P48 Patients on the liver transplant wait-list have an increased prevalence of undiagnosed depression

<h3>Background</h3> The prevalence of co-existent anxiety and depression is higher amongst patients with chronic liver disease (CLD) than the general population. Depression in CLD reduces survival and health-related quality of life. Depression increases liver transplant (LT) wait-list mortality and negatively impacts post-LT survival. Patients on the LT wait-list are under an immense psychological burden due to the inherent uncertainty of their situation. We aimed to identify the prevalence of anxiety and depression amongst our LT wait-list patient cohort and compare this to patients with CLD not on the wait-list. <h3>Methods</h3> An observational cross-sectional study was performed. The Hospital Anxiety and Depression Scale (HADS) questionnaire was distributed to a sequential unselected cohort of patients attending the LT wait-list clinic at King’s College Hospital, and compared to an unselected cohort of patients with CLD attending general hepatology clinics, not on the wait-list. An anxiety and/or depression sub-score (HADS-A,HADS-D) ≥ 8 was consistent with a probable diagnosis of current anxiety and/or depression. <h3>Results</h3> 15 patients on the LT wait-list and 15 patients with CLD not wait-listed were assessed. Patients in the wait-list cohort were younger (median age 46 years (IQR:33–58)) than those in the CLD cohort (median age 62 years (IQR:51–62),p=0.03). Aetiology of liver disease was significantly different between groups (p=0.008). The majority of patients in the CLD group had alcohol-related cirrhosis (abstinent). There was no significant difference in MELD between the wait-list group (median MELD 12) and CLD group (median MELD 10,p=0.17). 40% of the wait-list group had a pre-existing mental illness diagnosis, compared to 47% of the CLD group (p=0.71). 13% of the wait-list group and 40% of the CLD group were on anti-depressants (p=0.10). 67% of the wait-list cohort screened positive for depression compared to 27% of the CLD cohort (p=0.02). Prevalence of probable anxiety was similar in the wait-list and CLD groups (40% vs. 47% respectively,p=0.71). Interestingly, 60% of the cases of probable depression in the wait-list group were not previously diagnosed, whilst all cases in the CLD group had a pre-existing diagnosis of depression (p=0.04). <h3>Conclusion</h3> The prevalence of anxiety and depression is high in CLD, as previously described. The prevalence of depression is higher still amongst patients listed for LT. This study highlights the overarching need to take a holistic approach to the management of this patient cohort, to screen actively for anxiety and depression and ensure appropriate treatment and support is provided when needs are identified.