Interventions and clinical outcomes in patients excluded from liver transplant evaluation at a referral center
DOI:
https://doi.org/10.59093/27112330.122Keywords:
hepatic transplantation, preoperative evaluation, clinical outcomes, psychology, social work, postoperative complications.Abstract
Introduction. Liver transplantation is the treatment of choice for patients with end-stage liver disease of any etiology. The success of the intervention depends on the appropriate selection of both donor and recipient. Biopsychosocial determinants influence the rate of complications and post-transplant mortality. The objective of this article is to identify interventions and clinical outcomes in patients indicated for liver transplantation who were excluded from pre-transplant evaluation by the psychology and social work departments between January 2019 and December 2021 at a liver transplant referral center in Bogotá. Methodology. Cross-sectional study conducted on adult patients clinically indicated for liver transplantation who were deemed ineligible for pre-transplant evaluation during the social work and psychology assessments between January 2019 and December 2021. Results. Initially, 565 candidates for liver pre-transplant evaluation were identified. Among these, 122 patients evaluated by the psychology and social work departments were not deemed suitable to proceed with evaluation and were included in the study. Of this group, 58.2% (n=71) were male, 77% (n=94) were affiliated with the contributory regime, and 38.5% (n=47) had only completed primary education. Additionally, 34.4% (n=42) were unemployed, with a median monthly income of $1,000,000 COP (IQR $800,000-$1,950,000). A total of 32.5% (n=37) of these patients were eventually included in the pre-transplant study after receiving some form of intervention. Significant differences were observed in the activation of extended family networks between the group of patients included and not included in the pre-transplant study (48.6% vs 0.0%). Conclusion. Interventions conducted by the multidisciplinary transplant support team increase access to pre-transplant evaluation, waiting list inclusion, and transplantation for initially ineligible patients due to various modifiable causes addressed by these tools.
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