Psychological and Sociodemographic Predictors for Waitlist Enrollment, Liver Transplantation and Overall Survival

Introduction Liver transplantation (LT) is a complex procedure that can reinforce psychological distress, depression and addiction. At our center, a comprehensive psychiatric evaluation is integrated in the pre-transplant assessment to identify psychological risk factors. This study aims to assess the impact of psychological conditions, social environment and substance abuse on pre- and post-transplant outcomes.

Material and Methods In this single-center retrospective study, we analyzed waitlist enrollment, liver transplantation and overall survival in adult patients who underwent standardized psychiatric evaluation before their first LT between 2007 and 2021.

Results A total of 991 patients were evaluated, of whom 70.1% (n=695) were listed for transplantation, of whom 82.3% (n=572) underwent LT. Median survival was sig. longer in transplanted patients (12.9 years) compared to those who were not transplanted (2.2 years, p<0.001). The majority of LT candidates had a history of harmful drinking (51% of women and 65.4% of men) which was associated with sig. worse survival. Patients with>6 months of alcohol abstinence were significantly more likely to be transplanted. However, in transplanted patients, a history of harmful drinking or abstinence duration was not sig. associated with survival. Patients who were not listed or transplanted (n=419) were more often living alone (26.3% vs. 17.9%, p=0.004), with a weaker social network (86.7% vs. 95.1%, p<0.001), and lower educational attainment, higher rates of addiction treatment, psychiatric disorders, and an AUDIT risk score of>15. Patients with a high psychiatric risk estimate had sig. shorter survival, but this was not observed in the subgroup of transplanted patients. Multivariate regression analysis identified female sex as a negative predictor for listing (OR 0.58, p=0.032), whereas strong social/family support increased listing probability (OR 2.4, p=0.018).

Conclusion Psychological conditions, poor social support and substance abuse reduced the likelihood of LT listing and transplantation. However, these factors did not impact post-transplant survival, emphasizing the need for an unbiased approach in evaluating transplant eligibility.

Publication History

Article published online:
13 May 2025