S2875 The Impact of Aging on Coping Strategies and Psychological Health Metrics After Liver Transplantation

Introduction: As the population of liver transplant (LT) recipients continues to age, a growing proportion of transplants are being performed in adults over 65. While survival outcomes for older recipients have improved, less is known about their psychological wellbeing following transplantation. We aimed to characterize changes in psychological symptoms pre- vs post-LT and examine how aging affects psychological symptom burden and coping patterns during recovery. Methods: Adult LT recipients (LTRs) were prospectively enrolled at an academic transplant center and completed validated psychological surveys at baseline (waitlist) and at 6- or 12-months post-LT. Surveys included: 1) PROMIS (Patient-Reported Outcomes Measurement Information System) Anxiety, Depression, and Social Isolation scales; 2) NIH Perceived Stress Scale (PSS); and 3) Brief-COPE, which assesses reliance on specific coping strategies. Scores were analyzed using paired t-tests or ANOVA to evaluate pre- vs post-LT differences. Change scores were computed for each participant. Multivariable linear regression was used to identify factors associated with greater psychological symptom burden post-LT, with a focus on recipient age (<65 vs ≥65 years). Results: Sixty-eight LTRs completed pre- and post-LT assessments (mean age 50.1 ± 14.1 years; 38.2% woman; 83.8% White; 23.5% Hispanic). Compared to recipients aged <65, those ≥65 demonstrated significantly lower reliance on acceptance coping strategies both pre-LT (5.3 ± 1.6 vs 6.8 ± 1.5, P = 0.03) and post-LT (3.0 ± 1.7 vs 6.0 ± 2.2, P = 0.003). Older adults also exhibited greater declines in acceptance coping over time (–2.3 ± 1.2 vs –0.8 ± 2.1, P = 0.02). No statistically significant differences were observed between age groups in changes to PROMIS anxiety, depression, or isolation scores, nor in the use of active coping strategies. Conclusion: LTRs aged ≥65 experienced changes in psychological symptoms post-transplant, showing decreased reliance on adaptive coping strategies such as acceptance and active coping, both before and after LT. This finding may reflect greater vulnerability or differing recovery trajectories in older LTRs. Limited coping flexibility has been associated with worse emotional and functional outcomes in geriatric populations. Thus, integrating age-sensitive behavioral coping interventions that integrate acceptance and active coping styles into longitudinal post-LT care could promote psychological recovery and improve quality of life across the transplant continuum.