Relationship between Psychological Profile of Living Donor for Liver Transplantation and Post-Surgical Pain Score, Opioid Analgesics Amounts and Duration

Abstract

생체간이식은 제공자와 수용자 모두에게 상당한 심리적인 스트레스가 발생하는 치료방법이다. 본 연구에서는 2년간 이식 제공자로 수술 전 정신과적 평가를 완료한 사람들의 의무기록을 후향적으로 검토하여 상관분석과 회귀분석을 통해 생체간이식 제공자의 이식 전 MMPI-2 척도 중 강박증 척도가 이식 후의 주관적인 통증 점수와(R2=0.137, F=4.448), F척도는 아편유사진통제의 사용량과(R2=0.360, F=15.766), 우울척도는 이식 후 마약류 진통제의 사용기간과(R2=0.306, F=12.363) 유의한 상관관계와 함께 설명력이 있음을 확인하였다. MMPI-2의 F척도는 심리 문제를, 우울 척도는 현 상황에서의 불만족 상태를 반영하며 강박증 척도는 심리적 혼란과 불편을 잘 반영하는 신뢰할 만한 지표로 이는 제공자가 경험하는 심리적 상태를 시사할 수 있다고 생각한다. 향후 간이식 제공자에 대한 정신과적 평가를 통해 높은 불안감을 느끼는 제공자에게는 개인적인 정신과적 개입을 통해 통증을 잘 견뎌낼 수 있도록 도와줄 수 있을 것이다.

Objective: Living donor liver transplantation is a surgical treatment which could impose a heavy burden on both the recipient and the potential donor. Preoperative psychological evaluation of the potential donor is essential in protecting one’s psychosocial well-being, as well as one’s autonomy. In this research, we examined the correlation between the preoperative psychological profile of the potential donor and one’s postoperative pain and opioid analgesic usage.

Methods: Retrospective review of the medical records of all living donors who had completed preoperative psychological evaluation in our transplantation center from January, 2010 to December, 2011 was done. Preoperative psychological evaluation included Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Sentence Complete Test and an interview with a psychiatrist. Mean postoperative pain within 7 days after the surgery was evaluated. Dosages of all opioid analgesics were converted to equivalent dosage of morphine.

Results: Depression T-score showed a significant correlation with the duration of opioid analgesics usage (R2=0.306, F=12.363). Also, F score and dosage of opioid analgesics (R2=0.360, F=15.766), as well as Psychasthenia T- score and postoperative mean pain score (R2=0.137, F=4.448) showed significant correlation.

Conclusion: Depression T-score, F score and Psychastenia T-score from MMPI-2 are well known to reflect one’s depression, discontent, psychological instability and chronic anxiety. Such personalized and specified psychiatric intervention could help the donor to cope with post-surgical pain better.