The elderly liver transplant recipients: anxiety, depression, fatigue and life satisfaction

Felix Krenzien; Nicco Krezdorn; Mehmet H Morgül; Georg Wiltberger; Georgi Atanasov; Hans-Michael Hau; Andreas Hinz; Moritz Schmelzle; Michael Bartels; Christian Benzing

doi:10.1055/s-0043-102580

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2017; 55(06): 557-563
DOI: 10.1055/s-0043-102580

Originalarbeit

The elderly liver transplant recipients: anxiety, depression, fatigue and life satisfaction

Der ältere lebertransplantierte Patient: Angst, Depression, Fatigue und Lebenszufriedenheit

Authors

Felix Krenzien

¹Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany

²Berlin Institute of Health (BIH), Berlin,Germany
Nicco Krezdorn

³Department of Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
Mehmet H Morgül

¹Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
Georg Wiltberger

⁴Department of Visceral, Thoracic, Transplantation and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
Georgi Atanasov

¹Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany

²Berlin Institute of Health (BIH), Berlin,Germany
Hans-Michael Hau

⁴Department of Visceral, Thoracic, Transplantation and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
Andreas Hinz

⁵Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
Moritz Schmelzle

¹Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
Michael Bartels

⁴Department of Visceral, Thoracic, Transplantation and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
Christian Benzing

¹Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany

Abstract

Introduction Older patients are neglected in clinical trials and are likely to be excluded from liver transplantation (LT). The aim of this study was to assess fatigue, anxiety, depression, and health-related quality of life (HRQoL) in elderly LT recipients.

Methods Questionnaires were mailed to patients who underwent LT between 1993 and 2013. Three groups were created: patients ≥ 70, 60 – 69, and < 60 years old. Mental-health status, life satisfaction, and fatigue were assessed using, respectively, the Hospital Anxiety and Depression Scale (HADS), Questions on Life Satisfaction (FLZ-M), and the Multidimensional Fatigue Inventory (MFI-20).

Results In total, 276 eligible questionnaires (40.1 %) were received out of 689 patients with a history of LT. No age-related differences were found with regard to anxiety or depression in the study sample. Patients ≥ 70 years old had significantly better life satisfaction in regards to income (p = 0.003) and work (p = 0.005) compared to patients < 60 years. The overall fatigue scores were the highest in patients < 60 years (52.7, SD = 15.8) and ≥ 70 years (52.7, SD = 17.7) compared to patients 60 – 69 years old (48.2, SD = 17.3, p = 0.037).

Discussion Advanced age alone should not be considered a contraindication for LT due to potentially poor quality of life outcomes.

Abstract

Einleitung Ältere Patienten werden in klinischen Studien häufig nicht berücksichtigt, eine erfolgreiche Listung zur Lebertransplantation im höheren Lebensalter ist unwahrscheinlich. Das Ziel der vorliegenden Studie liegt darin, Fatigue, Angst, Depression und gesundheitsbezogene Lebensqualität bei älteren Patienten nach Lebertransplantation zu erfassen.

Methoden Die Fragebögen wurden an Patienten verschickt, welche sich zwischen 1993 und 2013 einer Lebertransplantation unterzogen haben. Psychischer Status, Lebenszufriedenheit und Fatigue wurden mithilfe des Hospital Anxiety and Depression Scale (HADS), Fragebogen zur Lebenszufriedenheit (FLZ) und dem Multidimensional Fatigue Inventory (MFI-20) erfasst.

Ergebnisse Insgesamt wurden 276 (40,1 %) vollständige und auswertbare Fragebögen von 689 angeschriebenen Patienten empfangen. Es wurden keine altersabhängigen Unterschiede hinsichtlich Angst und Depression gefunden. Die Gruppe ≥ 70y hatte verglichen mit der Altersgruppe < 60y signifikant bessere Lebenszufriedenheitswerte auf der Einkommen- und Arbeit-Skala (p = 0,003 und 0,005). Die Fatigue-Werte waren in Gruppe < 60y (52,7, SD = 15,8) und Gruppe ≥ 70y (52,7, SD = 17,7) am höchsten verglichen mit Gruppe 60 – 69y (48,2, SD = 17,3, p = 0,037).

Diskussion Ein höheres Lebensalter sollte nicht per se aufgrund einer unterstellten Einschränkung der Lebensqualität als Kontraindikation zur Lebertransplantation angesehen werden.

Schlüsselwörter

Lebertransplantation - ältere lebertransplantierte Patienten - Lebensqualität - Fatigue - Angst - Depression

Key words

liver transplantation - elderly recipients - quality of life - fatigue, anxiety - depression

Full Text

References

References
1 Agopian VG. Petrowsky H. Kaldas FM. et al. The evolution of liver transplantation during 3 decades: analysis of 5347 consecutive liver transplants at a single center. Ann Surg 2013; 258: 409-421
2 Samuel U. Eurotransplant International Foundation Annual Report 2014. Leiden: 2014 Available from https://www.eurotransplant.org
3 Slattery E. Hegarty JE. McCormick PA. It's a man's world: does orthotopic liver transplantation in the elderly male confer an additional risk on survival?. Can J Gastroenterol 2012; 26: 697-700
4 Adam R. Karam V. Delvart V. et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol 2012; 57: 675-688
5 Zigmond AS. Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-370
6 Pelgur H. Atak N. Kose K. Anxiety and depression levels of patients undergoing liver transplantation and their need for training. Transplant Proc 2009; 41: 1743-1748
7 Smets EM. Garssen B. Bonke B. et al. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 1995; 39: 315-325
8 Ware JE. Kosinski M. Gandek B. et al. The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998; 51: 1159-1165
9 Darwish Murad S. Heimbach JK. Gores GJ. et al. Excellent quality of life after liver transplantation for patients with perihilar cholangiocarcinoma who have undergone neoadjuvant chemoradiation. Liver Transpl 2013; 19: 521-528
10 Henrich G. Herschbach P. Questions on Life Satisfaction (FLZM) – A short questionnaire for assessing subjective quality of life. Eur J Psychol Assess 2000; 16: 150-159
11 Benzing C. Krezdorn N. Förster J. et al. Health-related quality of life and affective status in liver transplant recipients and patients on the waiting list with low MELD scores. HPB (Oxford) 2016; 18: 449-455
12 Benzing C. Krezdorn N. Förster J. et al. Impact of different immunosuppressive regimens on the health-related quality of life following orthotopic liver transplantation. Clin Transplant 2015; 29: 1081-1089
13 Sullivan KM. Radosevich DM. Lake JR. Health-related quality of life: two decades after liver transplantation. Liver Transpl 2014; 20: 649-654
14 van den Berg-Emons R. van Ginneken B. Wijffels M. et al. Fatigue is a major problem after liver transplantation. Liver Transpl 2006; 12: 928-933
15 Benzing C. Krezdorn N. Hinz A. et al. Mental status in patients before and after liver transplantation. Ann Transplant 2015; 20: 683-693
16 Zahn A. Seubert L. Jünger J. et al. Factors influencing long-term quality of life and depression in German liver transplant recipients: a single-centre cross-sectional study. Ann Transplant 2013; 18: 327-335
17 Telles-Correia D. Barbosa A. Mega I. et al. Psychosocial determinants of quality of life 6 months after transplantation: longitudinal prospective study. Transplant Proc 2009; 41: 898-900
18 Werkgartner G. Wagner D. Manhal S. et al. Long-term quality of life of liver transplant recipients beyond 60 years of age. Age (Dordr) 2013; 35: 2485-2492
19 Snaith RP. Zigmont AS. Hermann-Lingen C. HADS-D: Hospital Anxiety and Depression Scale-Deutsche Version; Ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin. Bern: Huber; 1995
20 Schoening WN. Buescher N. Rademacher S. et al. Twenty-year longitudinal follow-up after orthotopic liver transplantation: a single-center experience of 313 consecutive cases. Am J Transplant 2013; 13: 2384-2394
21 Bundesministerium für Gesundheit. Richtlinien zur Organtransplantation gem. § 16 TPG Richtlinie gemäß § 16 Abs. 1 S. 1 Nrn. 2u. 5 TPG für die Wartelistenführung und Organvermittlung zur Lebertransplantation. Dtsch Arztebl Int 2016; 113: 346
22 Blosser CD. Huverserian A. Bloom RD. et al. Age, exclusion criteria, and generalizability of randomized trials enrolling kidney transplant recipients. Transplantation 2011; 91: 858-863
23 Baranyi A. Krauseneck T. Rothenhäusler HB. Overall mental distress and health-related quality of life after solid-organ transplantation: results from a retrospective follow-up study. Health Qual Life Outcomes 2013; 11: 15
24 Nickel R. Wunsch A. Egle UT. et al. The relevance of anxiety, depression, and coping in patients after liver transplantation. Liver Transpl 2002; 8: 63-71
25 van Ginneken BT. van den Berg-Emons RJ. van der Windt A. et al. Persistent fatigue in liver transplant recipients: a two-year follow-up study. Clin Transplant 2010; 24: E10-E16
26 Carbone M. Bufton S. Monaco A. et al. The effect of liver transplantation on fatigue in patients with primary biliary cirrhosis: a prospective study. J Hepatol 2013; 59: 490-494
27 Cowling T. Jennings LW. Goldstein RM. et al. Liver transplantation and health-related quality of life: scoring differences between men and women. Liver Transpl 2004; 10: 88-96
28 Rongey C. Bambha K. Vanness D. et al. Employment and health insurance in long-term liver transplant recipients. Am J Transplant 2005; 5: 1901-1908
29 Aadahl M. Hansen BA. Kirkegaard P. et al. Fatigue and physical function after orthotopic liver transplantation. Liver Transpl 2002; 8: 251-259
30 Winsett RP. Posttransplant quality of life: a decade of descriptive studies leading to practice interventions. Posttransplant Quality of Life Intervention Study Group. J Transpl Coord 1998; 8: 236-240