O'Carroll Ronan E, Couston Margaret, Cossar Jill, Masterton George, Hayes Peter Clive
School of Psychology, University of St Andrews, UK.
Liver Transpl. 2003 Jul;9(7):712-20. doi: 10.1053/jlts.2003.50138.
Liver transplantation is a well-established treatment for liver failure. Prolongation in survival is accepted, but long-term effects of liver transplantation on cognitive and psychological outcome are unclear. In the present study, psychological data were prospectively collected for 164 patients who were assessed for liver transplantation. Memory impairment, psychomotor slowing, anxiety, and depression were commonly observed. Severity of liver disease at assessment was significantly associated with slowing of reaction time. Memory impairment distinguished those who were not listed for transplantation because of illness severity. One year posttransplantation, follow-up data from transplant recipients showed significant improvement in most psychological domains relative to both healthy comparison participants and patients with chronic liver disease who did not undergo transplantation. Immunosuppression (cyclosporine versus tacrolimus) did not have differential effects on quality of life, fatigue, or affective status, although those administered cyclosporine showed greater improvements at 1-year follow-up on simple and choice reaction times. Elevated levels of anxiety and neuroticism at pretransplantation assessment were associated with worse psychosocial outcome at 1 year posttransplantation. Severity of liver disease was not related to psychological outcome at 1 year. Good psychological outcome at 1 year was maintained at the 3-year follow-up.
肝移植是治疗肝衰竭的一种成熟疗法。生存期的延长是公认的，但肝移植对认知和心理结局的长期影响尚不清楚。在本研究中，前瞻性收集了164例接受肝移植评估患者的心理数据。常见的有记忆障碍、精神运动迟缓、焦虑和抑郁。评估时的肝病严重程度与反应时间减慢显著相关。记忆障碍区分了那些因病情严重而未被列入移植名单的患者。移植后一年，移植受者的随访数据显示，相对于健康对照参与者和未接受移植的慢性肝病患者，大多数心理领域都有显著改善。免疫抑制（环孢素与他克莫司）对生活质量、疲劳或情感状态没有差异影响，尽管接受环孢素治疗的患者在1年随访时在简单反应时间和选择反应时间方面有更大改善。移植前评估时焦虑和神经质水平升高与移植后1年更差的心理社会结局相关。肝病严重程度与1年时的心理结局无关。1年时良好的心理结局在3年随访时得以维持。
