Research led by DRS. Sarah R. Lieber and Amit G. Singal of Amit G. Southwestern surveyed patients who received liver transplants and found that approximately 25% of respondents suffered from clinically significant anxiety and depression. (Photo credit: Getty Images)
Dallas – April 26, 2023 – The resilience and coping ability of patients who have undergone liver transplants change over time and is often associated with sociodemographic factors such as income, race, and education. Findings may lead to coordinated interventions to optimize clinical and patient-centered outcomes among liver transplant recipients.
“When you look after a patient who has undergone this life-changing surgery, recovery actually evolves over time,” he said he is Sarah R. Lieber, MD, MSCR, assistant professor of internal medicine and a member of the Department of Gastrointestinal and Liver Diseases. “Current metrics focusing primarily on clinical outcomes such as survival do not fully understand or capture it. The purpose of this project was to obtain a more detailed view of the new concepts reported by patients at various stages of survival.”
Dr. Lieber leads research published in Liver Transplants and is a UTSW mentor, Amit G. Singal, M.D., Professor of Internal Medicine, MS, and a member of the Department of Gastrointestinal and Liver Diseases, and Medical Director of the Harold C. Simmons Comprehensive Cancer Center, Liver Tumor Program, and Dean of the Faculty of Liver Destiny.
Transplants provide treatment opportunities for thousands of U.S. patients each year with diseases and trauma that affect the liver. Over 70% of people who undergo this surgery survive at least five years, but Dr. Lieber said their recovery could be filled with physical, emotional and psychological challenges. Liver transplant survivors need to adapt to new lives, including strict medication, frequent clinical monitoring, and unexpected complications.
To better understand which factors affect survivors, Dr. Lieber and her colleagues emailed the survey to hundreds of patients who received liver transplants between January 1990 and November 2019, and were followed at the University of North Carolina Liver Transplant Center.
MSCR's Assistant Professor of Internal Medicine, MD Sarah R. Lieber is a member of the Gastrointestinal and Liver Diseases Division.
The study collected sociodemographic information such as age, gender, race, ethnicity, education level, and income. Pre-transplant characteristics such as reasons for transplantation, waitlist time, and mental history. Post-transplant characteristics including length of hospital stay, employment status, and whether the patient has a caregiver. It also included survey questions that tested other chronic diseases and assessing the patient's ability to actively cope with and post-traumatic growth (the ability to adapt and grow after a traumatic event), reorganization, and levels of anxiety and depression symptoms.
The researchers underwent 191 completed surveys from patients with wide survival ranging from less than 1 year to more than 10 years after implantation. The majority of respondents were male (approximately 64%) and white (approximately 84%), ranging from 28 to 83 years of age.
The study showed that 85% of early survival (within 1 year) had high post-traumatic growth, while only about 15% (5 to 10 years) of late survivors had the same characteristics. High resilience was reported only in about 33% of survivors and was associated with relatively high incomes.
Lower resilience was seen among patients with longer hospital stays and subsequent survival stages. Patients who reported poor ability to cope with post-transplant were more likely than 65 years of age, nonspheres, less educated, or required transplantation for nonviral liver disease. Dr. Lieber said about 25% of liver transplant survivors suffer from clinically significant anxiety and depression, which occurs more frequently between early survivors and women with pre-transplant mental disorders.
These characteristics could help predict clinical outcomes, she said. For example, anxiety and depression, coping ability, and resilience have been shown to predict that patients are effective and effective care of other chronic disease health systems and health systems, and are important predictors of quality of life and function. Dr. Lieber and her colleagues plan to continue studying other aspects of liver transplant patients' survival, including how these variables change over time.
“Quality care for patients after a liver transplant includes treatment for the whole person,” Dr. Lieber said. “Survivorship Research informs us how to develop and implement interventions to support the transplant community.”
Alvaro Noriega Ramirez, clinical research assistant in the Department of Gastrointestinal and Liver Diseases, also contributed to this study.
This study was funded by the UT Southwestern Fund to maintain Clinical Scientists (UT Focus), American Heart Association (923721), Doris Duke Charitable Foundation COVID-19 Fund for Maintaining Clinical Scientists, and the American Junior Facility Development Award.
Dr. Singal is a scholar in the Dedoman family of clinical care and holds Willis C. Madrid, a well-known chair for liver disease.
About UT Southwestern Medical Center
UT Southwestern, one of the nation's leading academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution's faculty has been awarded six Nobel Prizes, including 24 members of the National Academy of Sciences, 18 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute investigators. Over 2,900 full-time faculty members are responsible for groundbreaking medical advancements and are committed to rapidly translating science-driven research into new clinical treatments. The UT Southwest physicians provide care in more than 80 specialties to over 100,000 inpatients and over 360,000 emergency room patients and oversee nearly 4 million outpatient visits per year.
