Quality of life,depression and anxiety in potential living liver donors for pediatric recipients:A retrospective single center experience

BACKGROUND Living donor liver transplantation is a safe alternative for patients on a liver transplant list.Donor evaluation goes beyond physical variables to include social,emotional,and ethical aspects.The role of pre-donation sociopsychological evaluation of the donor candidate is as important to the success of the procedure as is the medical assessment.Success implies recovery from the operation and pro-mpt engagement in pre-transplant professional and social activities,without leading to psychological or physical distress.Psychological profiling of potential living liver donors(PLLD)and evaluation of quality of life(QOL)can influence outcomes.AIM To evaluate the socio-demographics and psychological aspects(QOL,depression,and anxiety)of PLLD for pediatric liver transplantation in a cohort of 250 patients.METHODS This was a retrospective cohort study of 250 PLLD who underwent psychological pre-donation evaluation between 2015 and 2019.All the recipients were children.The Beck anxiety inventory,Beck depression inventory,and 36-item short-form health survey(SF-36)scores were used to evaluate anxiety(Beck anxiety inventory),depression(Beck depression inventory),and QOL,respectively.RESULTS A total of 250 PLLD were evaluated.Most of them were women(54.4%),and the mean age was 29.2±7.2 years.A total of 120(48.8%)PLLD were employed at the time of evaluation for donation;however,most had low income(57%earned<2 times the minimum wage).A total of 110 patients(44%)did not finish the donation process,and 247 PLLD answered a questionnaire to evaluate depression,anxiety,and QOL(SF-36).Prevalence of depression was of 5.2%and anxiety 3.6%.Although most of the PLLD were optimistic regarding the donation process and never had doubts about becoming a donor,some traces of ambivalence were observed:46%of the respondents said they would feel relieved if a deceased donor became available.CONCLUSION PLLD had a low prevalence of anxiety and depression.The foundation for effective and satisfactory results can be found in the pre-transplantation process,during which evaluations must follow rigorous criteria to mitigate potential harm in the future.Pre-donation psychological evaluation plays a predictive role in post-donation emotional responses and mental health issues.The impact of such findings on the donation process and outcomes needs to be further investigated.

Should selection criteria for HCC be the same(or different)between LDLT and DDLT?

Since the Milan Criteria(MC)were adopted in many countries as the allocation policy criteria for patients with hepatocellular carcinoma to be transplanted,many groups started to expand it to provide a chance for patients with tumors outside the MC who could achieve similar survival rates.With the scarcity of deceased donors,Asian countries improved the results with living donor liver transplantation,allowing patients outside MC to be transplanted with a living donor.Newer prognostic models and a more profound understanding of tumor behavior are targeting better patient selection.Currently,patients are unevenly selected for liver transplantation and mostly separated into those fulfilling the MC and transplanted with a deceased donor and those with expanded criteria and transplanted with a living donor.In this paper,insight is brought into this debate.