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Daniel J, Dumortier J, Del Bello A, Gamon L, Molinari N, Faure S, Meszaros M, Ursic-Bedoya J, Meunier L, Monet C, Navarro F, Boillot O, Pageaux GP, Donnadieu-Rigole H. Integrating an addiction team into the management of patients transplanted for alcohol-associated liver disease reduces the risk of severe relapse. JHEP Rep 2023; 5:100832. [PMID: 37681206 PMCID: PMC10480527 DOI: 10.1016/j.jhepr.2023.100832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 09/09/2023] Open
Abstract
Background & Aims Liver transplantation (LT) is a last resort treatment for patients at high risk of mortality from end-stage liver disease. Over the past years, alcohol-associated liver disease has become the most frequent indication for LT in the world. The outcomes of LT for alcohol-associated liver disease are good, but return to alcohol use is detrimental for medium-term survival because of cancer development, cardiovascular events, and recurrent alcohol-associated cirrhosis. Several strategies have been developed to prevent return to alcohol use during the pre- or post-LT period, but there are no specific recommendations. Therefore, the main objective of this study was to investigate if the integration of an addiction team in a LT unit affected the rate of severe alcohol relapse after LT. The secondary objectives were to assess the effects of addiction follow up on cardiovascular events, cancer, and overall survival. Methods This study was a retrospective comparison between centres with or without addiction monitoring. Results The study included 611 patients of which 79.4% were male with a mean age of 55.4 years at the time of LT, 190 were managed by an integrated addiction team. The overall alcohol relapse rate was 28.9% and the rate of severe relapse was 13.0%. Patients with addiction follow-up had significantly less frequent severe alcohol relapse than those in the control group (p = 0.0218). Addiction follow up (odds ratio = 0.19; p = 0.001) and age at LT (odds ratio = 1.23; p = 0.02) remained significantly associated with post-LT cardiovascular events. Conclusions Our study confirms the benefits of integrating an addiction team to reduce return to alcohol use after LT. Clinical Trials registration This study is registered at ClinicalTrials.gov (NCT04964687). Impact and implications The main indication for liver transplantation is alcohol-associated cirrhosis. There are currently no specific recommendations on the addiction monitoring of transplant candidates, although severe return to alcohol use after liver transplantation has a negative impact on long-term survival of patients. In this study, we explored the impact of a systematic addiction intervention on the return to alcohol use rates. In our transplantation centre, we demonstrated the interest of an addiction follow up to limit the severe alcohol relapses rate. This information should be further investigated in prospective studies to validate these data.
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Affiliation(s)
- Jules Daniel
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Jérôme Dumortier
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon et Université Claude Bernard, Lyon, France
| | - Arnaud Del Bello
- Nephrology and Organ Transplant Department, CHU de Toulouse, Toulouse, France
| | - Lucie Gamon
- Medical Information Department, La Colombière Hospital, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Molinari
- Medical Information Department, La Colombière Hospital, University Hospital of Montpellier, Montpellier, France
- Medical University of Montpellier (UM1), Montpellier, France
| | - Stéphanie Faure
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Magdalena Meszaros
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - José Ursic-Bedoya
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Lucy Meunier
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Clément Monet
- Department of Anesthesia and Intensive Care Unit, University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, Montpellier, France
| | - Francis Navarro
- Medical University of Montpellier (UM1), Montpellier, France
- Department of Digestive Surgery, University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Olivier Boillot
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon et Université Claude Bernard, Lyon, France
| | - Georges-Philippe Pageaux
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
- Medical University of Montpellier (UM1), Montpellier, France
| | - Hélène Donnadieu-Rigole
- Medical University of Montpellier (UM1), Montpellier, France
- Addictions Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
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Greco B, Caviglia S, Martinelli D, Capitello TG, Liccardo D, De Nictolis F, Pietrobattista A, Huemer M, Piga S, Olivieri G, Spagnoletti G, Spada M, Dionisi-Vici C. The impact of liver transplantation on health-related quality of life in (acute) intoxication-type inborn errors of metabolism. J Inherit Metab Dis 2023; 46:906-915. [PMID: 37395264 DOI: 10.1002/jimd.12648] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/18/2023] [Accepted: 06/28/2023] [Indexed: 07/04/2023]
Abstract
Organic acidurias (OAs), urea-cycle disorders (UCDs), and maple syrup urine disease (MSUD) belong to the category of intoxication-type inborn errors of metabolism (IT-IEM). Liver transplantation (LTx) is increasingly utilized in IT-IEM. However, its impact has been mainly focused on clinical outcome measures and rarely on health-related quality of life (HRQoL). Aim of the study was to investigate the impact of LTx on HrQoL in IT-IEMs. This single center prospective study involved 32 patients (15 OA, 11 UCD, 6 MSUD; median age at LTx 3.0 years, range 0.8-26.0). HRQoL was assessed pre/post transplantation by PedsQL-General Module 4.0 and by MetabQoL 1.0, a specifically designed tool for IT-IEM. PedsQL highlighted significant post-LTx improvements in total and physical functioning in both patients' and parents' scores. According to age at transplantation (≤3 vs. >3 years), younger patients showed higher post-LTx scores on Physical (p = 0.03), Social (p < 0.001), and Total (p =0.007) functioning. MetabQoL confirmed significant post-LTx changes in Total and Physical functioning in both patients and parents scores (p ≤ 0.009). Differently from PedsQL, MetabQoL Mental (patients p = 0.013, parents p = 0.03) and Social scores (patients p = 0.02, parents p = 0.012) were significantly higher post-LTx. Significant improvements (p = 0.001-0.04) were also detected both in self- and proxy-reports for almost all MetabQoL subscales. This study shows the importance of assessing the impact of transplantation on HrQoL, a meaningful outcome reflecting patients' wellbeing. LTx is associated with significant improvements of HrQol in both self- and parent-reports. The comparison between PedsQL-GM and MetabQoL highlighted that MetabQoL demonstrated higher sensitivity in the assessment of disease-specific domains than the generic PedsQL tool.
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Affiliation(s)
- Benedetta Greco
- Division of Metabolic Diseases, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
- Unit of Clinical Psychology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Stefania Caviglia
- Unit of Clinical Psychology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Diego Martinelli
- Division of Metabolic Diseases, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Daniela Liccardo
- Division of Hepatology, Gastroenterology and Nutrition, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Andrea Pietrobattista
- Division of Hepatology, Gastroenterology and Nutrition, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Martina Huemer
- Division of Metabolism, Children's Research Center and University Children's Hospital Zurich, Zurich, Switzerland
| | - Simone Piga
- Unit of Clinical Epidemiology, Medical Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgia Olivieri
- Division of Metabolic Diseases, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Gionata Spagnoletti
- Unit of Hepato-Biliary-Pancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marco Spada
- Unit of Hepato-Biliary-Pancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolic Diseases, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Sgrò A, Cambridge WA, McLean KA, Drake TM, Camilleri-Brennan J, Knight SR, Pius R, Wu DA, Wigmore SJ, Harrison EM. Is socioeconomic deprivation associated with worse quality of life, anxiety and depression in liver transplant recipients? A cross-sectional study in a national transplantation programme. BMJ Open 2023; 13:e070422. [PMID: 37558450 PMCID: PMC10414121 DOI: 10.1136/bmjopen-2022-070422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/02/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To identify whether socioeconomic deprivation is associated with worse health-related quality of life (HR-QoL), anxiety and depression following liver transplantation. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Liver transplant recipients within a national transplantation programme. METHODS Participants completed the condition-specific 'Short Form of Liver Disease Quality of Life' Questionnaire, the Generalised Anxiety Disorder-7 (GAD-7) Questionnaire and the Patient Health Questionnaire-9 (PHQ-9). The aggregate HR-QoL Score (range 0-100) was derived, and multivariable linear regression was performed based on sociodemographic and clinical variables to estimate its independent association with Scottish Index of Multiple Deprivation (SIMD) quintiles. The GAD-7 Questionnaire and PHQ-9 were used to screen respondents for anxiety and depression, and multivariable logistic regression was performed to estimate their independent association with SIMD quintiles. RESULTS Some 331 patients completed the questionnaires. Quintiles were equally distributed in the cohort, with no significant differences observed in underlying patient characteristics. Following multivariable adjustment, greater socioeconomic deprivation was associated with lower post-transplantation HR-QoL scores, with a difference of 9.7 points (95% CI: 4.6 to 14.9, p<0.001) between the most and least deprived quintiles. Recipients living in areas of least deprivation were less likely to suffer from anxiety (OR 0.05, 95% CI: 0.00 to 0.28, p=0.003) or depression (OR 0.13, 95% CI: 0.02 to 0.56, p=0.009). CONCLUSION Despite the highly selected nature of liver transplant recipients, those living in the most deprived areas have a significantly lower HR-QoL and are more likely to suffer from anxiety and depression.
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Affiliation(s)
- Alessandro Sgrò
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William A Cambridge
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Kenneth A McLean
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Thomas M Drake
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Stephen R Knight
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Riinu Pius
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Diana A Wu
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Stephen J Wigmore
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
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Kaplan A, Korenjak M, Brown RS. Post-liver transplantation patient experience. J Hepatol 2023; 78:1234-1244. [PMID: 37208108 DOI: 10.1016/j.jhep.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 05/21/2023]
Abstract
Given improvements in post-transplant patient and graft survival, there is a growing need to focus on patient experience and health-related quality of life (HRQOL). Though liver transplantation can be life-saving, it can also be associated with significant morbidity and complications. Patient HRQOL improves after transplantation, but it may not improve to that of age-matched cohorts. Understanding patient experience and the factors that contribute to it, including physical and psychological health, immunosuppression and medication adherence, return to employment or school, financial burden, and expectations, helps when thinking creatively about potential interventions to improve HRQOL.
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Affiliation(s)
- Alyson Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY, USA
| | | | - Robert S Brown
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY, USA.
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Woelfel I, Faulkner D, Wong S, Washburn K, Schenk A. Patients are pragmatic and physicians are perfectionists? Comparing success after liver transplantation among patients and physicians. Liver Transpl 2023; 29:400-412. [PMID: 36724877 DOI: 10.1097/lvt.0000000000000012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/25/2022] [Indexed: 02/03/2023]
Abstract
Although both patients and physicians are key stakeholders in health care outcomes, patients and physicians often define success differently. The purpose of this study was to compare patient and physician perceptions of success 1 year after liver transplantation. This was a single-institution, qualitative study. We conducted in-person, semi-structured interviews with liver transplant recipients 1 year after transplantation and virtual interviews with transplant surgeons and hepatologists. Transcripts were coded and iteratively analyzed for themes using the principles of phenomenology. Twenty patients, 8 caregivers, 5 transplant surgeons, and 4 hepatologists were interviewed. Subject interviews averaged 57 (patient) and 27 (physician) minutes. Overall, patients and physicians had significant agreement in their definitions of success, which included avoidance of death, restoration of physical and mental function, return to society, acquisition of new health care knowledge, and open communication between the patient and the physician. Patients highlighted relief from worry about their future health status, and physicians highlighted decreased health care costs. Patients noted that a liver transplant did not have to be perfect, that is free from complications, to be successful. Physicians had a more stringent view and felt that any deviation from an ideal course reduced the relative success of a transplant. Detailed assessment of patient and physician responses reveals similar overall goals of regaining physical, mental, and emotional function. Complications are perceived differently by patients and physicians. Awareness of this discordance may serve to enhance relationships between transplant patients and their providers.
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Affiliation(s)
- Ingrid Woelfel
- Division of Transplantation, Department of Surgery, Ohio State University, Columbus, Ohio, USA
| | - Daria Faulkner
- Division of Transplantation, Department of Surgery, Ohio State University, Columbus, Ohio, USA
| | - Sandra Wong
- Division of Surgical Oncology, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Kenneth Washburn
- Division of Transplantation, Department of Surgery, Ohio State University, Columbus, Ohio, USA
| | - Austin Schenk
- Division of Transplantation, Department of Surgery, Ohio State University, Columbus, Ohio, USA
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