Butt Z, Dew M A, Liu Q, Simpson M A, Smith A R, Zee J, Gillespie B W, Abbey S E, Ladner D P, Weinrieb R, Fisher R A, Hafliger S, Terrault N, Burton J, Sherker A H, DiMartini A
Departments of Medical Social Sciences, Surgery & Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL.
Departments of Psychiatry, Surgery, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA.
Am J Transplant. 2017 May;17(5):1267-1277. doi: 10.1111/ajt.14134. Epub 2017 Jan 3.
Although single-center and cross-sectional studies have suggested a modest impact of liver donation on donor psychological well-being, few studies have assessed these outcomes prospectively among a large cohort. We conducted one of the largest, prospective, multicenter studies of psychological outcomes in living liver donors within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study2 (A2ALL-2) consortium. In total, 271 (91%) of 297 eligible donors were interviewed at least once before donation and at 3, 6, 12, and 24 mo after donation using validated measures. We found that living liver donors reported low rates of major depressive (0-3%), alcohol abuse (2-5%), and anxiety syndromes (2-3%) at any given assessment in their first 2 years after donation. Between 4.7% and 9.6% of donors reported impaired mental well-being at various time points. We identified significant predictors for donors' perceptions of being better people and experiencing psychological growth following donation, including age, sex, relationship to recipient, ambivalence and motivation regarding donation, and feeling that donation would make life more worthwhile. Our results highlight the need for close psychosocial monitoring for those donors whose recipients died (n=27); some of those donors experienced guilt and concerns about responsibility. Careful screening and targeted, data-driven follow-up hold promise for optimizing psychological outcomes following this procedure for potentially vulnerable donors.
尽管单中心和横断面研究表明活体肝捐赠对供体心理健康有一定程度的影响，但很少有研究对大量队列进行前瞻性评估这些结果。我们在成人对成人活体肝移植队列研究2（A2ALL - 2）联盟中开展了一项关于活体肝供体心理结果的最大规模的前瞻性多中心研究。在297名符合条件的供体中，共有271名（91%）在捐赠前至少接受了一次访谈，并在捐赠后的3个月、6个月、12个月和24个月使用经过验证的测量方法进行访谈。我们发现，活体肝供体在捐赠后的头两年的任何一次评估中，报告的重度抑郁（0 - 3%）、酒精滥用（2 - 5%）和焦虑综合征（2 - 3%）的发生率都很低。在不同时间点，有4.7%至9.6%的供体报告心理健康受损。我们确定了供体在捐赠后认为自己变得更好以及经历心理成长的重要预测因素，包括年龄、性别、与受者的关系、对捐赠的矛盾心理和动机，以及感觉捐赠会使生活更有价值。我们的结果强调了对那些受者死亡的供体（n = 27）进行密切心理社会监测的必要性；其中一些供体经历了内疚和对责任的担忧。仔细筛选和有针对性的数据驱动随访有望为优化这一手术对潜在脆弱供体的心理结果带来希望。
