Ein manualisiertes Gruppentherapiekonzept für alkoholabhängige Patienten vor der Lebertransplantation/ Manualised group therapy concept for patients with alcoholic cirrhosis awaiting liver transplantation

A review of behavioral alcohol interventions for transplant candidates and recipients with alcohol-related liver disease

Alcohol-related liver disease (ALD) is a common indication for liver transplantation. Reflecting growing consensus that early transplant (ie, prior to sustained abstinence) can be a viable option for acute alcoholic hepatitis, access to liver transplantation for ALD patients has increased. Prevention of alcohol relapse is critical to pretransplant stabilization and posttransplant survival. Behavioral interventions are a fundamental component of alcohol use disorder treatment, but have rarely been studied in the transplant context. This scoping review summarizes published reports of behavioral and psychosocial alcohol interventions conducted with ALD patients who were liver transplant candidates and/or recipients. A structured review identified 11 eligible reports (3 original research studies, 8 descriptive papers). Intervention characteristics and clinical outcomes were summarized. Interventions varied significantly in orientation, content, delivery format, and timing/duration. Observational findings illustrate the importance of situating alcohol interventions within a multidisciplinary treatment context, and suggest the potential efficacy of cognitive-behavioral and motivational enhancement interventions. However, given extremely limited research evaluating behavioral alcohol interventions among ALD patients, the efficacy of behavioral interventions for pre- and posttransplant alcohol relapse remains to be established.

[Stress symptoms and health-related quality of life in patients after orthotopic liver transplantation]

OBJECTIVES

The study explored the presence of stress symptoms among orthotopic liver transplantation (OLT) recipients and investigated how stress symptoms are linked to health-related quality of life (HRQOL). A new concept of adjustment disorder as a stress response syndrome according to Maercker was considered.

METHODS

We recruited 76 OLT recipients, all of whom had been treated in the Department of Surgery, Division of Transplantation Surgery, University of Medicine of Graz, Austria. A self-rating scale was administered to evaluate stress symptoms (PTSS-10). The data on health-related quality of life were obtained from the SF-36 (Health Status Questionnaire).

RESULTS

Following OLT 30.3 % (n = 23) of the sample suffered from stress symptoms. In the group of patients suffering from stress symptoms there were significant impairments in health related quality of life in the SF-36 health-related domains physical functioning, role physical, pain, general health, vitality, social functioning, role emotional, and mental health.

CONCLUSIONS

OLT recipients may face a major risk of OLT-related postoperative stress symptoms in the sense of adjustment disorders according to Maercker. Stress symptoms are highly associated with impairments in quality of life.

[Psychiatric assessment of alcoholic patients on a waiting list for liver transplantation: which prognostic criteria are empirically proven?]

Liver disorders are the most frequent somatic complications of alcoholism. As 10‑20% of alcoholic patients will develop liver cirrhosis, this is the most frequent reason for premature death in alcoholic patients. Liver transplantation is now an accepted therapy for alcoholic liver cirrhosis but psychiatric assessment is usually required for patients entering a waiting list for transplantation. Prognostic criteria are controversially discussed, especially the so-called 6-month rule. Numerous studies and recent meta-analyses have indicated that duration of alcoholism, family history, age, sex, comorbid substance use and psychiatric disorders, noncompliance and social instability are outcome predictors. The 6-month criterion is not well proven but some studies are indicative. Possible therapeutic interventions for alcoholic patients on a waiting list are discussed.

[Subjective experiences following organ transplantation--a qualitative study of 120 heart, lung, liver, and kidney recipients]

OBJECTIVES

The communication with patients who have undergoned transplantation is greatly influenced by their subjective experience. This paper deals with this subjective transplant-specific experience six months after surgery.

METHODS

Following their heart, lung, liver, or kidney transplantation, 120 patients were questioned concerning their experiences regarding the transplantation, the organ itself, and changes in their personal life. Their statements were investigated by qualitative content analysis.

RESULTS

Generally, the statements concerning the transplantation were positive. Interpersonal contact with the medical staff and or family members was perceived as very helpful. Two-thirds of the patients spoke openly about their organ. For the most part, their statements about changes in their personal life were positive, expressed in the sense of personal growth. Fears and insecurities occurred as negative changes.

CONCLUSIONS

On the whole, the majority of the patients expressed positive experiences regarding their transplantation. Interpersonal and supportive relationships played a significant role.

[Stabilisation of abstinence by means of psychoeducation for patients with alcoholic liver disease awaiting liver transplantation]

BACKGROUND

A manualised six-month psychoeducational intervention was conducted in patients with alcoholic liver disease and abstinence problems who were waiting for a transplantation.

OBJECTIVES

In a naturalistic design it was investigated whether the intervention could improve patients' alcohol abstinence.

METHODS

Between January 2002 and November 2003, 72 patients were enrolled in the therapeutic intervention, 48 of whom participated in group therapy. Health-related quality of life (SF-12), anxiety and depression (HADS-D), symptom strain (BSI) and social support (F-SOZU) were measured. Alcohol abstinence was examined in each group session by measuring the alcohol concentration in breath.

RESULTS

At the beginning and end of the group therapy patients showed subsyndromal measures of anxiety and depression and minor symptoms of psychopathology. Physical quality of life was reduced (t = -8.694; df = 44; p < .001). Mental quality of life was in the range of the normative sample and was correlated with depression (r = -0.400; p = .009). Patients perceived high social support (t = 8.213; df = 45; p < .001). During the course of therapy four patients had relapses but the remaining patients stayed abstinent. Physical quality of life improved (t = -2.275; df = 27; p = .031), mental quality of life and symptom strain remained stable.

CONCLUSIONS

The therapy presented here facilitated a stabilisation of mental well-being in patients with alcoholic liver disease who were waiting for organ transplantation. The relapse rate measured by alcohol concentration in breath remained low.