Application of the Validated Social Assessment Instrument for Liver Transplantation Candidates.

The use of appropriate instruments for social assessment in health aims at both the participation of the subject and effectiveness in resolving demands. The objective of this study was to characterize the population assessed by the Validated Social Assessment Instrument and its implications; a descriptive, documental study with participant and dialectical observation. The data survey were taken from the social assessments applied from July 2020 to June 2021 in a transplant center in northwestern São Paulo state in Brazil. Descriptive statistics were performed. The 65 social evaluations of candidates for liver transplantation (LTx) have presented the following sociodemographic characteristics: male sex (n = 47; 72.3%); mean age of 55.05 years (range: 24-75 years old); with a partner (n = 50; 76.9%); low education level (n = 30; 46.2%); and coming from the state of São Paulo (n = 54; 83.1). Of those evaluated, 48 candidates (74%) were professionally inactive and 37 (56.9%) received assistance or social security benefits; 62 (95.4%) had a family caregiver; 61 (93.9%) had a resolutive compliance family response; 57 (87.7%) had facilitated accessibility; 59 (90.8%) met satisfactory housing standards; and 60 (92.3%) had full acceptance for LTx. The 65 candidates' (100%) social opinions were favorable, and 21 (32.3%) had some limitations and required further assistance. All of them received basic and specific social orientations, and 25 (38.5%) required social referrals. The variables have allowed a view at the totality of the social being in addition to widening the subject's participation in order to identify the real demands and facilitate the monitoring of actions, thus contributing for favorable conditions for treatment.

Burden, Stress, and Depression in Informal Caregivers of Patients Pre and Post Liver Transplant.

BACKGROUND: Caring for a patient with chronic liver disease involves exposure to factors that increase family caregivers' vulnerability to developing mental disorders. This study reassessed the scores of burden, stress, and depression in informal (family) caregivers of patients with liver disease after liver transplant. METHODS: In this observational and descriptive study, the caregivers were reassessed for the same outcomes 4 to 10 years following the initial assessment pre-transplant. The data were obtained from the identification card, the interview script, the Brazilian version of the Caregiver Burden Scale, the Lipp Inventory of Stress Symptoms for Adults, and the Beck Depression Inventory. Descriptive statistics of pre- and post-liver transplant phases were calculated, and the Wilcoxon signed rank test was used to compare the burden scores. RESULTS: The 5 caregivers were women, with a mean age of 51.6 (SD, 8.38) years. All of the caregivers' (100%) burden score increased, 2 caregivers needed to seek some form of help, and 3 caregivers showed an indication of burden risk. Regarding stress symptoms, 3 caregivers (60%) maintained a score indicating no stress, 2 caregivers (40%) presented increased scores, and the predominant symptoms changed from psychological to physical. Regarding depression, 3 caregivers (60%) maintained the minimum level of symptoms for depression, and 2 caregivers (40%) presented increased scores. CONCLUSION: After liver transplant, caregivers' burden scores increased, and levels of stress and depression increased for caregivers who already showed symptoms in the pre-transplant phase.

Validation of the Adapted Social Assessment Instrument for Liver Transplantation Candidates.

BACKGROUND AND AIMS: Assessment is considered a duty, as well as a part of the tasks of social workers; in addition, they have an ethical commitment to improve their working tools. This study aimed at validating the Adapted Social Assessment Instrument used in a transplant center in the state of São Paulo, Brazil, for liver transplantation candidates, requiring its improvement and strengthening. METHODS: The methodology was based on both Marxian dialectics and the method of content validation. The content validation analysis was performed by 5 social workers from 3 Brazilian transplant centers. They evaluated the 5 domains of the instrument: identification, socio-demographic profile, eligibility criteria, evaluation, and social interventions. Descriptive statistics of data were performed, and qualitative analysis was associated to the participant observation. RESULTS: The 5 professionals (100%) assigned the scores 3 and 4, which have demonstrated clarity, relevance, and feasibility, pointing out suggestions for improvement, some of which were considered. CONCLUSIONS: The instrument was evaluated with an approval percentage of above 80%; therefore, the instrument is a valid measure.

Adaptação do instrumental de avaliação social em transplante hepático / Adaptation of the instruments of social assessment in liver transplantation

Introdução: O fator social interfere na realização de um transplante hepático, podendo contraindicá-lo momentaneamente. Para a análise e intervenção na realidade social do sujeito/paciente, o assistente social utiliza um instrumental que, devido ao seu valor, necessita de implementações, dado o movimento social. Objetivo: Adaptar o instrumental de avaliação social utilizado na Unidade de Transplante de Fígado. Método: Estudo quanti-qualitativo, pesquisa de campo com amostra intencional (assistentes sociais de Unidade de Transplante, com experiência no uso de instrumental de avaliação), análise de dados na perspectiva dialética e observação participante. Resultados: Todos os assistentes sociais utilizavam e três apontaram sugestões de melhorias, sendo os itens meios de comunicação e renda familiar os de maior destaque para alterações. As sugestões específicas para determinada unidade e as que alterariam o score do sistema de avaliação não foram implementadas. A partir da observação participante, outras alterações e informações foram incluídas para melhorar e ampliar o instrumental de acordo com a necessidade observada no cotidiano profissional. Conclusão: As alterações realizadas na adaptação favorecem a abordagem das variáveis sociais no momento da avaliação e contribui para o registro das intervenções sociais. Além disso, avança na visão totalitária do sujeito e da realidade social.

Introduction: The social factor interferes with the performance of a liver transplant and may contraindicate it momentarily. For the analysis and intervention in the social reality of the subject / patient, the social worker uses a tool that, due to its importance, needs implementations, due to the social movement. Objective: To adapt the social assessment tool used in the Liver Transplant Unit. Methods: Qualitative and quantitative approach study, field research with intentional sample (Transplant Unit social workers experienced in using assessment tools), data analysis was performed from a dialectical perspective and participant observation. Results: All social workers used it, and three pointed to suggestions for improvement, with media and household income being the most prominent items for change. Specific suggestions for a particular unit and those that would change the rating system score were not implemented. From participant observation, other changes and information were included to improve and expand the tool according to the need observed in the professional routine. Conclusion: Changes in adaptation favor the approach of social variables at the time of assessment and contribute to the registration of social interventions. Moreover, it advances in the totalitarian view of the subject and social reality.

Mortality and complications in patients with portal hypertension who underwent transjugular intrahepatic portosystemic shunt (TIPS) - 12 years experience.

CONTEXT: Transjugular intrahepatic portosystemic shunt (TIPS) is the non-surgical treatment option with low level of morbi-mortality and possibility of accomplishment in patients with severe hepatic dysfunction which aims at decompressing the portal system treating or reducing the portal hypertension complications. OBJECTIVE: Outline the profile analyze global and early mortality, and the complications presented by cirrhotic patients who underwent TIPS for treatment of digestive hemorrhage by portal hypertension. METHOD: Retrospective study based on the data bank of cirrhotic patients' medical reports, who underwent TIPS for digestive hemorrhage by portal hypertension treatment who did not respond to clinical endoscopic treatment, and were assisted from 1998 to 2010 in the Liver Transplant Service at a university hospital. The study was approved by the Committee of Ethics and Research. RESULTS: The sample was comprised of 72 (84.7%) patients, being 57 (79.2%) males, average age 47.7 years (age range from 16 to 85 years and SD = 13), 21 (29.2%) patients presented liver disease as cause excessive intake of alcoholic drinks; 21 (29.2%) contamination by hepatitis virus, 16 (22.2%) excessive alcohol intake associated with virus and 14 (19.4%) patients presented other causes. As for initial classification, 14 (20%) had Child-Pugh A, 33 (47.1%) Child-Pugh B and 23 (32.9%) Child-Pugh C. Initial MELD was obtained in 68 patients being 37 (54.4%) higher than 15 points while 31 (45.6%) had up to 15 points. Early death occurred in 19 (26.4%). Global mortality occurred in 41 (60.3%). CONCLUSIONS: Mortality is directly related to clinical factors of patients, being Child-Pugh and MELD classifications predictors of mortality, with more impact in patients with Child-Pugh class C and MELD > 15. The complications found were similar to those described in the literature, although the dysfunction by stent stenosis (26.4%) was lower than in the most of the studies and the encephalopathy incidence (58.3%) was higher. Probably, the high incidence of encephalopathy is explained by the low incidence of stenosis.

Mortality and complications in patients with portal hypertension who underwent transjugular intrahepatic portosystemic shunt (TIPS) - 12 years experience / Mortalidade e complicações em pacientes com hipertensão portal submetidos a derivação portossistêmica transjugular intra-hepática (TIPS) - 12 anos de experiência

CONTEXT: Transjugular intrahepatic portosystemic shunt (TIPS) is the non-surgical treatment option with low level of morbi-mortality and possibility of accomplishment in patients with severe hepatic dysfunction which aims at decompressing the portal system treating or reducing the portal hypertension complications. OBJECTIVE: Outline the profile analyze global and early mortality, and the complications presented by cirrhotic patients who underwent TIPS for treatment of digestive hemorrhage by portal hypertension. METHOD: Retrospective study based on the data bank of cirrhotic patients' medical reports, who underwent TIPS for digestive hemorrhage by portal hypertension treatment who did not respond to clinical endoscopic treatment, and were assisted from 1998 to 2010 in the Liver Transplant Service at a university hospital. The study was approved by the Committee of Ethics and Research. RESULTS: The sample was comprised of 72 (84.7%) patients, being 57 (79.2%) males, average age 47.7 years (age range from 16 to 85 years and SD = 13), 21 (29.2%) patients presented liver disease as cause excessive intake of alcoholic drinks; 21 (29.2%) contamination by hepatitis virus, 16 (22.2%) excessive alcohol intake associated with virus and 14 (19.4%) patients presented other causes. As for initial classification, 14 (20%) had Child-Pugh A, 33 (47.1%) Child-Pugh B and 23 (32.9%) Child-Pugh C. Initial MELD was obtained in 68 patients being 37 (54.4%) higher than 15 points while 31 (45.6%) had up to 15 points. Early death occurred in 19 (26.4%). Global mortality occurred in 41 (60.3%). CONCLUSIONS: Mortality is directly related to clinical factors of patients, being Child-Pugh and MELD classifications predictors of mortality, with more impact in patients with Child-Pugh class C and MELD > 15. The complications found were similar to those described in the literature, although the dysfunction by stent stenosis (26.4%) was lower than in the most of the studies and the encephalopathy incidence (58.3%) was higher. Probably, the high incidence of encephalopathy is explained by the low incidence of stenosis.

CONTEXTO: Derivação portossistêmica transjugular intra-hepática (TIPS) é opção de tratamento não cirúrgico com baixo índice de morbimortalidade e possibilidade de realização em pacientes com disfunção hepática grave que visa descomprimir o sistema porta tratando ou reduzindo as complicações da hipertensão portal. OBJETIVO: Traçar o perfil, analisar mortalidade global e precoce, e as complicações apresentadas pelos pacientes cirróticos submetidos a TIPS para tratamento da hemorragia digestiva por hipertensão portal. MÉTODOS: Estudo retrospectivo baseado no banco de dados dos prontuários dos pacientes cirróticos submetidos a TIPS para tratamento da hemorragia digestiva por hipertensão portal que não responderam ao tratamento clínico-endoscópico e atendidos no período de 1998 a 2010 no Serviço de Transplante de Fígado de um hospital universitário. O estudo foi aprovado pelo Comitê de Ética e Pesquisa. RESULTADOS: Amostra foi composta de 72 (84,7%) pacientes, sendo 57 (79,2%) do sexo masculino, idade média de 47,4 anos (entre 16 e 85 anos e DP = 13); 21 (29,2%) pacientes apresentavam como causa da doença hepática o consumo excessivo de álcool; 21 (29,2%) a contaminação por vírus da hepatite, 16 (22,2%) o consumo excessivo de álcool associado a vírus e 14 (19,4%) pacientes apresentavam outras causas. Quanto à classificação inicial, 14 (20%) tinham Child-Pugh A, 33 (47,1%) Child-Pugh B e 23 (32,9%) Child-Pugh C. MELD inicial foi obtido em 68 pacientes, sendo 37 (54,4%) com mais de 15 pontos, enquanto 31 (45,6%) tiveram até 15 pontos. Óbito precoce ocorreu em 19 (26,4%). Mortalidade global ocorreu em 41 (60,3%). CONCLUSÃO: Mortalidade está diretamente relacionada a fatores clínicos dos pacientes, sendo as classificações de Child-Pugh e MELD preditoras de mortalidade, com maior impacto em pacientes com Child-Pugh classe C e MELD >15. As complicações encontradas foram semelhantes às descritas na literatura, porém a disfunção por estenose do stent (26,4%) foi menor que a maioria dos estudos e a incidência de encefalopatia (58,3%) superior. Provavelmente, esta alta incidência seja explicada pela baixa incidência de estenose.