Psychological well-being in liver transplant patients

Student thesis: Doctoral ThesisDoctor of Philosophy


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.
Date of AwardDec 2007
Original languageEnglish
Awarding Institution
  • Queen's University Belfast
SupervisorMartin Dempster (Supervisor) & Orla Muldoon (Supervisor)

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