Psychological well-being in liver patients.

Liver transplantation is a widespread treatment for both acute and chronic liver disease. Previous research has indicated that psychological well-being is strongly associated with positive outcomes post-transplant. There is also evidence however to suggest a significant level of psychiatric morbidity in patients post-transplant. Therefore, it is essential to evaluate liver transplant surgery according to both physical and psychological results. This study implemented a longitudinal mixed methods approach. The objectives were to; describe the experience of patients awaiting liver transplant surgery, to examine the relationships between psychological state pre-transplant and psychological health post-transplant. To explore any changes made to an individual’s frame of reference for self-evaluation of Health-Related Quality of Life (HRQoL) and to identify any factors that were associated with this change. One-to-one interviews were conducted with 18 patients with End-Stage Liver Disease (ESLD); 9 of these participants were interviewed again at 1 month, 3 months and 9 months post liver transplant. Thematic analysis produced 5 themes across time: impact of liver disease/ transplant on patients’ life, emotional reaction to liver disease/ transplant, methods of coping with liver disease/ transplant, support of others and perception of the future.
Quantitative analyses indicated an improvement in HRQoL from pre-transplant to 3 months post-transplant. High levels of anxiety were evident at 1-month post-surgery whilst depression decreased over time. Optimism scores increased from pre-transplant to 9 months post-surgery. Response shift effects were observed at all post-transplant time-points with patients rating their HRQoL significantly lower (on average) in retrospect than they did at pre-transplant. The largest response shift occurred at 3 months post-transplant. The occurrence of response shift in HRQoL ratings over time for this population could have implications for the estimation of the effectiveness of liver transplant surgery.