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Psychother Psychosom Med Psychol 2001; 51(12): 438-446
DOI: 10.1055/s-2001-19403
Übersichtsarbeit
© Georg Thieme Verlag Stuttgart · New York

Psychosomatische Betreuung von Transplantationspatienten

Fakten und NotwendigkeitenPsychosomatic Medicine and Transplant Patients - What is Known and what is NeededBernd  Johann1 , Yesim  Erim1
  • 1Klinik für Psychotherapie und Psychosomatik (Direktor: Prof. Dr. Wolfgang Senf), Universitätsklinikum Essen
Bernd Johann verstarb am 2. 6. 2001
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Publication History

25. 6. 2001

13. 9. 2001

Publication Date:
02 January 2002 (online)

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Zusammenfassung

Die Psychosomatik in der Transplantationsmedizin hat eine umfangreiche Datenbasis erarbeitet, die es erlaubt, den psychischen Zustand der Patienten und ihrer Angehörigen im Verlaufe des Transplantationsprozesses zu beschreiben und wichtige prognostische Faktoren sowohl für das somatische Outcome als auch für das psychische Befinden der Patienten zu isolieren. In der vorliegenden Literaturübersicht soll ein Überblick über praxisrelevante Ergebnisse der Psychosomatik in der Transplantationsmedizin vermittelt werden. Dabei liegt der Schwerpunkt auf der Betrachtung der Copingprozesse des Organempfängers und seiner Angehörigen. Auf die spezielle Problematik der Lebendorganspende wird nicht eingegangen. Es wird versucht, aus den vorliegenden Daten Perspektiven für die Entwicklung psychosomatischer Interventionen in der Betreuung von Transplantationspatienten abzuleiten.

Abstract

Psychosomatic research has resulted in a huge pool of data concerning the psychic state of transplant patients and their relatives during the course of organ transplantation. It has been possible as well to describe important psychosocial prognostic factors, influencing both somatic and psychosocial outcome after transplantation. The following review article gives an overview of the results that are relevant to daily psychosomatic practice in transplantation medicine. It mainly deals with the problems of transplant patients and their relatives. The special issues of living related organ donation cannot be subject of this review. Finally the article tries to show perspectives for the development of psychosomatic interventions in the treatment of organ transplant patients.

Key words

Organ transplantation - Psychiatric morbidity - Compliance - Social support - Prognostic psychosocial factors - Psychotherapeutic interventions

Literatur

  • 1 Abbey S, Farrow S. Group therapy and organ transplantation.  International Journal of Group Psychotherapy. 1998;  48 163-185
    PubMedGoogle Scholar
  • 2 Abschlussbericht der Fachgruppe Transplantation an den Koordinierungsausschuss zur Weiterentwicklung und Pflege von Fallpauschalen und Sonderentgelten 29.4.99 (unveröffentlichtes Manuskript). 
    Google Scholar
  • 3 Albert W, Schmid P, Heidmann V, Hetzer R. Non-compliant behavior in post-heart-transplant adolescents. The First European Symposium on Non-Compliance in Transplantation 1999 Abstract 9
    Google Scholar
  • 4 Auerbach S. Trait-state anxiety and adjustment to surgery.  J Consult Clin Psych. 1973;  40 264-271
    PubMedGoogle Scholar
  • 5 Beck D, Fennell R, Yost R, Robinson J, Geary D, Richards G. Evaluation of an educational programme on compliance with medication regimens in paediatric patients with renal transplants.  J Paediatr. 1980;  96 1094
    PubMedGoogle Scholar
  • 6 Belle S, Porayko M, Hoofnagle J, Lake J, Zetterman R. Changes in Quality of Life after Liver Transplantation among Adults.  Liver Transplantation and Surgery. 1997;  3 93-104
    PubMedGoogle Scholar
  • 7 Berlakovich G, Steininger R, Herbst F, Barlan M, Mittlböck M, Mühlbacher F. Efficacy of liver transplantation for alcoholic cirrhosis with respect to recidivism and compliance.  Transplantation. 1994;  58 560-565
    PubMedGoogle Scholar
  • 8 Bird G, O'Grady J, Harvey F, Calne R, Williams R. Liver transplantation in patients with alcoholic cirrhosis: selection criteria and rates of survival and relapse.  British Medical Journal. 1990;  301 15-17
    PubMedGoogle Scholar
  • 9 Bundesärztekammer . Richtlinien zur Organtransplantation gemäß § 16 Transplantationsgesetz.  Deutsches Ärzteblatt. 2000;  97, Heft 7 A396-A411
    PubMedGoogle Scholar
  • 10 Bunzel B. Herztransplantation: psychosoziale Grundlagen und Forschungsergebnisse zur Lebensqualität. Stuttgart; Thieme 1993: 41ff
    Google Scholar
  • 11 Bunzel B, Laederach-Hofmann K. Noncompliance in der Organtransplantation: ein Überblick. Wiener Klinische Wochenschrift 2000 (in press)
    Google Scholar
  • 12 Carnrike C, McCracken L, Aikens J. Social desirability, perceived stress and PACT ratings in lung transplant candidates: a preliminary investigation.  Journal of Clinical Psychology in Medical Settings. 1996;  3 57-67
    PubMedGoogle Scholar
  • 13 Chacko R, Harper R, Gotto J, Young J. Psychiatric Interview and Psychometric Predictors of Cardiac Transplant Survival.  American Journal of Psychiatry. 1996;  153 1607-1612
    PubMedGoogle Scholar
  • 14 Cifani L, Vargo R. Teaching strategies for the transplant recipient: a review and future directions.  Focus on Critical Care. 1990;  17 476-479
    PubMedGoogle Scholar
  • 15 Coffman K, Hoffman A, Sher L, Rojter S, Vierling J, Makowka L. Treatment of the Postoperative Alcoholic Liver Transplant Recipient with other Addictions Liver.  Transplantation and Surgery. 1997;  3 322-327
    PubMedGoogle Scholar
  • 16 Collis I, Burroughs A, Rolles K, Lloyd G. Psychiatric and Social Outcome of Liver Transplantation.  British Journal of Psychiatry. 1995;  166 521-524
    PubMedGoogle Scholar
  • 17 Combs C. Theories of group intervention.  Transplantation Proceedings. 1999;  31, Suppl 4A 46S-47S
    CrossrefPubMedGoogle Scholar
  • 18 De Geest S, Abraham I, Moons P, Vandeputte M, Van Cleemput J, Evers G, Daenen W. Late Acute Rejections and subclinical Noncompliance With Cyclosporine Therapy in Heart Transplant Recipients.  The Journal of Heart and Lung Transplantation. 1998;  17 854-863
    PubMedGoogle Scholar
  • 19 De Geest S, Borgermans L, Gemoets H, Abrahm I, Vlaminc H, Evers G, Vanrentergh Y. Incidence, Determinants and Consequences of Subclinical Noncompliance with Immunosuppressive Therapy in Renal Transplant Recipients.  Transplantation. 1995;  59 340-347
    CrossrefPubMedGoogle Scholar
  • 20 Deshields T, McDonough E, Mannen R, Miller L. Psychological and cognitive status before and after heart transplantation.  General Hospital Psychiatry. 1996;  18 62-69
    CrossrefPubMedGoogle Scholar
  • 21 Deshields T, Mannen K, Tait R, Bajaj V. Quality of life in heart transplant candidates.  Journal of Clinical Psychology in Medical Settings. 1997;  14 327-341
    PubMedGoogle Scholar
  • 22 Dew M, Kormos R, Roth L, Murali S, DiMartini A, Griffith B. Early Post-Transplant Medical Compliance and Mental Health Predict Physical Morbidity and Mortality One to Three Years After Heart Transplantation.  The Journal of Heart and Lung Transplantation. 1999;  18 549-562
    CrossrefPubMedGoogle Scholar
  • 23 Dew M, Goycoolea J, Stukas A, Switzer G, Simmons R, Roth L, DiMartini A. Temporal Profiles of Physical Health in Family Members of Heart Transplant Recipients: Predictors of Health Change During Caregiving.  Health Psychology. 1998;  17 138-151
    CrossrefPubMedGoogle Scholar
  • 24 Dew M, Roth L, Schulberg H, Simmons R, Kormos R, Trzepacz P, Griffith B. Prevalence and Predictors of Depression and Anxiety Related Disorders During the Year After Heart Transplantation.  General Hospital Psychiatry. 1996;  18 48-61
    CrossrefPubMedGoogle Scholar
  • 25 Dew M, Roth L, Thompson M, Kormos R, Griffith B. Medical Compliance and its predictors in the first year after Heart Transplantation.  J Heart Lung Transplant. 1996;  15 631-645
    PubMedGoogle Scholar
  • 26 Dew M, Simmons R, Roth L, Schulberg H, Thompson M, Armitage J, Griffith B. Psychosocial Predictors of Vulnerability to Distress in The Year Following Heart Transplantation.  Psychological Medicine. 1994;  24 929-945
    PubMedGoogle Scholar
  • 27 Douglas S, Blixen C, Rossman Bartucci M. Relationship between pretransplant noncompliance and posttransplant outcomes in renal transplant recipients.  Journal of Transplant Coordination. 1996;  6 53-58
    PubMedGoogle Scholar
  • 28 Everson G, Bharadhwaj G, House R, Talamantes M, Bilir B, Beresford T. Long-term follow-up of patients with alcoholic liver disease who underwent hepatic transplantation.  Liver Transplantation and Surgery. 1997;  3 263-274
    PubMedGoogle Scholar
  • 29 Faulk J. Peer-to-peer transplant mentor program: the San Diego experience.  Transplantation Proceedings 1999;. 31;  Suppl 4A 75S
    PubMedGoogle Scholar
  • 30 Fawzy I, Fawzy N. A Structured Psychoeducational Intervention for Cancer Patients.  General Hospital Psychiatry. 1994;  16 149-192
    CrossrefPubMedGoogle Scholar
  • 31 Frazier P, Davis-Ali S, Dahl K. Correlates of Noncompliance Among Renal Transplant Recipients.  Clinical Transplantation. 1994;  8 550-557
    PubMedGoogle Scholar
  • 32 Frazier P, Davis-Ali S, Dahl K. Stressors, Social Support And Adjustment In Kidney Transplant Patients And Their Spouses.  Social Work in Health Care. 1995;  21 93-108
    CrossrefPubMedGoogle Scholar
  • 33 Fukinushi I, Hasegawa A, Ohara T, Aikawa A, Hatanaka A, Suzuki J, Kikushi M, Amagasaki T. Kidney Transplantation and liaison psychiatry part I: anxiety before and the prevalence rate of psychiatric disorders before and after transplantation.  Psychiatry and Clinical Neurosciences. 1997;  51 301-304
    PubMedGoogle Scholar
  • 34 Garcia V, Bittar A, Keitel E, Goldani J, Minozzo M, Pontremoli M, Garcia C, Neumann J. Patient Noncompliance as a Major Cause of Kidney Graft Failure.  Transplantation Proceedings. 1997;  29 252-254
    CrossrefPubMedGoogle Scholar
  • 35 Gerhardt T, Goldstein R, Urschel H, Tripp L, Levy M, Husberg B, Jennings L, Gonwa T. Alcohol use following liver transplantation for alcoholic cirrhosis.  Transplantation. 1996;  62 1060-1063
    CrossrefPubMedGoogle Scholar
  • 36 Gier M, Levick M, Blazina P. Stress reduction with heart transplant patients and their families: a multidisciplinary approach.  Journal of Heart Transplant. 1988;  7 342-347
    PubMedGoogle Scholar
  • 37 Grady K, Jalowiec A, White-Williams C, Hetfleisch M, Penicook J, Blood M. Heart Transplant Candidates' Perception of helpfulness of health Care Provider Interventions.  Cardiovascular Nursing. 1993;  29 33-37
    PubMedGoogle Scholar
  • 38 Grady K, Jalowiec A, White-Williams C. Predictors of quality of life in patients at one year after heart transplantation.  The Journal of Heart and Lung Transplantation. 1999;  18 202-210
    PubMedGoogle Scholar
  • 39 Harper R, Chacko R, Kotik-Harper D, Young J, Gotto J. Self-Report Evaluation of Health Behavior, Stress Vulnerability and Medical Outcome of Heart Transplant Recipients.  Psychosomatic Medicine. 1998;  60 563-569
    PubMedGoogle Scholar
  • 40 Hathaway D, Combs C, De Geest S, Stergachis A, Moore L. The perceptions of transplant clinicians regarding patient compliance. The First European Symposium on Non-Compliance in Transplantation 1999 Abstract 7
    Google Scholar
  • 41 Herzog T, Stein B. (Hrsg) .Praxisleitlinien für die Konsiliar- und Liaisonversorgung in der Psychosomatischen und Psychotherapeutischen Medizin. Quellentext Unveröffentlichtes Manuskript Januar 1999
    Google Scholar
  • 42 Heyink J, Tymstra T, Sloof M, Klompmaker I. Liver Transplantation - Psychosocial Problems Following The Operation.  Transplantation. 1990;  49 1018-1019
    PubMedGoogle Scholar
  • 43 Hilbrands L, Hoitsma A, Koene R. Medication Compliance after Renal Transplantation.  Transplantation. 1995;  60 914-920
    PubMedGoogle Scholar
  • 44 Hoevels R, Schlehofer B, Zipfel S, Löwe B, Herzog W, Bergmann G. Psychotherapeutische und psychosoziale Betreuung von Herztransplantationspatienten. In: Johann B, Lange R (Hrsg) Psychotherapeutische Interventionen in der Transplantationsmedizin. Lengerich; Pabst Science Publishers 1999
    Google Scholar
  • 45 Howard L, Fahy T, Wong P, Sherman D, Gane E, Williams R. Psychiatric outcome in alcoholic liver transplant patients.  Q J Med. 1994;  87 731-736
    PubMedGoogle Scholar
  • 46 Howard L, Fahy T. Liver transplantation for alcoholic liver disease.  British Journal of Psychiatry. 1997;  171 497-500
    PubMedGoogle Scholar
  • 47 Johann B, Lorenzen J. Die psychosomatische Evaluation von Lebertransplantationspatienten, Anwendungsmöglichkeiten der Transplant-Evaluation-Rating-Scale. In: Johann B, Erhard J (Hrsg) Psychosomatische Betreuung von Transplantationspatienten. Lengerich; Pabst Science Publishers 1997
    Google Scholar
  • 48 Johann B, Senf W. Das subjektive Element in der Transplantationsmedizin. Die Untersuchung psychosozialer Prädiktoren der Transplantation und ihrer Ergebnisse bezüglich der Lebensqualität.  Zentralblatt für Chirurgie. 1999;  124 84-89
    PubMedGoogle Scholar
  • 49 Konstam V, Surman O, Hizzazi K, Fierstein J, Konstam M, Turbett A, Dec G. Marital Adjustment in Heart Transplantation Patients And Their Spouses: A Longitudinal Perspective.  The American Journal of Family Therapy. 1988;  26 147-158
    PubMedGoogle Scholar
  • 50 Kuhn W, Myers B, Brennan F, Davis M, Lippmann S, Laman A, Pool G. Psychopathology in Heart Transplant Candidates.  The Journal of Heart Transplantation. 1988;  7 223-226
    PubMedGoogle Scholar
  • 51 Kumar S, Stauber R, Gavaler J, Basista M, Dindzans V, Schade R, Rabinovitz M, Tarter R. Orthotopic liver transplantation for alcoholic liver disease.  Hepatology. 1990;  11 159-164
    PubMedGoogle Scholar
  • 52 Leedham B, Meyerowitz B, Muirhead J, Frist W. Positive expectations predict health after heart transplantation.  Health Psychology. 1995;  14 74-79
    CrossrefPubMedGoogle Scholar
  • 53 Martin S, De Geest S, Vandevelde B, Droogne W, Van Cleemput J, Vanhaecke J. The ambulatory follow-up of heart transplant recipients at the University Hospitals of Leuven: optimising organisational factors that might influence compliance behaviour. First European Symposium on Non-Compliance in Transplantation 2000 Poster 15
    Google Scholar
  • 54 McQuellon R, Russel G, Rambo T, Craven B, Radford J, Perry J, Cruz J, Hurd D. Quality of life and psychological distress of bone marrow transplant recipients: the time trajectory to recovery over the first year.  Bone Marrow Transplantation. 1998;  21 477-486
    CrossrefPubMedGoogle Scholar
  • 55 Mishel M, Murdaugh C. Family adjustment to heart transplantation: Redesigning the dream.  Nurs Research. 1987;  36 332-338
    PubMedGoogle Scholar
  • 56 Olbrisch M, Levenson J. Psychosocial Assessment of Organ Transplant Candidates - Current Status and Methodological and Philosophical Issues.  Psychosomatics. 1995;  36 236-243
    PubMedGoogle Scholar
  • 57 Osorio R, Ascher N, Avery M, Bacchetti P, Roberts J, Lake J. Predicting recidivism after orthotopic liver transplantation for alcoholic liver disease.  Hepatology. 1994;  20 105-110
    CrossrefPubMedGoogle Scholar
  • 58 Pageaux G, Fabre J, Perrigault P, Navarro F, Blanc P, Souche B, Possoz P, Larrey D. Liver transplantation for alcoholic cirrhosis: a monocentric experience about 44 patients with control group over a five year period.  Gastroenterology. 1995;  108, Suppl 4A 1141
    PubMedGoogle Scholar
  • 59 Paris W, Muchmore J, Pribil A, Zuhdi N, Cooper D. Study of the relative incidences of psychosocial factors before and after heart transplantation and the influence of posttransplantation psychosocial factors on heart transplantation outcome.  Journal Heart Lung Transplant. 1994;  13 (3) 424-432
    PubMedGoogle Scholar
  • 60 Phipps L. Psychiatric evaluation and outcomes in candidates for heart transplantation.  Clin Invest Med. 1997;  20 388-395
    PubMedGoogle Scholar
  • 61 Presberg B A, Levenson J L, Olbrish M E, Best A M. Rating Scales for the Psychosocial Evaluation of Organ Transplant Candidates. Comparison of the PACT and TERS With Bone Marrow Transplant Recipients.  Psychosomatics. 1995;  36 458-461
    PubMedGoogle Scholar
  • 62 Raakow R, Langrehr J, Lohmann R, Knoop M, Keck H, Kling N, Neuhaus R, Blumhardt G. Is Orthotopic Liver Transplantation for End-Stage Alcoholic Cirrhosis Justified?.  Transplantation Proceedings. 1995;  27 1241-1242
    PubMedGoogle Scholar
  • 63 Rovelli M, Palmeri D, Vossler E, Bartus S, Hull D, Schweizer R. Noncompliance in organ transplant recipients.  Transplantation Proceedings. 1989;  21 (1) 833-834
    PubMedGoogle Scholar
  • 64 Rundell J, Hall R. Psychiatric Characteristics of Consecutively Evaluated Outpatient Renal Transplant Candidates and Comparisons.  Psychosomatics. 1997;  38 269-276
    PubMedGoogle Scholar
  • 65 Saravay S, Lavin M. Psychiatric comorbidity and length of stay in the general hospital. A critical review of outcome studies. Special Series 1994
    Google Scholar
  • 66 Schulz K H, Pöhlmann U, Kjer S, Koch U, Kuhlencordt R, Sterneck M, Rogiers X, Broelsch C E. Lebensqualität und Rezidivquote nach Lebertransplantation (LTX) bei Patienten mit äthyltoxischer Leberzirrhose - Ein Überblick und eine katamnestische Studie. In: Johann B, Lange R (Hrsg) Psychotherapeutische Interventionen in der Transplantationsmedizin. Lengerich; Pabst Science Publishers 1999
    Google Scholar
  • 67 Schweizer R, Rovelli M, Palmeri D, Vossler E, Hull D, Bartus S. Noncompliance in Organ Transplant Recipients.  Transplantation. 1990;  49 374-377
    PubMedGoogle Scholar
  • 68 Sears S, Rodrigue J, Greene A, Mills R. Predicting Quality of Life with a Pretransplantation Battery: A Prospective Study of Cardiac Recipients.  Journal of Clinical Psychology in Medical Settings. 1995;  2 335-355
    PubMedGoogle Scholar
  • 69 Sensky T. Psychiatric Morbidity in Renal Tranplantation.  Psychotherapy and Psychosomatics. 1989;  52 41-46
    PubMedGoogle Scholar
  • 70 Shapiro P, Williams D, Foray A, Gelman I, Wukich N, Sciacca R. Psychosocial Evaluation and Prediction of Compliance Problems and Morbidity after Heart Transplantation.  Transplantation. 1995;  60 1462-1466
    PubMedGoogle Scholar
  • 71 Steinglass P. The Ackerman/Memorial Sloan-Kettering Multiple Family Discussion Group Treatment Manual. nicht publiziertes Manuskript
    Google Scholar
  • 72 Stukas A, Dew M, Switzer G, DiMartini A, Kormos R, Griffith B. PTSD in heart transplant recipients and their primary family caregivers.  Psychosomatics. 1999;  40 212-221
    Google Scholar
  • 73 Surman O. Psychiatric aspects of organ transplantation.  American Journal of Psychiatry. 1989;  146 972-982
    PubMedGoogle Scholar
  • 74 Twillman R, Manetto C, Wellish D K, Wolcott D L. The Transplant Evaluation Rating Scale. A Revision of the Psychosocial Levels System for Evaluation of Organ Transplant Candidates.  Psychosomatics. 1993;  34 144-153
    Google Scholar
  • 75 Van Thiel D, Bonet H, Gavaler J, Wright H. Effect of alcohol use on allograft rejection rates after liver transplantation for alcoholic liver disease.  Alcohol Clin Exp Res. 1995;  19 1151-1155
    PubMedGoogle Scholar
  • 76 Zipfel S, Löwe B, Paschke T, Immel B, Lange R, Zimmermann R, Herzog W, Bergmann G. Psychological Distress in Patients Awaiting Heart Transplantation.  Journal of Psychosomatic Research. 1998;  5 465-470
    PubMedGoogle Scholar

Dr. Yesim Erim

Klinik für Psychotherapie und Psychosomatik · Universitätsklinikum Essen

Virchowstraße 174

45147 Essen

Email: yesim.erim@uni-essen.de

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