Comparing quality of life following liver transplantation for Laennec's versus non‐Laennec's patients 1

Abstract

The overall success of orthotopic liver transplantation (OLTX) includes not only survival, but quality of life (QOL) as well. We studied one controversial group of OLTX recipients, patients transplanted for alcoholic liver disease (Laennec's), to determine if their post-OLTX QOL was similar to that of patients transplanted for non-alcoholic liver disease (non-Laennec's). Over a 10-yr period, patients undergoing OLTX at our institution were asked to complete a QOL questionnaire addressing a wide range of topics from demographics and employment to symptom distress/frequency, activities of daily living, and effect of loss of health on daily life. Twenty-four Laennec's and 100 non-Laennec's OLTX recipients completed the questionnaire at both their 2- and 5-yr follow-up visits at our institution. Both groups were well-matched in age, race, and patient location status at the time of OLTX. No significant differences could be detected between Laennec's and non-Laennec's scores regarding overall QOL, including one's ability to function, health perception, and self-perception at 2 and 5 years post-OLTX, and between 2 and 5 years post-OLTX. Although not between groups, a significant difference was noted regarding patients' satisfaction with life, with less satisfaction reported at the 5-yr versus the 2-yr time point post-OLTX. Rates of current/recent employment between both groups were also similar at 2 years post-OLTX, and again at 5 years post-OLTX. We conclude that overall QOL and employment levels appear similar between patients transplanted for alcoholic and non-alcoholic liver disease. This similarity appears to extend to 5 years post-OLTX.

Fatigue and physical function after orthotopic liver transplantation

“…Other studies found no difference in HRQL 17,18 between patients with alcoholic and nonalcoholic diagnoses. However, these studies did not use multiple regression methods; therefore, results may have been confounded by other factors.…”

“…Although it was deliberately chosen to focus on physical function and fatigue in this study, future research should investigate further the entire range of symptoms and problems after OLT, thus also using liver disease-specific questionnaires, as have several other studies. 3,7,18 Finally, no information was obtained on alcohol consumption. Especially in relation to patients with an alcoholic diagnosis, alcohol consumption may be a potential confounder.…”

“…5,8,[15][16][17][18] More research seems necessary to clarify the role of different predictors of HRQL. Aims of this study are to describe the HRQL of Danish liver transplant recipients, investigate the nature of their fatigue in detail, compare their HRQL against that of the Danish general population, and identify predictors of physical function and physical fatigue.…”

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

“…Questions that comprise every domain are descendants of several validated instruments, such as the Karnofsky scale, Sickness Impact Profile (SIP), Index of Well-Being, Medical Outcome Study (MOS), and Nottingham Health Profile (NHP). Five studies evaluating the QOL after LT have used this instrument to date: the studies by Levy et al, 9 Cowling et al, 10 Belle et al, 5 Gross et al, 11 and Kim et al 12 However, additional information regarding the validity of this composite tool is needed. 13 The NIDDK questionnaire was subjected to translation and back-translation to ensure the equivalence of the USA and French versions, and was reviewed for content validity.…”

Quality of life after liver transplantation. A systematic review

“…Among the conditions that have been investigated are alcoholic liver disease (ALD), HCV infection, acute liver failure (ALF), and chronic cholestatic syndromes. Several studies have reported on QOL after LT in patients transplanted for ALD [5][6][7][8][9]. While the majority of the studies have shown striking impairment before LT and significant improvement after LT, there remains debate about the QOL responses in ALD recipients when compared to patients transplanted for other conditions.…”