Factors associated to complexity of patients evaluated for inclusion in orthotopic liver transplantation: a retrospective study.

INTRODUCTION In this retrospective study, the main clinical features of patients waiting for orthotopic liver transplantation (pre-OLTx) assessed at the Consultation-Liaison Psychiatric Service (CLPS) of the Modena General University Hospital were collected and analyzed, with the aim to assist early detection of complex patients. METHODS Relevant information about OLTx patients were extracted from the electronic database of the CLPS. Repeated referral for the same patient was considered as indicator con complexity. RESULTS During five years between 1st of January 2008 and 31st of December 2013, a total of 6011 first psychiatric assessment were performed by the CLPS. Of these, 366 (6.09%) were pre-OLTx assessments. Ninety subject (27.6% of total pre-OLTx assessments) were referred for psychiatric assessment more than once, and precisely: 62.2% twice, 27.8% three times and the remaining 10% more than three times. Main reasons for repeated referral of patients were depression (33 patients, 36,7%) and second evaluation pre-OLTx (35 patients, 38,9%). Repeatedly referred patients had the following features: the majority (56, 62.2%) were male, 61,1% (55) had a lifetime positive psychiatric history, 33.3% (30) were already on psychotropics, but 85.6% (77) were not under regular charge of psychiatric services. Among the 90 patients, a psychiatric disorder was diagnosed in 40 (44.4%) subjects, and the most common was depression/adjustment disorder (37.5%). A psychotropic medication was advised to 42 (46.7%) patients, most commonly antidepressants (42.9%) and benzodiazepines (35.7%). Patients were most commonly back-referred to their GP, but 20 (22.2%) were referred to community mental health care centers or to the CLPS itself. CONCLUSIONS A high number of presumably complex management patients were identified among the group of pre-OLTx, requiring better understanding of factors associated to complexity and need of integrated management.