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What’s on your mind?

Emotions and perceptions of liver transplant candidates and recipients
PhD ceremony:dr. J.H. (Coby) Annema-de Jong
When:January 09, 2017
Supervisors:prof. dr. A.V. (Adelita) Ranchor, P.F. (Petrie) Roodbol, prof. dr. R.J. (Robert) Porte
Where:Academy building RUG
Faculty:Medical Sciences / UMCG

Psychological stress common after liver transplant

Approximately one third of all adult liver transplant patients in the Netherlands experience psychological problems such as anxiety, depression or post-traumatic stress (PTS). They are often caused by the side-effects of immunosuppressive medication or symptoms of illness. These are findings from research conducted by nurse and researcher Coby Annema at the University Medical Center Groningen. She will be awarded a PhD by the University of Groningen on 9 January.

Undergoing a liver transplant is a major event in a person’s life. Although a transplant usually has a positive effect on the patient’s health and quality of life, the transplant process itself involves a great deal of stress. Patients with a life-threatening illness must wait for a suitable donor before undergoing a major operation. After the transplant, patients have to follow strict rules, remain on medication for the rest of their lives, and there is always a risk of medical complications. Even though liver transplants have been carried out in the Netherlands since 1979, very little is known about the psychological wellbeing of transplant patients. Coby Annema’s research explores this topic, with the aim of optimizing psycho-social care for liver transplant patients both before and after the transplant.  

One third of patients experience psychological problems

Annema studied 281 patients who had undergone a liver transplant in the University Medical Center Groningen between 1979 and 2009. Her research revealed that psychological problems are present both in the short and the long term. Ten years after receiving a new liver, over 35% of patients reported psychological problems, most commonly anxiety (33%) and depression (23%).

Poorer quality of life and lower compliance

A study by Annema of 260 patients from all the liver transplant centres in the Netherlands shows that 49% of patients on the waiting list experience symptoms of anxiety, 34% experience symptoms of depression, and 32% experience symptoms of PTS. Once patients start to experience anxiety or depression, this tends to last throughout the waiting period. Although the transplant generally has a positive effect on their psychological functioning, some patients continue to experience psychological problems (23% anxiety, 29% depression, 15% PTS) during the two years immediately after the transplant. Some of these problems are caused by clinical variables such as symptoms of illness and the side-effects of medication. Individual characteristics, such as the way in which someone deals with problems and feelings of lacking control, can also cause psychological problems. Annema distinguished different trajectories of psychological symptoms. She discovered that patients who continue to experience anxiety and depression after a transplant have a poorer quality of life and are less compliant with therapy.

Importance of psychological help

According to Annema, her results emphasize the importance of psycho-social screening and support in the care offered to liver transplant patients throughout the transplant process. She would advise to screen for psychological problems early on and to continue screening throughout the transplant process so that appropriate psycho-social support can be provided. She also recommends appointing a psychological or psychiatric healthcare professional to transplant teams.

Curriculum vitae

Coby Annema-de Jong (1966, Bedum) studied Nursing Science at Maastricht University. She conducted her research at the SHARE research institute of the UMCG. Her thesis is entitled: ‘What’s on your mind? Emotions and perceptions of liver transplant candidates and recipients’. She will continue working as a post-doc researcher at the UMCG after receiving her PhD.