Psychological consequences of solid organ transplantation. A study among Dutch liver transplant recipients

Organ transplantation has become the treatment of choice for a number of
life-threatening illnesses. As the clinical outcomes and survival of organ
transplantation improve, other outcomes such as health related quality of life
and psychosocial consequences of transplantation become increasingly important
targets of evaluation. Generally, health related quality of life improves after
transplantation but, especially psychological health, does not restore to the
level in the general population. Recent studies show that 40-55% of transplant
recipients experience stress even years after the transplantation. About 12%
experiende hihg levcels of stress,which may lead to poorer psychological health
and poorer adjustment to transplantation. To understand the impact of medical
illnesses on peoples lives the application of a trauma model can be
informative. Transplantation is a life changing, life threatening and potential
life ending experience, which can be felt as traumatic. This traumatic
experience may have negative as well as postive consequences for the
psychological health of transplant recipients. negative consequences include:
anxiety, depression and post traumatic stress (PTS). Positive consequences can
be beneficial psychological adjustment and post traumatic growth (PTG).
So far, 3 studies have been performed on PTS in organ transplant recipients.
These studies show that 5-17% of transplant recipeunst meet the criterai for
Post Traumatic Stress Disorder (PTSD), and another 5-17% of transplant
recipienst are diagnosed with sub treshold PTSD. Though, numerous riskfactors
of PTSD, like personale chracteristiccs transplant related characteristics and
chracteristics of teh consequences of transplantation, are mentioned in these
studies, it is not clear what the most important risk factors are. Also, the
impact of PTS on outcomes as quality of life, psychological health, adherence,
mortality and morbidity are inconclusive. To our knowledge, no research has
been performed on PTG after organ transplantation yet.

This study will focus on the positive and negative psychological consequences
of organ transplantation in Dutch organ transplant recipients. The study will
describe on posttraumatic stress and posttraumatic growth after organ
transplantation, their associated factors and impact on outcome variables.

Objectives of this study
1.To determine the prevalence of posttraumatic stress symptoms and post
traumatic growth in Dutch solid organ transplant recipients.
2.To identify factors associated with posttraumatic stress symptoms and post
traumatic growth in Dutch solid organ transplant recipients.
3.To determine the impact of posttraumatic stress symptoms and post traumatic
growth PTSD on quality of life, psychological health, non compliance, mortality
and morbidity in Dutch solid organ recipients.

With the results of the study counseling programs to prevent negative
consequences of transplantation and to promote positive consequences of
transplantation can be developed.

A prospective cohort study. Liver transplant recipients will be followed before
transplantation (waiting list period) and in the first two years after
transplantation. Data assesment, by questionnaire, will be done before
transplantation and 3, 6, 12 and 24 months after transplantation. Transplant
related characteristics, mortality and morbidity after transplantation will be
assesed by medical record review.

No serious adverse events should be expected. In case participants experience
disadvantages due to participation in the research counseling will be offered
by the department of Health Psychology of the UMCG.
Participants will be asked to fill in a questionaiire 5 times. The time needed
to fill in the questionaire varies between 35 en 60 minutes. Patient enlisted
on the waiting list, if not yet transplanted, will receive a brief
questionnaire every 6 months to updat the pre transplant status of
psychological helath and quality of life. Time investment of this brief
questionnaire is about 20 minutes.