Abstracts

PSYCHOSOCIAL REHABILITATION AFTER INTESTINAL AND MULTIVISCERAL TRANSPLANTATION

Maureen Emerling, Maher Ayyash, Darlene Koritsky, Lillian Martin, Bonita Schuster, June Stamos, Laura Matarese, Geoffrey Bond, Guilherme Costa, Kareem Abu-Elmagd. University of Pittsburgh Medical Center, Thomas E Starzl Transplantation Institute, Pittsburgh, PA.

Purpose: Intestinal transplantation has evolved to be effective therapy for patients with intestinal and TPN failure. With continuous improvement in survival, quality of life has become primary rather than secondary endpoints. With current limitations in relevant scientific publications, this study highlights the therapeutic rehabilitative index with assessment of the global psychosocial status of the patients.

Methods: A total of 112 patients who survived intestinal and multivisceral transplantation with functioning grafts were evaluated and voluntarily participated in full psychosocial assessment. All patients were studied before and after transplantation. The study tools were the standardized Quality of Life Inventory(QOLI), and personal interview of current functional and occupational status. QOLI is a self-reported assessment reviewing 26 life domains.

Results: Before transplantation, 89% of patients were TPN dependent and reported a need for full(73%) or part time(13%) assistance with daily living activities. The remaining 14% adapted to their illness and rarely required significant assistance. Because of the chronic illness and associated complex abdominal pathology, 65% of the patients continued to be narcotic dependent despite efforts to achieve drug rehabilitation from the time of initial evaluation. With a mean follow-up of 48.2+35.4 yrs(range:0.5-186 mos), 109(97%) survivors achieved full nutritional autonomy enjoying unrestricted oral diet. Of these, 92(84%) reached total independence with meaningful life activities. In addition, narcotic dependence was significantly reduced and only 18(16%) patients continued to require narcotics. However, the overall outlook was positive despite the bidirectional changes in the mean scores of QOLI domains. With 20 patients currently in the recovery phase, 92 fully recovered with an occupational rehabilitation rate of 84%. Of these, 29 resumed full time job/studies, 35 were home makers, 9 were senior citizens and 19 did not seek job opportunities because of the fear of losing medical and social security benefits.

Conclusion: Intestinal and multivisceral transplantation achieved a high rehabilitative index with improvement in the psychosocial impairment induced by chronic intestinal failure and TPN therapy. Such an efficiacy could be further improved by early consideration of transplantation.

Top Updated 9/20/06