Quality of life up to 30 years following liver transplantation

Abstract

Liver transplantation provides a return to a satisfactory quality of life (QOL) for the majority of patients in the short to medium term (first 5 years), but there is very little information on the QOL in the longer term and the factors influencing it. We therefore undertook a single-center cross-sectional analysis to determine QOL in patients 10 or more years after liver transplantation. All liver transplant recipients who were followed up at the Cambridge Transplant Unit for 10 or more years (transplanted between 1968 and 1994) and resident in the United Kingdom were asked to complete by post the Short Form 36 version 2 and the Ferrans and Powers questionnaires to evaluate their QOL. Univariate and multivariate analysis were performed to assess the relationship between a range of clinical parameters and QOL. One hundred two patients were invited to participate, and 61 (59.8%) responded. Overall, the patients reported a satisfactory QOL. On the Ferrans and Powers questionnaire, the patients had a mean Quality of Life Index score of 24.5. Factors associated with reduced physical functioning were age Ͼ 50 years at transplantation, female gender, and recurrence of the primary liver disease. On the Short Form 36 version 2 questionnaire, recipients had reduced physical functioning but normal mental health parameters in comparison with the normal population. Age Ͼ 60 years at the time of survey, female gender, and posttransplant complications were associated with reduced physical functioning. In conclusion, patients 10 or more years after liver transplantation generally have a good QOL, although physical functioning is reduced. Addressing issues such as recurrent disease and posttransplant problems such as osteoporosis may help to improve long-term QOL.

Quality of life in liver transplant recipients and the influence of sociodemographic factors

“…A study conducted in Italy compared the quality of life before and after the transplant, and the demographic characteristics showed no significant differences between groups (16) . Another study performed in Cambridge (England) included patients in follow-up of 30 years post-transplant, and demonstrated that receptors of female gender and aged over 60 years were important factors associated with reduced physical functioning of the SF-36 scale (17) . The marital status of participants was in line with findings of a study conducted in Belgium, in which most liver transplant patients were married, corresponding to 69.8% of the sample (18) .…”

Long-term improvement in health-related quality of life after orthotopic liver transplantation

“…7 Desai et al's study 8 in this issue of Liver Transplantation provides valuable cross-sectional information on the quality of life of patients at least 10 years (and up to 30 years) after they underwent liver transplantation. Their patient population consists of 57 residents in the United Kingdom who received a liver transplant between 1968 and 1994 and completed a mail survey asking about their quality of life.…”

“…One of the greatest strengths of this study by Desai et al 8 is that they used both a generic (global) HRQL measure and a disease-specific HRQL measure. The generic instrument, the SF-36, which is a widely used 8-domain HRQL instrument, allows for comparisons in quality of life to be made across patient groups, including long-term HRQL outcomes of other organ transplant patients.…”

“…Although Desai et al 8 make a cross-sectional comparison of liver transplant recipients' HRQL to that of the general population, it would have been interesting to have comparative data pre-OLT or shortly after OLT with the same instruments. It would have also been valuable, despite the small sample size, to provide some psychometric information on the HRQL domains measured because little is known about the HRQL of this patient group in the long term.…”

Psychosocial functioning in patients with alcohol-related liver disease post liver transplantation

“…Differing patterns of psychosocial adjustment between aetiological (disease) groups receiving OLT also requires further investigation. Many psychosocial studies of OLT recipients have not considered the type of liver disease (Blanch, et al, 2004;Cowling, et al, 2004a;Cowling, et al, 2004b;Desai, et al, 2008;O'Carroll, Couston, Cossar, Masterton & Hayes, 2003;Ratcliffe, et al, 2002;Younossi, et al, 2000). Given the aetiological heterogeneity among liver disease patients, and the unique characteristics of ALD patients, this is an important limitation.…”