What’s on your mind?:emotions and perceptions of liver transplant candidates and recipients

Undergoing a liver transplant is a stressful and major life event. A significant part of the Dutch liver transplant patients experience, therefore, psychological problems such as symptoms of anxiety, depression, or posttraumatic stress (PTS), both before and after the transplant.A prospective study among 260 patients of all Dutch liver transplant centers, shows that of the waiting-list patients 49% experience symptoms of anxiety, 34% depressive symptoms, and 32% symptoms of PTS. Patients who once show symptoms of anxiety or depression remain anxious or depressed throughout the waiting-list period. Although the transplant has a beneficial effect on the psychological functioning of liver transplant recipients, a significant part show persistent symptoms (23% anxiety, 29% depression, 15% PTS) in the first two years after the transplant. These patients also report poorer results regarding medication adherence and quality of life.Besides this, a cross-sectional study among 281 patients who underwent a liver transplant at the University Medical Center Groningen between 1979 and 2009, shows that psychological problems are also present in the long-term after transplantation. Over 35% of the patients who had been transplanted longer than 10 years ago reported psychological problems, in particular anxiety (33%) and depression (23%).Important risk factors associated with psychological problems are individual factors, such as sense of control and coping style, and transplant-related factors, such as severity of liver disease symptoms and side-effects of the immunosuppressive medication.Our results emphasize the importance of psychosocial screening and support in the care of liver transplant patients throughout the transplant process