The Frequency and Impact of Adverse Childhood Experiences on Mood, Alcohol Relapse, and Outcomes in Liver Transplantation: A Retrospective Cohort Study

David C Fipps; Tyler Nguyen; Rachel Meyer; Byron Smith; Richard Roden; Matthew M Clark; Kymberly D Watt; Sheila G Jowsey-Gregoire

doi:10.1016/j.jaclp.2024.06.006

The Frequency and Impact of Adverse Childhood Experiences on Mood, Alcohol Relapse, and Outcomes in Liver Transplantation: A Retrospective Cohort Study

J Acad Consult Liaison Psychiatry. 2024 Jun 26:S2667-2960(24)00068-5. doi: 10.1016/j.jaclp.2024.06.006. Online ahead of print.

Authors

David C Fipps¹, Tyler Nguyen², Rachel Meyer³, Byron Smith⁴, Richard Roden², Matthew M Clark³, Kymberly D Watt⁵, Sheila G Jowsey-Gregoire⁶

Affiliations

¹ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN. Electronic address: fipps.david@mayo.edu.
² Mayo Clinic Alix School of Medicine, Rochester, MN.
³ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
⁴ Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN.
⁵ Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN.
⁶ Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL.

PMID: 38942236
DOI: 10.1016/j.jaclp.2024.06.006

Abstract

Background: Adverse childhood experiences (ACEs) are associated with the development of negative health behaviors and medical illnesses. ACE's association with poor health outcomes has been well documented in the general population; however, this relationship remains less clear in liver transplant (LT) recipients.

Objective: The aims of this study were to determine the prevalence of ACE and the influence of ACE on LT outcomes.

Methods: A retrospective electronic medical record review of all LT recipients over 11 years at an academic LT center. Demographic, diagnostic, and disease characteristics were extracted and compared for a history of ACE. Associations between a history of ACE and extracted variables were statistically tested using Student's t-test, chi-square tests, or Fisher's exact test, where appropriate. Graft and patient survival were tested using log-rank tests.

Results: Of the 1172 LT recipients, 24.1% endorsed a history of ACE. Females (P = 0.017) and recipients with lower levels of education (P < 0.001) had a higher frequency of ACE. Those with a history of ACE had a higher prevalence of hepatitis C virus (P < 0.001) and higher pretransplant body mass index (P < 0.001). Recipients with a history of ACE had higher prevalence of mood (P < 0.001), anxiety (P < 0.001), post traumatic stress disorder (P < 0.001), alcohol use (P < 0.001), and cannabis use (P < 0.001) disorders, as well as higher Patient Health Questionnaire-9 (P < 0.001) and General Anxiety Disorder-7 (P < 0.001) scores pre- and post-transplant. Those with ACE had a higher incidence of recorded relapses to alcohol by 3 years post-transplant (P = 0.027). Mean lab values, graft survival, and patient survival were not significantly different between those with and without a history of ACE except for total bilirubin at 6 months (P = 0.021).

Conclusions: One-quarter of LT recipients have experienced ACE. ACE was associated with a history of psychiatric diagnoses, substance use disorders, elevated Patient Health Questionnaire-9 and General Anxiety Disorder-7 scores, and a higher prevalence of relapse to alcohol use after transplant. This population may benefit from increased/improved access to appropriate mental health and substance use services and support in the peri- and post-transplant period.

Keywords: adverse childhood experiences; alcohol use; anxiety; consultation liaison; depression; liver transplantation; mood; psychiatry and psychology; relapse; trauma.