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Original Article

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

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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

Copyright © 2015 Korean Society of Adult Nursing

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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  • 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
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
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
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
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† Nonea 7 (5.9) 167.71±19.09 1.14 98.57±12.95 4.21
Spouseb 95 (80.5) 173.12±14.33 (.325) 110.41±10.38 (.017*)
Parents, Childc 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
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
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† Childa 54 (45.8) 175.43±14.36 2.24 110.85±10.75 5.38
Spouseb 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
acquaintancec          
Deceased donord 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
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
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
M±SD t p
GOT (IU/L) 13~34 Normal 98 (83.1) 172.36±15.05 0.40 .689
Abnormal 20 (16.9) 170.90±13.50
GPT (IU/L) 5~46 Normal 99 (83.9) 172.56±15.24 0.75 .457
Abnormal 19 (16.1) 169.79±11.96
Total bilirubin (mg/dL) 0.5~1.8 Normal 113 (95.8) 172.15±14.97 0.14 .889
Abnormal 5 (4.2) 171.20±9.73
Total cholesterol (mg/dL) 142~240 Normal 111 (94.1) 172.47±14.83 1.05 .295
Abnormal 7 (5.9) 166.43±13.14
eGFR (mL/min/1.73 m2) ≥ 60 Normal 78 (66.1) 171.78±15.35 0.93 .737
Abnormal 40 (33.9) 172.75±13.68
Creatinine (mg/dL) 0.68~1.19 Normal 78 (66.1) 171.50±14.91 -0.63 .533
Abnormal 40 (33.9) 173.30±14.50
Serum glucose (mg/dL) 70~110 Normal 74 (62.7) 172.77±15.32 0.63 .531
Abnormal 44 (37.3) 171.00±13.85
BMI (kg/m2) 19.5~24.9 Normal 101 (85.6) 172.72±14.24 0.95 .355
Abnormal 77 (14.4) 168.47±17.54
SBP (mmHg) 90~120 Normal 35 (29.7) 169.37±16.23 -1.31 .192
Abnormal 83 (70.3) 173.27±14.03
DBP (mmHg) 60~80 Normal 60 (50.8) 173.27±14.86 0.87 .389
Abnormal 58 (49.2) 170.91±14.68

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

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

    Characteristics Categories n (%) or M±SD Self-care Social support
    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
    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
    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
    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† Nonea 7 (5.9) 167.71±19.09 1.14 98.57±12.95 4.21
    Spouseb 95 (80.5) 173.12±14.33 (.325) 110.41±10.38 (.017*)
    Parents, Childc 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
    No 98 (83.1) 170.98±14.62 (.065) 108.86±11.43 (.398)

    †Scheffe test applied; ́

    ‡Single, separation, divorce, widowed.

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

    Characteristics Categories n (%) or M±SD Self-care Social support
    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† Childa 54 (45.8) 175.43±14.36 2.24 110.85±10.75 5.38
    Spouseb 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
    acquaintancec          
    Deceased donord 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
    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
    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. ́

    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.

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

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

    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.
    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.

    Table 4. Participants' Self-care by Biomarkers (N=118)

    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.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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