Neurocognitive status is associated with all-cause mortality among psychiatric,high-risk liver transplant candidates and recipients

Abstract

Objective

Judicious selection of potential liver transplant candidates and close monitoring of progress are essential to successful outcomes. Pretransplant psychosocial evaluations are the norm, but the relationship between psychosocial (and neurocognitive status) and longer term medical outcomes is understudied. This exploratory study sought to examine the relationship between objective measures of pretransplant psychosocial and neurocognitive status and service utilization, transplant status, and all-cause mortality.

Methods

This retrospective chart review examined outcomes among 108 psychiatric, high-risk liver transplant candidates up to four years following initial evaluation. Predictor variables of outcomes included demographic, medical, neurocognitive, psychological, and mental health treatment variables.

Results

Transplant status and neurocognitive functioning were independently associated with all-cause mortality. None of the other variables were associated with outcomes.

Conclusions

Better neurocognitive functioning in high-risk liver transplant candidates may allow for greater involvement in medical care and/or compliance with treatment recommendations. More aggressive assessment and management of neurocognitive dysfunction may improve outcomes. Objective measures identified significant psychopathology typical of liver transplant candidates but were not associated with outcomes; engagement in specialized mental health care may have attenuated this relationship. Further study is needed to better understand the relationship between psychosocial functioning and outcomes.

Keywords

Liver transplantation psychosocial factors memory executive function mortality outcomes research

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References

Organ Procurement and Transplantation Network, http://optn.transplant.hrsa.gov/ (accessed 27 January 2014).

Levenson

Olbrisch

. Psychosocial evaluation of organ transplant candidates: a comparative survey of process, criteria, and outcomes in heart, liver, and kidney transplantation. Psychosomatics 1993; 34: 314–323.

Chacko

Harper

Gotto

. Psychiatric interview and psychometric predictors of cardiac transplant survival. Am J Psych 1996; 12: 1607–1612.

Dieperink

Willenbring

. Neuropsychiatric symptoms associated with hepatitis C and interferon alpha: a review. Am J Psych 2000; 6: 867–876.

Singh

Gayowski

Wagener

. Vulnerability to psychological distress and depression in patients with end-stage liver disease due to hepatitis C virus. Clin Transplant 1997; 11: 406–411.

Rodrigue

Davis

Howard

. Psychological adjustment of liver transplant candidates. Clin Transplant 1993; 7: 228–229.

Singh

Gayowski

Wagener

. Quality of life, functional status, and depression in male liver transplant recipients with recurrent viral hepatitis C. Transplantation 1999; 67: 69–72.

Bianchi

Marchesini

Nicolino

. Psychological status and depression in patients with liver cirrhosis. Dig Liver Dis 2005; 37: 593–600.

Krahn

DiMartini

. Psychiatric and psychological aspects of liver transplantation. Liver Transplant 2005; 10: 1157–1168.

10.

Telles-Correia

Barboa

Mega

. Psychosocial predictors of adherence after liver transplant in a single transplant center in Portugal. Prog Trans 2012; 22: 91–94.

11.

Rodrigue

Nelson

Hanto

. Patient-reported immunosuppression nonadherence 6 to 24 months after liver transplant: association with pretransplant psychosocial factors and perceptions of health status change. Prog Trans 2013; 23: 319–328.

12.

Heinrich

Marcangelo

. Psychiatric issues in solid organ transplantation. Harv Rev Psychiatry 2009; 17: 398–406.

13.

Dew

Switzer

DiMartini

. Psychosocial assessments and outcomes in organ transplantation. Prog Transplant 2000; 10: 239–259.

14.

Butcher

Hostetler

. Abbreviating MMPI item administration: what can be learned from the MMPI for the MMPI-2? Psychol Assess 1990; 2: 12–21.

15.

Butcher

Graham

Ben-Porath

. MMPI-2: manual for administration, scoring, and interpretation, Rev. ed. Minneapolis: University of Minnesota press, 2001.

16.

Arbisi

Butcher

. Relationship between personality and health symptoms: use of MMPI-2 in medical assessments. Int J Clin Health Psychol 2004; 4: 571–595.

17.

Crews

Jefferson

Broshek

. Neuropsychological dysfunction in patients with end-stage pulmonary disease: lung transplant evaluation. Arch of Clin Neuropsychol 2001; 18: 353–362.

18.

Greene

. MMPI-2: an interpretative manual, 2nd ed. Needham Heights, MA: Allyn & Bacon, 2000.

19.

Wechsler

. WAIS-III manual, 3rd ed. New York, NY: Psychological Corporation, 1997.

20.

Reitan

. Manual for administration of neuropsychological test batteries for adults and children, Tucson, AZ: Reitan Neuropsychological Laboratories, 1979.

21.

Heaton

. Wisconsin card sorting manual, Odessa, FL: Psychological Assessment Resources, 1981.

22.

Wechsler

. The WMS-III, 3rd ed. San Antonio, TX: Psychological Corporation, 1997.

23.

Guadagnoli

Velicer

. Relation of sample size to the stability of component patterns. Psychol Bull 1988; 103: 265–275.

24.

Grimm

Yarnold

. Reading and understanding more multivariate statistics, Washington, DC: American Psychological Association, 2000.

25.

Nunnally

. Psychometric theory, 2nd ed. New York, NY: McGraw-Hill, 1978.

26.

Osborne

Costello

. Sample size and subject to item ratio in principal components analysis. Prac Assess Res Eval 2004; 9.

27.

Sood

Sarin

Mahaptra

. Comparative efficacy of psychometric tests in detection of subclinical hepatic encephalopathy in nonalcoholic cirrhotics: search for a rational approach. Am J Gastroenterol 1989; 84: 156–159.

28.

Jalan

Gooday

O’Carroll

. A prospective evaluation of changes in neuropsychological and liver function tests following transjugular intrahepatic portosystemic stent-shunt. J Hepatol 1995; 23: 697–705.

29.

Tarter

Van Thiel

Neuropsychological dysfunction due to liver disease. In: Butters

Beers

Tarter

Edwards

van Thiel

(eds). Medical neuropsychology: second edition (critical issues in neuropsychology), New York, NY: Springer, 2001, pp. 84–106.

30.

McCrea

Cordoba

Vessey

. Neuropsychological characterization and detection of subclinical hepatic encephalopathy. Arch Neurol 1996; 53: 758–763.

31.

Tarter

Hegedus

Van Thiel

. Nonalcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy. Gastroenterology 1984; 86: 1421–1427.

32.

Madan

Netson

Meidinger

. Verbal memory is impaired in patients with cirrhosis. J Behav Health 2013; 2: 79–86.

33.

Pantiga

Rodrigo

Cuesta

. Cognitive deficits in patients with hepatic cirrhosis and in liver transplant recipients. J Neuropsychiatry Clin Neurosci 2003; 15: 84–89.

34.

Gallan

Block

. Adherence to antiretroviral regimens in HIV-infected patients: results of a survey among physicians and patients. J Int Assoc Physicians AIDS Care 1998; 4: 32–35.

35.

Chesney

Ickovics

Chambers

. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG Adherence Instruments. AIDS Care 2000; 12: 255–266.

36.

Bornstein

Nasrallah

Para

. Neuropsychological performance in asymptomatic HIV infection. J Neuropsychiatry Clin Neurosci 1992; 4: 386–394.

37.

Reger

Welsh

Razani

. A meta-analysis of the neuropsychological sequelae of HIV infection. J Int Neuropsychol Soc 2002; 8: 410–424.

38.

Selnes

. Neurocognitive aspects of medication adherence in HIV infection. J Acquir Immune Defic Syndr 2002; 31: S132–S135.

39.

Wagner

. Predictors of antiretroviral adherence as measured by self-report, electronic monitoring, and medication diaries. AIDS Patient Care STDs 2002; 16: 599–608.

40.

Madan

White-Williams

Borckardt

. Assessing historical compliance with medical recommendations among transplant candidates: preliminary findings. Prog Trans 2010; 20: 47–52, 95.

41.

Pronk

Anderson

Crain

. Meeting recommendations for multiple healthy lifestyle factors. Prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. Am J Prev Med 2004; 27(2 Suppl): 25–33.

42.

Butterworth

. Hepatic encephalopathy in alcoholic cirrhosis. Handb Clin Neurol 2014; 125: 589–602.

43.

Rahimi

RS1

Rockey

. Hepatic encephalopathy: how to test and treat. Curr Opin Gastroenterol 2014; 30: 265–271.

44.

Amodio

Canesso

Montagnese

. Dietary management of hepatic encephalopathy revisited. Curr Opin Clin Nutr Metab Care 2014; 17: 448–452.

45.

Durning

Perri

Rodrigue

. MMPI profiles of liver and heart transplant candidates with and without significant histories of heavy alcohol use. J Clin Psych Med Setting 1998; 5: 35–47.

46.

Skotzko

Rudis

Kobashingawa

. Psychiatric disorders and outcome following cardiac transplantation. J Heart Lung Transplant 1999; 18: 952–956.

47.

Zipfel

Schneider

Wild

. Effect of depressive symptoms on survival after heart transplantation. Psychosom Med 2002; 64: 740–747.

48.

Madan

White-Williams

Borckardt

. Beyond rose colored glasses: the adaptive role of anxious and depressive symptoms among individuals with heart failure who were evaluated for transplantation. Clin Transplant 2012; 26: E223–E231.

49.

Singh

Gayowski

Wagener

. Depression in patients with cirrhosis. Impact on outcome. Dig Dis Sci 1997; 42: 1421–1427.

50.

Miller

Paulson

Eshelman

. Mental health affects quality of life and recovery after liver transplantation. Liver Trans 2013; 19: 1272–1278.

51.

Grenard

Munjas

Adams

. Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis. J Gen Intern Med 2011; 26: 1175–1182.