Journal Article Annotations
2016, 4th Quarter
Annotations by Paula Zimbrean, MD, FAPM
Also of interest:
The finding: This article presents data from A2ALL-2, a prospective multi-center study of liver organ donors. Subjects (N=271) underwent structured psychosocial evaluations pre- and post-donation, with a total follow-up of 2 years. A significant number of patients (44%) reported significant financial burden following the donation; however, the majority (>50%) reported improved relationships with the recipient.
Strength and weaknesses: This is the most rigorous assessment and follow-up of liver donors reported so far. It is a large, multi-center, prospective study. The study did not comment on the psychosocial criteria for donor selection.
Relevance: The results described suggest that the psychosocial evaluation of liver donors should address the risk of financial burden. In addition, the study suggests a potential psychological benefit of improved relationship with the recipient for the liver donor; the factors contributing to this potential improvement need further evaluation.
The finding: This article presents data from A2ALL-2, a prospective multi-center study of liver organ donors. Subjects (N=271) underwent structured psychosocial evaluations pre-and post-donation, with a total follow-up of 2 years. The following measures were used for assessing psychological outcomes: Primary Care Evaluation of Mental Disorders, Mental Component summary (MCS), Posttraumatic Growth Inventory–short form (PTGI-SF), Simmons “better person” scale. Between 4% and 9.5% of donors reported at least one psychiatric symptom on PRIME MD. The most common problem was alcohol abuse (2-5%), followed by anxiety (2-3%) and major depression (3%). There were no clear predictors for mental health symptoms in regards to demographics, post-donation recipient status, postoperative complications. Donors whose recipients died were more likely to experience guilt after donation.
Strength and weaknesses: This is the most rigorous assessment and follow-up of liver donors reported so far. It is a large, multi-center, prospective study. However, due to the low incidents of problem outcomes, statistical modelling was not possible. The study does not comment on the psychosocial criteria used for donor selection.
Relevance: This study confirms that the rate of psychiatric complications after liver donation is low. It also suggests that donors whose recipients die are at higher risk of psychological distress.
The finding: The study suggests that patients with bipolar disorder and schizophrenia can undergo kidney transplantation with outcomes comparable with other kidney transplant recipients without those psychiatric diagnoses.
Strength and weaknesses: This is a retrospective study of kidney transplantations performed over a period of 7 years at a single center in Ireland. It is remarkable to notice that due to a very low prevalence of bipolar disorder and schizophrenia in this group (much lower than in the general population), a long period of activity had to be reviewed. The authors compared the outcomes of kidney recipients with a diagnosis of bipolar disorder and schizophrenia to recipients of kidney transplantation at the same center without those psychiatric disorders. The study has two major limitations, in addition to the ones discussed by the authors: the article does not address the issue of the patient selection criteria, and the analysis did not control for medical comorbidities and relevant surgical parameters that can impact the outcomes (such as chronic medical illness—diabetes for instance—or surgical parameters such as cold time, type of organ).
Relevance: This study challenges an old preconception that serious mental illness is an automatic contraindication to transplantation. Although many psychiatrists focus on optimizing care, rather than excluding patients from transplantation, there is very limited literature to support transplant candidacy of patients with severe mental illness, which increases the significance of this paper’s findings.