Psychiatric diagnoses are common after liver transplantation and are associated with increased health care utilization and patient financial burden.

Autor:	Lieber SR; Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Jones AR; Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Jiang Y; Department of Statistical Science, Duke University, Durham, North Carolina, USA., Gowda P; Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Patel M; Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Lippe B; Department of Psychiatry, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Shenoy A; Department of Psychiatry, Columbia University Medical Center, New York, New York, USA., Evon DM; Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA., Gurley T; Department of Public Health, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Ngo V; Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Olumesi M; Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Trudeau RE; Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Noriega Ramirez A; Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Jordan-Genco L; Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA.; Department of Psychiatry, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Mufti A; Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., Lee SC; Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA., Singal AG; Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA., VanWagner LB; Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA.
Jazyk:	angličtina
Zdroj:	Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2024 Jun 25. Date of Electronic Publication: 2024 Jun 25.
DOI:	10.1097/LVT.0000000000000390
Abstrakt:	Psychiatric disorders after liver transplantation (LT) are associated with worse patient and graft outcomes, which may be amplified by inadequate treatment. We aimed to characterize the burden of psychiatric disorders, treatment patterns, and associated financial burden among liver transplantation recipients (LTRs). IQVIA PharMetrics (R) Plus for Academics-a large health plan claims database representative of the commercially insured US population-was used to identify psychiatric diagnoses among adult LTRs and assess treatment. Multivariable logistic regression analysis identified factors associated with post-LT psychiatric diagnoses and receipt of pharmacotherapy. Patient financial liability was estimated using adjudicated medical/pharmacy claims for LTRs with and without psychiatric diagnoses. Post-LT psychiatric diagnoses were identified in 395 (29.5%) of 1338 LTRs, of which 106 (26.8%) were incident cases. Treatment varied, with 67.3% receiving pharmacotherapy, 32.1% psychotherapy, 21.0% combination therapy, and 21.5% no treatment. Among 340 LTRs on psychotropic medications before transplant, 24% did not continue them post-LT. Post-LT psychiatric diagnoses were independently associated with female sex, alcohol-associated liver disease (ALD), prolonged LT hospitalization (>2 wk), and pre-LT psychiatric diagnosis. Incident psychiatric diagnoses were associated with female sex, ALD, and prolonged LT hospitalization. Patients with a post-LT psychiatric diagnosis had higher rates of hospitalization (89.6% vs. 81.5%, p <0.001) and financial liability (median $5.5K vs. $4.6K USD, p =0.006). Having a psychiatric diagnosis post-LT was independently associated with experiencing high financial liability >$5K. Over 1 in 4 LTRs had a psychiatric diagnosis in a large national cohort, yet nearly a quarter received no treatment. LTRs with psychiatric diagnoses experienced increased health care utilization and higher financial liability. Sociodemographic and clinical risk factors could inform high-risk subgroups who may benefit from screening and mitigation strategies. (Copyright © 2024 American Association for the Study of Liver Diseases.)
Databáze:	MEDLINE
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