | Grade of Recommendation; Strong/For]. This article is protected by copyright. All rights reserved.