Self-care, Social Support, and Biological Markers in Liver Transplant Recipients

Hyunkyung Kim; Mona Choi; So Sun Kim; Soon-il Kim

doi:10.7475/kjan.2015.27.2.170

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Self-care, Social Support, and Biological Markers in Liver Transplant Recipients

Hyunkyung Kim¹, Mona Choi², So Sun Kim², Soon-il Kim³

Korean Journal of Adult Nursing 2015;27(2):170-179.
Published online: April 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.2.170

¹Yonsei University Health System · Severance Hospital, Seoul

²College of Nursing · Nursing Policy Research Institute, Yonsei University, Seoul

³Department of Surgery, College of Medicine, Yonsei University, Seoul, Korea

Corresponding author: Choi, Mona Nursing Policy Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-2-2228-3341, Fax: +82-2-392-5440, E-mail: MONACHOI@yuhs.ac

• Received: January 6, 2015 • Accepted: April 13, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
To examine the relationships between self-care, social support, and biological markers in liver transplant recipients.
Methods
The participants included 118 liver transplant recipients who visited outpatient clinic at Y University Hospital in Seoul from April to May, 2013. Questionnaires consisted of self-care and social support scales. The biological markers were collected by reviewing electronic medical records. Data were analyzed with descriptive statistics, t-test, ANOVA with Scheffé post-hoc test, and Pearson's correlation.
Results
The self-care score was significantly higher in a patient group within 6 months post-transplant when compared to a patient group post-transplant 3 to 5 years (F=3.10, p=.018). The self-care showed positive correlation with social support with statistical significance (r=.36, p<.001).
Conclusion
As the self-care in liver transplant recipients had a positive correlation with social support from family and healthcare providers, the development of comprehensive long-term nursing intervention systems including counseling, education, and support in consideration of progress of time period after transplantation is necessary to enhance self-care behaviors among this population.
Key Words: Liver; Transplant Recipients; Self-care; Social support; Biological markers

Table 1.

Participants' Self-care and Social Support by Socio-demographic Characteristics (N=118)

Characteristics	Categories	n (%) or M±SD	Self-care		Social support
Characteristics	Categories	n (%) or M±SD	M±SD	t or F (p)	M±SD	t or F (p)
Gender	Male	90 (76.3)	171.81±15.22	0.39	109.00±11.32	0.46
Gender	Female	28 (23.7)	173.07±13.38	(.695)	110.11±10.92	(.649)
Age (year)	＜ 50	20 (16.9)	168.45±14.03	1.01	105.95±14.41	3.99
	50~59	60 (50.8)	171.98±15.07	(.367)	108.22±11.26	(.054)
	≥ 60	38 (32.2)	174.24±14.61		112.66±8.22
		56.2±7.07
Marital status	Married	104 (88.1)	172.65±14.89	1.09	109.64±11.05	1.01
Marital status	Etc.^‡	14 (11.9)	168.07±13.53	(.277)	106.43±12.22	(.315)
Education level	≤ Elementary School	15 (12.7)	168.60±15.63	1.26	109.53±9.64	0.45
	Middle School	17 (14.4)	170.24±16.49	(.292)	108.35±11.94	(.721)
	High School	40 (33.9)	175.65±12.80		110.83±11.59
	≥ College graduate	46 (39.0)	170.87±15.27		108.15±11.22
Occupation	Unemployed	30 (25.4)	173.53±15.43	0.61	111.37±9.72	1.20
Occupation	Employed	88 (74.6)	171.63±14.58	(.543)	108.55±11.61	(.235)
Perceived economic status	High	7 (5.9)	180.86±7.84	3.96	110.57±15.75	0.21
	Middle	77 (65.3)	173.62±13.75	(.022*)	108.78±11.39	(.811)
	Low	34 (28.8)	166.88±16.60		110.09±9.93
Cohabitation	None	5 (4.2)	170.60±17.95	1.12	102.80±12.97	0.63
	Spouse	33 (28.0)	169.94±15.84	(.343)	110.00±10.30	(.581)
	Spouse and child	73 (61.9)	173.86±13.94		109.52±11.34
	Child and others	7 (5.9)	165.14±15.83		107.71±13.39
Main caregiver^†	None^a	7 (5.9)	167.71±19.09	1.14	98.57±12.95	4.21
	Spouse^b	95 (80.5)	173.12±14.33	(.325)	110.41±10.38	(.017*)
	Parents, Child^c	16 (13.6)	168.06±15.23		107.13±12.98	a ＜ b
Participate in self-help groups	Yes	20 (16.9)	177.65±14.49	1.86	111.20±9.95	0.85
Participate in self-help groups	No	98 (83.1)	170.98±14.62	(.065)	108.86±11.43	(.398)

^†Scheffe test applied; ́

^‡Single, separation, divorce, widowed.

Table 2.

Participants' Self-Care and Social Support by Disease-related Characteristics (N=118)

Characteristics	Categories	n (%) or M±SD	Self-care		Social support
Characteristics	Categories	n (%) or M±SD	M±SD	t or F (p)	M±SD	t or F (p)
Diagnosis	HCC	31 (26.3)	171.94±15.51	0.48	108.16±12.17	0.17
	LC	42 (35.6)	172.52±14.11	(.698)	110.05±10.65	(.918)
	HCC with LC	41 (34.7)	172.66±15.08		109.24±11.16
	FHF	4 (3.4)	163.50±15.09		109.75±13.05
Donor^†	Child^a	54 (45.8)	175.43±14.36	2.24	110.85±10.75	5.38
	Spouse^b	12 (10.2)	166.50±15.75	(.088)	110.67±10.14	(.002*)
	Sibling, Relative, friend,	20 (16.9)	167.45±14.70		100.60±8.17	c ＜ a, d
	acquaintance^c
	Deceased donor^d	32 (27.1)	171.53±14.25		111.47±8.17
Time period since transplant (year)	＜ 0.5	20 (16.9)	175.95±14.14	3.10	113.45±7.49	0.97
	≥ 0.5~ ＜ 1	24 (20.3)	173.67±14.13	(.018*)	109.75±11.65	(.428)
	≥ 1~ ＜ 3	33 (28.0)	174.88±12.18		107.79±12.06
	≥ 3~ ＜ 5	15 (12.7)	161.00±15.97		108.53±14.19
	≥ 5	26 (22.0)	170.62±15.81		107.88±10.00
Number of types of immunosuppressive	1	9 (7.6)	174.11±11.72	0.11	111.56±10.30	1.99
	2	78 (66.1)	172.14±15.41	(.894)	107.81±12.28	(.141)
	≥ 3	31 (26.3)	171.45±14.19		112.26±7.51
Number of rehospitalization (times)	None	51 (43.2)	171.76±15.84	0.38	111.12±8.30	1.58
	1~2	41 (34.7)	173.59±14.98	(.687)	108.73±12.21	(.211)
	≥ 3	26 (22.0)	172.11±12.31		106.46±13.92
		2.93±2.72
Comorbidity before transplant^†	Yes	42 (35.6)	168.14±15.54	2.21	107.93±10.15	0.96
Comorbidity before transplant^†	No	76 (64.4)	174.30±13.92	(.029*)	110.00±11.72	(.338)
Newly developed disease after transplant^†	Yes	47 (39.8)	172.28±13.97	0.10	108.62±12.03	0.51
Newly developed disease after transplant^†	No	71 (60.2)	172.00±15.35	(.921)	109.69±10.66	(.612)

HCC=hepato-cellular carcinoma, LC=liver cirrhosis, FHF=fulminant hepatic failure;

^†Scheffe test applied. ́

Table 3.

Participants' Self-care and Social Support (N=118)

Variables	Categories (number of items)	Sum average (SD)	Mean average (SD)
Self-care	Outpatient clinic visit and regular checkup (3)	14.75 (1.03)	4.92 (0.40)
	Taking medicine (7)	32.09 (2.63)	4.58 (0.80)
	Wound and drainage tube management (3)	13.33 (1.99)	4.44 (0.96)
	Daily life (7)	30.59 (3.49)	4.37 (0.98)
	Dietary control (7)	29.93 (4.08)	4.28 (1.04)
	Infection prevention (10)	41.09 (5.92)	4.11 (1.11)
	Sleep management (3)	10.31 (3.02)	3.44 (1.35)
	Total: Sum/Mean	172.11 (14.76)	4.31 (0.95)
Social support	Support by family members (12)	55.34 (6.48)	4.61 (0.79)
	Support by healthcare providers (12)	53.92 (6.64)	4.49 (0.79)
	Total: Sum/Mean	109.26 (11.19)	4.55 (0.79)

Mean scores were based on a 5 point scale from 1=strongly disagree to 5=strongly agree.

Table 4.

Participants' Self-care by Biomarkers (N=118)

Biomarkers (measurement unit)	Normal range	Categories	n (%)	Self-care
Biomarkers (measurement unit)	Normal range	Categories	n (%)	M±SD	t	p
GOT (IU/L)	13~34	Normal	98 (83.1)	172.36±15.05	0.40	.689
GOT (IU/L)	13~34	Abnormal	20 (16.9)	170.90±13.50	0.40	.689
GPT (IU/L)	5~46	Normal	99 (83.9)	172.56±15.24	0.75	.457
GPT (IU/L)	5~46	Abnormal	19 (16.1)	169.79±11.96	0.75	.457
Total bilirubin (mg/dL)	0.5~1.8	Normal	113 (95.8)	172.15±14.97	0.14	.889
Total bilirubin (mg/dL)	0.5~1.8	Abnormal	5 (4.2)	171.20±9.73	0.14	.889
Total cholesterol (mg/dL)	142~240	Normal	111 (94.1)	172.47±14.83	1.05	.295
Total cholesterol (mg/dL)	142~240	Abnormal	7 (5.9)	166.43±13.14	1.05	.295
eGFR (mL/min/1.73 m²)	≥ 60	Normal	78 (66.1)	171.78±15.35	0.93	.737
eGFR (mL/min/1.73 m²)	≥ 60	Abnormal	40 (33.9)	172.75±13.68	0.93	.737
Creatinine (mg/dL)	0.68~1.19	Normal	78 (66.1)	171.50±14.91	-0.63	.533
Creatinine (mg/dL)	0.68~1.19	Abnormal	40 (33.9)	173.30±14.50	-0.63	.533
Serum glucose (mg/dL)	70~110	Normal	74 (62.7)	172.77±15.32	0.63	.531
Serum glucose (mg/dL)	70~110	Abnormal	44 (37.3)	171.00±13.85	0.63	.531
BMI (kg/m²)	19.5~24.9	Normal	101 (85.6)	172.72±14.24	0.95	.355
BMI (kg/m²)	19.5~24.9	Abnormal	77 (14.4)	168.47±17.54	0.95	.355
SBP (mmHg)	90~120	Normal	35 (29.7)	169.37±16.23	-1.31	.192
SBP (mmHg)	90~120	Abnormal	83 (70.3)	173.27±14.03	-1.31	.192
DBP (mmHg)	60~80	Normal	60 (50.8)	173.27±14.86	0.87	.389
DBP (mmHg)	60~80	Abnormal	58 (49.2)	170.91±14.68	0.87	.389

GOT=glutamate oxaloacetate transaminase; GPT=glutamate pyruvate transaminase; eGFR=estimated glomerular filtration rate; BMI=body mass index; SBP=systolic blood pressure; DBP=diastolic blood pressure.

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Self-care, Social Support, and Biological Markers in Liver Transplant Recipients

Korean J Adult Nurs. 2015;27(2):170-179. Published online April 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.2.170

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Self-care, Social Support, and Biological Markers in Liver Transplant Recipients

Korean J Adult Nurs. 2015;27(2):170-179. Published online April 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.2.170

Self-care, Social Support, and Biological Markers in Liver Transplant Recipients

Table 1.

Participants' Self-care and Social Support by Socio-demographic Characteristics (N=118)

Characteristics	Categories	n (%) or M±SD	Self-care		Social support
Characteristics	Categories	n (%) or M±SD	M±SD	t or F (p)	M±SD	t or F (p)
Gender	Male	90 (76.3)	171.81±15.22	0.39	109.00±11.32	0.46
Gender	Female	28 (23.7)	173.07±13.38	(.695)	110.11±10.92	(.649)
Age (year)	＜ 50	20 (16.9)	168.45±14.03	1.01	105.95±14.41	3.99
	50~59	60 (50.8)	171.98±15.07	(.367)	108.22±11.26	(.054)
	≥ 60	38 (32.2)	174.24±14.61		112.66±8.22
		56.2±7.07
Marital status	Married	104 (88.1)	172.65±14.89	1.09	109.64±11.05	1.01
Marital status	Etc.^‡	14 (11.9)	168.07±13.53	(.277)	106.43±12.22	(.315)
Education level	≤ Elementary School	15 (12.7)	168.60±15.63	1.26	109.53±9.64	0.45
	Middle School	17 (14.4)	170.24±16.49	(.292)	108.35±11.94	(.721)
	High School	40 (33.9)	175.65±12.80		110.83±11.59
	≥ College graduate	46 (39.0)	170.87±15.27		108.15±11.22
Occupation	Unemployed	30 (25.4)	173.53±15.43	0.61	111.37±9.72	1.20
Occupation	Employed	88 (74.6)	171.63±14.58	(.543)	108.55±11.61	(.235)
Perceived economic status	High	7 (5.9)	180.86±7.84	3.96	110.57±15.75	0.21
	Middle	77 (65.3)	173.62±13.75	(.022*)	108.78±11.39	(.811)
	Low	34 (28.8)	166.88±16.60		110.09±9.93
Cohabitation	None	5 (4.2)	170.60±17.95	1.12	102.80±12.97	0.63
	Spouse	33 (28.0)	169.94±15.84	(.343)	110.00±10.30	(.581)
	Spouse and child	73 (61.9)	173.86±13.94		109.52±11.34
	Child and others	7 (5.9)	165.14±15.83		107.71±13.39
Main caregiver^†	None^a	7 (5.9)	167.71±19.09	1.14	98.57±12.95	4.21
	Spouse^b	95 (80.5)	173.12±14.33	(.325)	110.41±10.38	(.017*)
	Parents, Child^c	16 (13.6)	168.06±15.23		107.13±12.98	a ＜ b
Participate in self-help groups	Yes	20 (16.9)	177.65±14.49	1.86	111.20±9.95	0.85
Participate in self-help groups	No	98 (83.1)	170.98±14.62	(.065)	108.86±11.43	(.398)

^†Scheffe test applied; ́

^‡Single, separation, divorce, widowed.

Table 2.

Participants' Self-Care and Social Support by Disease-related Characteristics (N=118)

Characteristics	Categories	n (%) or M±SD	Self-care		Social support
Characteristics	Categories	n (%) or M±SD	M±SD	t or F (p)	M±SD	t or F (p)
Diagnosis	HCC	31 (26.3)	171.94±15.51	0.48	108.16±12.17	0.17
	LC	42 (35.6)	172.52±14.11	(.698)	110.05±10.65	(.918)
	HCC with LC	41 (34.7)	172.66±15.08		109.24±11.16
	FHF	4 (3.4)	163.50±15.09		109.75±13.05
Donor^†	Child^a	54 (45.8)	175.43±14.36	2.24	110.85±10.75	5.38
	Spouse^b	12 (10.2)	166.50±15.75	(.088)	110.67±10.14	(.002*)
	Sibling, Relative, friend,	20 (16.9)	167.45±14.70		100.60±8.17	c ＜ a, d
	acquaintance^c
	Deceased donor^d	32 (27.1)	171.53±14.25		111.47±8.17
Time period since transplant (year)	＜ 0.5	20 (16.9)	175.95±14.14	3.10	113.45±7.49	0.97
	≥ 0.5~ ＜ 1	24 (20.3)	173.67±14.13	(.018*)	109.75±11.65	(.428)
	≥ 1~ ＜ 3	33 (28.0)	174.88±12.18		107.79±12.06
	≥ 3~ ＜ 5	15 (12.7)	161.00±15.97		108.53±14.19
	≥ 5	26 (22.0)	170.62±15.81		107.88±10.00
Number of types of immunosuppressive	1	9 (7.6)	174.11±11.72	0.11	111.56±10.30	1.99
	2	78 (66.1)	172.14±15.41	(.894)	107.81±12.28	(.141)
	≥ 3	31 (26.3)	171.45±14.19		112.26±7.51
Number of rehospitalization (times)	None	51 (43.2)	171.76±15.84	0.38	111.12±8.30	1.58
	1~2	41 (34.7)	173.59±14.98	(.687)	108.73±12.21	(.211)
	≥ 3	26 (22.0)	172.11±12.31		106.46±13.92
		2.93±2.72
Comorbidity before transplant^†	Yes	42 (35.6)	168.14±15.54	2.21	107.93±10.15	0.96
Comorbidity before transplant^†	No	76 (64.4)	174.30±13.92	(.029*)	110.00±11.72	(.338)
Newly developed disease after transplant^†	Yes	47 (39.8)	172.28±13.97	0.10	108.62±12.03	0.51
Newly developed disease after transplant^†	No	71 (60.2)	172.00±15.35	(.921)	109.69±10.66	(.612)

HCC=hepato-cellular carcinoma, LC=liver cirrhosis, FHF=fulminant hepatic failure;

^†Scheffe test applied. ́

Table 3.

Participants' Self-care and Social Support (N=118)

Variables	Categories (number of items)	Sum average (SD)	Mean average (SD)
Self-care	Outpatient clinic visit and regular checkup (3)	14.75 (1.03)	4.92 (0.40)
	Taking medicine (7)	32.09 (2.63)	4.58 (0.80)
	Wound and drainage tube management (3)	13.33 (1.99)	4.44 (0.96)
	Daily life (7)	30.59 (3.49)	4.37 (0.98)
	Dietary control (7)	29.93 (4.08)	4.28 (1.04)
	Infection prevention (10)	41.09 (5.92)	4.11 (1.11)
	Sleep management (3)	10.31 (3.02)	3.44 (1.35)
	Total: Sum/Mean	172.11 (14.76)	4.31 (0.95)
Social support	Support by family members (12)	55.34 (6.48)	4.61 (0.79)
	Support by healthcare providers (12)	53.92 (6.64)	4.49 (0.79)
	Total: Sum/Mean	109.26 (11.19)	4.55 (0.79)

Mean scores were based on a 5 point scale from 1=strongly disagree to 5=strongly agree.

Table 4.

Participants' Self-care by Biomarkers (N=118)

Biomarkers (measurement unit)	Normal range	Categories	n (%)	Self-care
Biomarkers (measurement unit)	Normal range	Categories	n (%)	M±SD	t	p
GOT (IU/L)	13~34	Normal	98 (83.1)	172.36±15.05	0.40	.689
GOT (IU/L)	13~34	Abnormal	20 (16.9)	170.90±13.50	0.40	.689
GPT (IU/L)	5~46	Normal	99 (83.9)	172.56±15.24	0.75	.457
GPT (IU/L)	5~46	Abnormal	19 (16.1)	169.79±11.96	0.75	.457
Total bilirubin (mg/dL)	0.5~1.8	Normal	113 (95.8)	172.15±14.97	0.14	.889
Total bilirubin (mg/dL)	0.5~1.8	Abnormal	5 (4.2)	171.20±9.73	0.14	.889
Total cholesterol (mg/dL)	142~240	Normal	111 (94.1)	172.47±14.83	1.05	.295
Total cholesterol (mg/dL)	142~240	Abnormal	7 (5.9)	166.43±13.14	1.05	.295
eGFR (mL/min/1.73 m²)	≥ 60	Normal	78 (66.1)	171.78±15.35	0.93	.737
eGFR (mL/min/1.73 m²)	≥ 60	Abnormal	40 (33.9)	172.75±13.68	0.93	.737
Creatinine (mg/dL)	0.68~1.19	Normal	78 (66.1)	171.50±14.91	-0.63	.533
Creatinine (mg/dL)	0.68~1.19	Abnormal	40 (33.9)	173.30±14.50	-0.63	.533
Serum glucose (mg/dL)	70~110	Normal	74 (62.7)	172.77±15.32	0.63	.531
Serum glucose (mg/dL)	70~110	Abnormal	44 (37.3)	171.00±13.85	0.63	.531
BMI (kg/m²)	19.5~24.9	Normal	101 (85.6)	172.72±14.24	0.95	.355
BMI (kg/m²)	19.5~24.9	Abnormal	77 (14.4)	168.47±17.54	0.95	.355
SBP (mmHg)	90~120	Normal	35 (29.7)	169.37±16.23	-1.31	.192
SBP (mmHg)	90~120	Abnormal	83 (70.3)	173.27±14.03	-1.31	.192
DBP (mmHg)	60~80	Normal	60 (50.8)	173.27±14.86	0.87	.389
DBP (mmHg)	60~80	Abnormal	58 (49.2)	170.91±14.68	0.87	.389

Table 1. Participants' Self-care and Social Support by Socio-demographic Characteristics (N=118)

†

Scheffe test applied; ́

‡

Single, separation, divorce, widowed.

Table 2. Participants' Self-Care and Social Support by Disease-related Characteristics (N=118)

HCC=hepato-cellular carcinoma, LC=liver cirrhosis, FHF=fulminant hepatic failure;

†

Scheffe test applied. ́

Table 3. Participants' Self-care and Social Support (N=118)

Mean scores were based on a 5 point scale from 1=strongly disagree to 5=strongly agree.

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