Cooper Katherine M, Colletta Alessandro, Amin Dhruval, Herscovici Darya M, Devuni Deepika
Department of Medicine UMass Chan Medical School, Worcester 01655, MA, USA.
Division of Gastroenterology and Hepatology UMass Chan Medical School, Worcester 01655, MA, USA.
J Transplant. 2024 Aug 13;2024:2455942. doi: 10.1155/2024/2455942. eCollection 2024.
Few studies have evaluated the impact of psychological trauma (mental, emotional, or physical) on liver transplant (LT) candidacy and outcomes.
We performed a single center retrospective analysis of patients who completed routine LT evaluation between October 2017 and June 2021. We identified the prevalence of psychological trauma history in men and women LT candidates and evaluated the association between trauma history and LT access. The primary outcome measure was listing for LT.
A total of 463 patients completed LT evaluation, of which 17% ( = 79) reported a history of trauma: 49 of 159 women and 30 of 304 men. Trauma history was significantly more common in women than in men (31% vs. 10%, < 0.001). Women with trauma history were less likely to be listed for LT (80% vs. 93%, = 0.016). Women with trauma history were also more likely to be removed from the LT waitlist (26% vs. 12%, = 0.045); this persists when excluding patients removed for transfer to another center or for medical improvement (22% vs. 7%, = 0.020). In contrast, listing for LT (87% vs. 86%, = 0.973) and waitlist removal (12% vs. 10%, = 0.766) did not differ in men with and without trauma history. In those that received a LT ( = 107), post-LT relapse, rejection, readmissions, and death did not differ in patients with (n=13)and without (n=94) trauma history.
Trauma history is associated with reduced access to LT in women but not men with chronic liver disease. Further studies are needed to understand the impact of psychological trauma on LT access and post-LT outcomes.
很少有研究评估心理创伤（精神、情感或身体方面）对肝移植（LT）候选资格及预后的影响。
我们对2017年10月至2021年6月期间完成常规LT评估的患者进行了单中心回顾性分析。我们确定了男性和女性LT候选者中心理创伤史的患病率，并评估了创伤史与LT准入之间的关联。主要结局指标是被列入LT名单。
共有463例患者完成了LT评估，其中17%（n = 79）报告有创伤史：159名女性中有49例，304名男性中有30例。创伤史在女性中比在男性中更为常见（31%对10%，P < 0.001）。有创伤史的女性被列入LT名单的可能性较小（80%对93%，P = 0.016）。有创伤史的女性也更有可能从LT等待名单中被移除（26%对12%，P = 0.045）；排除因转至另一中心或病情改善而被移除的患者后，这种情况仍然存在（22%对7%，P = 0.020）。相比之下，有和没有创伤史的男性在被列入LT名单方面（87%对86%，P = 0.973）以及从等待名单中被移除方面（12%对10%，P = 0.766）没有差异。在接受LT的患者中（n = 107），有（n = 13）和没有（n = 94）创伤史的患者在LT后复发、排斥反应、再次入院和死亡方面没有差异。
创伤史与慢性肝病女性获得LT的机会减少有关，但与男性无关。需要进一步研究以了解心理创伤对LT准入和LT后结局的影响。
