Psycho-cognitive individual resources of Liver Pre-Transplant Candidates pave the way for identifying an adherence core: A Retrospective Pilot Study

Graziella Orru, Ciro Conversano, Rebecca Ciacchini, Valentina Cesari, Eleonora Malloggi, Mario Miccoli, Valentina Giglioli, Angelo Gemignani, Paolo De Simone


Background: Patients’ adherence to medical prescription during pre- and post- liver transplant phases is crucial to prevent treatment inefficacy. Literature has highlighted the urge of performing a psychological characterization to prevent post-intervention relapses and to impede treatment non-adherence behavior. The aim of this study is to define an “adherence core” by investigating personality traits, cognitive functions, and affective symptoms of patients waiting for liver transplant to enhance treatment effectiveness. We hypothesize a negative correlation between depressive and anxious symptoms and cognitive abilities and a positive association between some personality traits (Open-mindedness, Conscientiousness and Extraversion) and cognitive functions.

Materials and methods: Forty-six candidates (23 females, mean age: 56.02±7.81 years, range: 39-76) for liver transplantation were assessed utilizing the following psychometric tools: State-Trait Anxiety Inventory Form Y1 and Form Y2, Big Five Questionnaire and Beck Depression Inventory 2. Cognitive assessment included: Coloured Progressive Matrices, Rey's 15-word list, Semantic Incidental Memory Test for Adults, Attentional Matrices Test and Corsi Block-tapping Test.

Results:  The findings showed that education level negatively correlated with trait anxiety and positively correlated with Open-mindedness and Emotional Stability. Coloured Progressive Matrices negatively correlated with trait anxiety and depressive symptoms and positively correlated with Emotional Stability and Open-mindedness. Significant correlations were also shown between cognitive tests. Rey Immediate Recall scores showed positive correlation with: Rey Delayed Recall, Semantic Incidental Memory, and Attentional Matrices. Moreover, the findings demonstrated a positive correlation between trait anxiety and depressive symptoms, as well as a negative correlation between trait anxiety and Emotional Stability. Additionally, state anxiety was found to be positively correlated with depressive symptoms and negatively correlated with Energy and Open-mindedness.

Discussion: Higher fluid abilities, with lower degree of depression state, less pronounced anxious trait, and more open-minded personality can potentially aid patients in managing the distress associated with pre- and post-transplantation, ultimately resulting in optimal adherence. Furthermore, the positive association observed between the attention and memory domains might suggest their significant involvement in predicting adherence trajectories. In line with literature highlighting the paramount role of psychological factors in recovering from organ transplant, this study paves the road for the potentiation of individual resources and weaknesses identification to reduce relapses and healthcare costs. However, small sample size and lack of causality direction of results prevent robust conclusions.


Adherence; Cognitive Functions; Affective disorders; Personality; Transplantation.

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