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Factors that may predict health outcomes following liver transplantation

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The number of liver transplants performed in the U.S. has more than doubled since 1998, an increase largely due to medical and surgical advances that have dramatically improved the procedure’s success rate. However, patients play an equally important role in ensuring their own good health and prolonging survival if they follow the prescribed life-long course of treatment and lifestyle changes.

While compliance with post-transplant regimens has been studied in other transplant populations, such as heart, lung and kidney recipients, little is known about the extent to which adherence influences outcomes in liver recipients. With a $1.6 million grant from the National Institutes of Health, researchers from the University of Pittsburgh Schools of Nursing, Medicine and Pharmacy will conduct the first-known prospective study to pinpoint the characteristics of liver recipients who fare best after their transplants and determine what individual and environmental factors affect adherence and outcomes. With such information, clinicians should be able to identify patients early in the transplant process who may require individualized interventions to maximize transplant benefits.”In the liver transplant population, we and others have primarily studied alcohol relapse in patients who received transplants due to alcoholic cirrhosis. In this study, we will be looking at all liver transplant patients and at adherence to the entire treatment regimen, which includes much more than abstinence from alcohol. It includes taking medications on a regular basis, keeping clinic appointments and sustaining recommended lifestyle changes,” said principal investigator Carol Stilley, Ph.D., R.N., an assistant professor of nursing and psychiatry at the School of Nursing and project director at its Center for Research in Chronic Disorders. “Yet, compared to kidney and heart transplant patients, who have been studied fairly extensively, liver transplant patients are more diverse in terms of their psychosocial, behavioral and medical histories. As such, we think they may differ in their patterns of adherence, which are likely to affect health outcomes as well.”A good prognosis is partially dependent on the level of a patient’s dedication to a complicated regimen that involves multiple medications, numerous checkups, lab tests and biopsies to monitor ongoing health status, and abstinence from high-risk behaviors such as alcohol abuse, smoking, promiscuous sexual activity and intravenous drug use that can lead to diseases that could potentially destroy the new liver. Through a variety of methods, the researchers will collect data that reflect patient behaviors in those areas.By examining that data, Dr. Stilley and her colleagues hope to identify patterns that differentiate patients and put them at risk for developing post-transplant complications or contribute to their successful recovery. Furthermore, the study will attempt to determine which individual and environmental factors contribute to variations in compliance and health outcomes. Such factors may include emotional stability, impulse control, family and social support and access to health care. “Research in other transplant populations has suggested that better adherence to the treatment regimen leads to better outcomes,” Dr. Stilley said. “If we can determine which personal and environmental factors influence adherence, we may be able to help clinicians better identify patients who will need interventions and additional support in order to maintain their post-transplant course of care.”Without evidence-based guidelines to help them specifically target potentially vulnerable liver transplant patients, clinicians find it challenging to maximize the procedure’s benefits. The failure to identify at-risk patients is not only costly to the patients, but it drains the resources of the health care system and society as well. This study’s results will help in the development of assessments and interventions that allow clinicians to take action earlier to promote more positive outcomes. (Source: University of Pittsburgh School of Nursing, Medicine and Pharmacy: May 2006.)


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Posted On: 22 May, 2006
Modified On: 16 January, 2014

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