Long-term quality of life after liver donation in the adult to adult living donor liver transplantation cohort study (A2ALL)

Abstract

Background and Aims. There are few long-term studies of health-related quality of life (HRQOL) in living liver donors. This study aimed to characterize donor HRQOL in the Adult to Adult Living Donor Liver Transplantation Study (A2ALL) up to 11 years post-donation. Methods. Between 2004-2013, HRQOL was assessed at evaluation, and 3 months and yearly post-donation in prevalent liver donors using the Short Form survey (SF-36), which provides a physical (PCS) and a mental component summary (MCS). Results. Of the 458 donors enrolled in A2ALL, 374 (82%) had SF-36 data. Mean age at evaluation was 38 (range 18-63), 47% were male, 93% white, and 43% had a bachelor’s degree or higher. MCS and PCS means were above the US population at all time points. However, at every time point there were some donors who reported poor scores (>1/2 standard deviation below the age and sex adjusted mean) (PCS: 5.3%-26.8%, MCS: 10.0%-25.0%). Predictors of poor PCS and MCS scores included recipient death within the two years prior to the survey and education less than a bachelor’s degree; poor PCS scores were also predicted by time since donation, Hispanic ethnicity, and at the 3-month post-donation time point. Conclusions. In summary, most living donors maintain above average HRQOL up to 11 years prospectively supporting the notion that living donation does not negatively affect HRQOL. However, targeted support for donors at risk for poor HRQOL may improve overall HRQOL outcomes for living liver donors.

Updates in Psychosomatic Medicine: 2014

“…The articles were Updates in Psychosomatic Medicine related to 15 subspecialties: cardiac psychiatry, [4][5][6][7][8][9] collaborative care/integrated behavioral health, 10,11 emergency psychiatry, 12,13 HIV psychiatry, [14][15][16][17][18][19][20] neuropsychiatry, 21-31 pediatric psychosomatic medicine, 32-36 psychodermatology, [37][38][39][40][41][42][43][44][45] psychonephrology, 46-55 psycho-oncology and palliative care, [56][57][58][59][60][61][62][63][64] serious mental illness, [65][66][67][68][69][70][71][72] somatic symptom disorders, 73 suicide, 74-78 transplant psychiatry, [79][80][81][82][83][84]…”

Use of a severity indicator as a predictor of the use of hepatic transplantation resources

“…Clinical conditions that virtually sealed the death prognosis currently have new therapeutic approaches that ensure longer survival and resolution of various conditions of extreme severity. For example, in end-stage liver failure, a severe medical condition that usually affects patients with chronic or acute liver disease, as in acute fulminant hepatitis (1) , liver transplantation became a therapeutic alternative of great effectiveness, affecting survival and improving quality of life (2) . To enable the care of these worsening health conditions, hospitals have undergone major transformations in their physical infrastructure and in personnel qualification.…”

“…To enable the care of these worsening health conditions, hospitals have undergone major transformations in their physical infrastructure and in personnel qualification. The management of end-stage liver failure demands the development of specific skills from the care staff, from both the medical-surgical point of view and the nursing process (2) , and requires the availability of therapeutic resources, technical and administrative support. Issues related to the existence of appropriate technologies, maintaining low risk contamination environments and the development of logistics processes for selection and collection of organ and tissue started to dominate the routine of specialized units' managers (3) .…”

Adult living donor liver imaging

“…Studies of LDLT have shown acceptable results in terms of short-term survival and graft outcomes compared with deceased donor liver transplantation with full size organ (1) and long-term donor quality of life (2). In the nine-center adult-to-adult living donor liver transplantation cohort study (A2ALL), one-year graft survival was 81% (3) and most living donors maintained an above average health-related quality of life at 11 years postoperatively (4). In addition, recent advancements in surgical techniques and presurgical evaluation and preparation have continued to improve outcomes (5).…”