Psychiatric approach of liver transplant.

Abstract

There is enough evidence about the importance psychiatric disorders (in the pre or post-operative period) have on the transplanted patient's clinical evolution and quality of life. In this review we describe, the main psychiatric items involved in the selection of candidates and accompaniment of transplanted patients. We concluded that psychiatric disorders are common in candidates in the pre-operative period. In this period the prevalence of depression is 33%, anxiety 34%, alcohol dependence/abuse (in hepatic transplant candidates) 59%, delirium 24% and alexithymia 28%. Psychiatric disorders are also common in candidates in the post-operative period. In this period the prevalence of depression is 30%, anxiety 26%, delirium 30%, PTSD 6.4% and psychosis 7.5%. The alcohol relapse after liver transplant occurs in about 29% of the transplanted patients. Patients with liver disease present metabolic specificities. In this article we list the psychiatric medications that are indicated in these kind of patients. Quality of life of the transplanted patient is determined by many factors such as neuropsychiatric status, psychiatric accompaniment, social support, planification, diet and compliance. Living donors must not be accepted when factors such as coercion and financial incentives or no understanding of the risks inherent in hepatic lobectomy are present.