Wu Ming-Kung, Hsu Li-Wen, Huang Kuang-Tzu, Lin Chih-Che, Wang Chih-Chi, Lin Ting-Lung, Li Wei-Feng, Goto Shigeru, Chen Chao-Long, Chen Chien-Chih
Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan,
Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan,
Neuropsychiatr Dis Treat. 2018 Aug 8;14:1999-2005. doi: 10.2147/NDT.S165270. eCollection 2018.
Living donor liver transplantation (LDLT) has been developed as one of gold standard treatments for end-stage liver disease. Mental health is a required selection criterion for adult living liver donors and may influence the quality of life after operation.
A total of 1,210 potential living donor candidates for liver transplantation (LT) underwent psychosocial evaluation that included a semi-structured interview, multi-choice self-reported inventory (Beck Depression Inventory-2nd edition [BDI-II], Beck Anxiety Inventory [BAI]), and the family APGAR (Adaptability, Partnership, Growth, Affection, Resolve) index. The test results were compared by family relationships, and subgroups were classified based on the donation type: 1) parents to children, 2) grown children to parents, 3) siblings to siblings, 4) spouses to spouses, and 5) other relatives to other relatives.
The BDI-II ( < 0.001) and BAI differed considerably according to the donation type in potential donor candidates. Compared with other subgroups, parents donating to their children suffered the most severe psychological stress before LDLT and exhibited more depressive ( < 0.001) and anxiety symptoms. However, the stress associated with grown children donating to their parents, siblings, and spouses was not significantly higher than it was for other relatives. Furthermore, a significant negative correlation existed between family APGAR scores and the severity of depression and anxiety ( < 0.001) among potential donor candidates.
These results indicate the importance of understanding potential donor candidates' psychological characteristics before LT. Greater anxiety and depression may be exhibited by parent donors due to the distress from fears of death or illness of the recipients, or their guilty feeling for their child. Additionally, family dysfunction also revealed more depression and anxiety. Such donor candidates should be given more extensive pre-donation counseling for minimizing pre-LDLT psychological stress.
活体肝移植已发展成为终末期肝病的金标准治疗方法之一。心理健康是成年活体肝供体的必要选择标准，可能会影响术后生活质量。
共有1210名潜在的活体肝移植供体候选人接受了心理社会评估，评估内容包括半结构化访谈、多项选择自我报告量表（贝克抑郁量表第二版[BDI-II]、贝克焦虑量表[BAI]）以及家庭APGAR（适应度、合作度、成长度、亲密度、解决度）指数。根据家庭关系对测试结果进行比较，并根据捐赠类型将亚组分类为：1）父母捐给子女，2）成年子女捐给父母，3）兄弟姐妹之间捐赠，4）配偶之间捐赠，5）其他亲属之间捐赠。
潜在供体候选人中，BDI-II（<0.001）和BAI根据捐赠类型有显著差异。与其他亚组相比，父母捐给子女的在活体肝移植前承受的心理压力最大，表现出更严重的抑郁（<0.001）和焦虑症状。然而，成年子女捐给父母、兄弟姐妹和配偶的压力并不显著高于其他亲属。此外，潜在供体候选人的家庭APGAR得分与抑郁和焦虑严重程度之间存在显著负相关（<0.001）。
这些结果表明了解潜在供体候选人肝移植前心理特征的重要性。父母供体可能会因担心受者死亡或患病而感到痛苦，或对自己的孩子有负罪感，从而表现出更大的焦虑和抑郁。此外，家庭功能障碍也显示出更多的抑郁和焦虑。对于这类供体候选人，应给予更广泛的捐赠前咨询，以尽量减少活体肝移植前的心理压力。
