BACKGROUND: The use of ex vivo liver resection and autologous liver transplantation (ELRA) for end-stage hepatic alveolar echinococcosis is gradually increasing, while postoperative psychological disorders in these patients remain underrecognized. We prespecified that longer pre-transplant waiting time, postoperative complications, and higher transfusion volume would be associated with worse anxiety, depression, and sleep disturbance at 1 month after ELRA.

MATERIAL AND METHODS: This single-center retrospective study enrolled 138 patients who underwent ELRA from 2020 to 2025. We collected demographic data, perioperative clinical indexes, and scores at baseline and 1 month postoperatively using the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), and Pittsburgh Sleep Quality Index (PSQI). Univariate analysis and multivariate linear regression were used to identify independent influencing factors.

RESULTS: Longer pre-transplant waiting time independently predicted worse scores across all psychological and sleep scales (all P<0.05). Prolonged anhepatic phase duration was specifically associated with higher PSQI scores (P<0.05). Intraoperative transfusion showed marginal but nonsignificant associations, and postoperative complications were significant only in univariate analysis.

CONCLUSIONS: Longer pre‑transplant waiting time is the core and most consistent risk factor for poor mental health after ELRA, while prolonged anhepatic phase is specifically linked to postoperative sleep disturbance. These findings support the implementation of targeted, stage-specific psychological interventions, especially during the pre-transplant waiting period, to improve mental health and quality of life in patients undergoing ELRA.

Keywords: Anxiety, Depression, Liver Transplantation