A Psychological Support Concept and Quality of Life Research in a Liver Transplantation Program: An Interdisciplinary Multicenter Study

Abstract

Considering the increasing number of liver transplantations with longer periods of transplant function, there is a growing need for quality of life research in the field. In addition to lethality, mortality and rehabilitation, parameters of ‘quality of life’ are to be evaluated: the patient’s rating of his subjective physical symptoms, psychological condition (anxiety, depression and mental adjustment), social reintegration and life satisfaction. This paper describes our psychological support program that has been established at the Hamburg LTX center as well as the first results of the ongoing QoL research study. Using the methods developed by the Hamburg Study group on ‘quality of life in surgery’, 38 liver transplantation patients of the University of Chicago (cross-sectional study with control groups of patients with chronic liver disease as well as healthy individuals) and 29 patients of the University Clinic of Hamburg (longitudinal study with points of evaluation before and 2, 6, 12, 24 and 36 months after transplantation) have been evaluated. First results: (1) All successfully transplanted patients show a significant postoperative increase of their overall quality of life. (2) The psychological parameters of quality of life are only partly correlated with physical symptoms. (3) There is a high correlation between rejection crisis periods and the decreaes of all quality of life parameters. (4) In both samples men have a lower quality of life than women. (5) Preoperative depression and lack of social support might be considered as being possible risk factors for long-term survival. (6) Long-term survivors rate their quality of life significantly higher than patients with chronic liver disease and – despite some persisting somatic restrictions – as high as healthy controls. (7) A psychotherapeutic support program increases the patient’s compliance resulting a better adaption to the transplant procedure including rehabilitation.

Longitudinal prospective evaluation of quality of life in adult patients before and one year after liver transplantation

“…Gender may also be important; in this study, 73% of subjects were male. Kober et al 20 found that the QOL reported by men was less than the one reported by women, whereas in a later study Moore et al did not find any difference. 21 Results of QOL studies that used different tools should be compared with caution, however.…”

Quality of Life and Cognitive Function of Liver Transplant Patients: A Prospective Study

“…Other studies using questionnaire data reported patients rating their QoL as good to excellent after OLT, 9,36,37 and Lowe et al 38 stated such ratings are not significantly different from community norms. Interestingly, Kober et al 15 found QoL reported by men was less than that reported by women. Post hoc examination of the present data showed no gender differences on recipients' ratings of their QoL (t 22 ϭ 1.19; P Ͻ .05).…”

“…13 An article from the Helsinki group provided the first major attempt to compare patients pre-OLT and post-OLT on neurological state. 14 Even so, their study and a similar design from Kober et al 15 were limited in the scope of domains assessed and contained method problems. Our own group extended this pre-post design by the addition of control groups and reported significant improvements in recipients' mood and work status after OLT.…”

Health-related quality of life after liver transplantation: A meta-analysis

“…Of the 5505 studies, 58 met our inclusion criteria (39 from MEDLINE, 11 from Embase, and 8 from manual searches). 4, We combined multiple reports of the same patient populations: the Chicago-Hamburg group, 49 …”