A study led by UT Southwestern Medical Center (UTSMC) found that the resilience and coping abilities of people who have had liver transplants may evolve over time according to sociodemographic factors, such as race, income and education, reports a UTSMC news release.

“When we take care of patients who have gone through this life-changing surgery, recovery really evolves over time,” lead study author and transplant hepatologist Sarah Lieber, MD, MSCR, told UTSMC. “We don’t fully understand or capture that with current metrics that focus on mainly clinical outcomes, such as survival. The aim of this project was to get a more in-depth view of novel patient-reported concepts at different stages of survivorship.”

Lieber, an assistant professor of internal medicine at UTSMC, noted that for the thousands of people with diseases or trauma affecting the liver, transplantation may offer a potential cure; however, the road to recovery may be paved with physical, emotional and psychological difficulties.

For the study, published in Liver Transplantation, UTSMC researchers emailed a survey to hundreds of patients who had liver transplants between January 1990 and November 2019. The survey gathered sociodemographic data including age, sex, race, ethnicity, education level and income. It also inquired about pretransplant characteristics, such as reason for transplantation, time spent on the waiting list and psychiatric history as well as posttransplant characteristics, including duration of hospital stay, employment status and whether patients had a caregiver, according to the news release.

The survey also asked patients about their ability to positively cope, their ability to adapt and grow from a traumatic event (also known as level of posttraumatic growth), resilience and symptoms of anxiety and depression.

A total of 191 surveys were completed. Respondents ranged from 28 to 83 years old, 64% were male and 84% were white. Survivorship ranged from less than a year posttransplant to more than 10 years.

The survey results showed that 85% of patients in the early survival period of one year or less experienced high posttraumatic growth, compared with only about 15% of late survivors (those who’d survived between five and 10 years). Only about 33% of survivors reported high resilience, which was associated with relatively high income, according to the news release.

Those who reported a lower ability to cope posttransplant were more likely to be 65 or older and non-Caucasian, have less education and to have needed a transplant for a nonviral liver disease.

About 25% of liver transplant survivors experienced significant anxiety and depression, which was more frequent among early survivors and women with mental health disorders pretransplant, according to Lieber.

Researchers noted that identifying these characteristics may help clinicians develop interventions to improve outcomes and quality of life.

“High-quality care of patients after liver transplant includes treating the whole person,” Lieber said. “Survivorship research informs how we develop and implement interventions to help our transplant community.”