Fineberg Sarah K, West Adrienne, Na Peter Jongho, Oldham Mark, Schilsky Michael, Hawkins Keith A, Lee Hochang Benjamin
Department of Psychiatry, School of Medicine, Yale University, 300 George Street, New Haven, CT, U.S.A., 06519.
Department of Medicine, Yale University Medical Center, 333 Cedar Street, LMP 1080, New Haven, CT, 06520; Department of Surgery, Yale University Medical Center, 333 Cedar Street, LMP 1080, New Haven, CT, 06520.
Gen Hosp Psychiatry. 2016 May-Jun;40:4-11. doi: 10.1016/j.genhosppsych.2016.01.006. Epub 2016 Jan 22.
Evaluation of liver transplant (LT) candidacy involves psychosocial evaluation to ensure appropriate organ allocation. However, the utility of pre-LT psychiatric and neuropsychological factors in predicting posttransplant outcomes remains uncertain. We reviewed current evidence on the prognostic value of pre-LT psychological factors for outcomes after LT.
We conducted a systematic review of studies with adult LT recipients that investigate the relationship between pre-LT psychiatric and neuropsychological variables and posttransplant outcomes. We searched Ovid, MEDLINE, PsycINFO, EMBASE/Scopus, Cochrane Controlled trials register and Web of Science (January 1975 to May 2015) for longitudinal, peer-reviewed studies of at least 20 subjects and written in English.
The 19 studies included in this review are heterogeneous in population, prognosis and duration of follow-up (from 20days to more than 3 years). Findings on the prognostic value of pre-LT depression or anxiety on post-LT outcomes are mixed, though depression appears to predict lower quality of life (QOL). Pre-LT suicidal thoughts in particular are associated with post-LT depression. High submissiveness may predict rejection within 20days of LT, and low conscientiousness is associated with greater nonadherence. Whereas pre-LT cognitive performance has not been shown to predict survival, poorer performance may predict poorer QOL after LT.
Further studies are needed to examine this important element of LT candidacy evaluation. Studies should evaluate psychiatric factors in large samples, include systematic evaluations by mental health clinicians and explore broader neuropsychological domains in predicting posttransplant outcomes.
评估肝移植（LT）候选资格涉及社会心理评估，以确保器官的合理分配。然而，LT术前精神和神经心理因素对移植后结局的预测作用仍不明确。我们回顾了当前关于LT术前心理因素对LT术后结局预后价值的证据。
我们对成年LT受者的研究进行了系统评价，这些研究调查了LT术前精神和神经心理变量与移植后结局之间的关系。我们在Ovid、MEDLINE、PsycINFO、EMBASE/Scopus、Cochrane对照试验注册库和科学网（1975年1月至2015年5月）中搜索了至少20名受试者的纵向、经同行评审且以英文撰写的研究。
本评价纳入的19项研究在人群、预后和随访时间（从20天到3年以上）方面存在异质性。关于LT术前抑郁或焦虑对LT术后结局预后价值的研究结果不一，不过抑郁似乎预示着较低的生活质量（QOL）。LT术前的自杀念头尤其与LT术后抑郁相关。高度顺从可能预示着LT术后20天内发生排斥反应，而低尽责性与更高的不依从性相关。虽然LT术前的认知表现尚未显示出可预测生存率，但较差的表现可能预示着LT术后较差的QOL。
需要进一步研究来检验LT候选资格评估的这一重要因素。研究应在大样本中评估精神因素，包括由心理健康临床医生进行系统评估，并在预测移植后结局时探索更广泛的神经心理领域。
