Evaluation of quality of life, psychopathology and stress disorders in children and adolescent patients that wait for liver transplantation

The aim of this study was to evaluate the quality of life, prevalence of psychopathology, and post-traumatic stress disorder in pediatric patients at the liver transplantation waiting list and who had undergone liver transplantation. All children and adolescents aged 5-18 years who had undergone liver transplantation in the Transplantation Unit of the Hospital of Akdeniz University and followed up for 2 months-5 years in the outpatient clinics (n:20) and their parents (transplantation group-TxG), and the children and adolescents at the liver transplantation waiting list (n:10) and their parents (pre-transplantation group-pTxG) were included in the study between the dates January 2017-December 2017. Children with previous application to the child and adolescent psychiatry, mental developmental delay and diseases disrupting reality testing were excluded before. A total of 20 children and adolescents, without any medical illness and/or mental retardation and age- and gender-matched with the patient group, consisted the control group. All children and parents were invited to the clinic and interviewed by a child psychiatrist. The Pediatric Quality of Life Inventory (PedsQL) was used to assess the quality of life of children and adolescents. The Child Depression Inventory (CDI) and The Screen for Child Anxiety Related Disorders (SCARED) were administered to determine the psychopathologies that may be present. Child Posttraumatic Stress disorder-Reaction Index (CPTSD-RI) was given to children and adolescents to evaluate post-traumatic stress disorder. When the groups were compared in terms of PedsQL scores reported by children; in the control group, the total quality of life scale scores were found to be significantly higher than TxG and pTxG. There was no significant difference between TxG and pTxG in terms of quality of life scores of children. When the groups were compared in terms of the PedsQL scores reported by the parents; in the control group, the total score of quality of life was significantly higher than that of TxG. However, there was no significant difference between pTxG and control group. Although the quality of life scores reported by parents in TxG were lower than those of pTxG, this difference was not statistically significant. In TxG, clinically significant anxiety was found in 17 (85%) of the patients, whereas it was 7 (70%) in pTxG and 2 (10%) in the control group. A significant difference was found between the study groups and the control group in terms of clinically significant anxiety level rates. There was clinically significant depression in 4 patients (20%) in TxG, 2 patients (20%) in pTxG and 1 patient in control group (5%). There was no significant difference between the three groups in terms of the number of patients with clinically significant depression. When the anxiety and depression scale scores of the groups were compared, scores of the control group were significantly lower than TxG and pTxG. There was no significant difference between TxG and pTxG scores for both of the scales. Clinically significant PTSD was detected in 11 (55%) patients in the TxG, 6 (60%) in the pTxG and 2 (10%) in the control group. Clinically significant PTSD was significantly higher in both study groups, compared to the control group. When 3 groups were compared in terms of CPTSD-RI scores, the scores of the control group were significantly lower than that of TxG and pTxG. However, there was no significant difference between TxG and pTxG in terms of trauma scores. In conclusion, high prevalence of psychiatric disorders and low quality of life were determined in TxG and pTxG, compared to their healthy peers. These findings indicate that pediatric patients at the waiting list were at peril, in terms of psychiatric disorders, and the risk continues during the post-tx period. In this regard, regular psychiatric evaluation and follow-up is essential for tx patients at all stages of treatment. Keywords: Pediatric, liver transplantation, quality of life, anxiety, depression, posttraumatic stress disorder