Kober B, Küchler T, Broelsch C, Kremer B, Henne-Bruns D
Department of Surgery, University of Chicago, Ill.
Psychother Psychosom. 1990;54(2-3):117-31. doi: 10.1159/000288386.
Considering the increasing number of liver transplantations with longer periods of transplant function, there is a growing need for quality of life research in the field. In addition to lethality, mortality and rehabilitation, parameters of 'quality of life' are to be evaluated: the patient's rating of his subjective physical symptoms, psychological condition (anxiety, depression and mental adjustment), social reintegration and life satisfaction. This paper describes our psychological support program that has been established at the Hamburg LTX center as well as the first results of the ongoing QoL research study. Using the methods developed by the Hamburg Study group on 'quality of life in surgery', 38 liver transplantation patients of the University of Chicago (cross-sectional study with control groups of patients with chronic liver disease as well as healthy individuals) and 29 patients of the University Clinic of Hamburg (longitudinal study with points of evaluation before and 2, 6, 12, 24 and 36 months after transplantation) have been evaluated. First results: (1) All successfully transplanted patients show a significant postoperative increase of their overall quality of life. (2) The psychological parameters of quality of life are only partly correlated with physical symptoms. (3) There is a high correlation between rejection crisis periods and the decrease of all quality of life parameters. (4) In both samples men have a lower quality of life than women, (5) Preoperative depression and lack of social support might be considered as being possible risk factors for long-term survival. (6) Long-term survivors rate their quality of life significantly higher than patients with chronic liver disease and--despite some persisting somatic restrictions--as high as healthy controls. (7) A psychotherapeutic support program increases the patient's compliance resulting a better adaption to the transplant procedure including rehabilitation.
鉴于肝移植数量不断增加且移植功能期延长，该领域对生活质量研究的需求日益增长。除了致死率、死亡率和康复情况外，还需评估“生活质量”参数：患者对其主观身体症状、心理状况（焦虑、抑郁和心理调适）、社会重新融入和生活满意度的评分。本文介绍了我们在汉堡肝移植中心设立的心理支持项目以及正在进行的生活质量研究的初步结果。采用汉堡“手术生活质量”研究小组开发的方法，对芝加哥大学的38例肝移植患者（与慢性肝病患者及健康个体对照组进行横断面研究）和汉堡大学诊所的29例患者（移植前及移植后2、6、12、24和36个月进行评估的纵向研究）进行了评估。初步结果：（1）所有成功进行肝移植的患者术后总体生活质量均显著提高。（2）生活质量的心理参数仅部分与身体症状相关。（3）排斥危机期与所有生活质量参数的下降高度相关。（4）在两个样本中，男性的生活质量均低于女性。（5）术前抑郁和缺乏社会支持可能被视为长期生存的潜在风险因素。（6）长期存活者对其生活质量的评分显著高于慢性肝病患者，且尽管存在一些持续的躯体限制，但与健康对照组一样高。（7）心理治疗支持项目可提高患者的依从性，从而更好地适应移植过程，包括康复。
