Study of the Factors Affecting Health-Related Quality of Life in Adolescents After Liver Transplantation

Abstract

The aim of the study was to identify factors affecting health-related quality of life (HRQL) in adolescents after liver transplantation. HRQL was measured using the CHQ-CF87 in 55 adolescents, aged 12-18 years. Factors associated with HRQL included allograft morbidity, psychological and family-related variables measured through standardized questionnaires. The domains of the CHQ-CF87 were reduced using factor analysis to give physical, psychological and social domains. Impacting factors were identified through stepwise, multiple regression analysis. Adolescents had significantly lower HRQL in every domain except for role/social-behavior and family cohesion compared to the general population. Adolescents experienced median 18 (range 4-31) symptoms related to immunosuppression, 40(75%) had one or more chronic illnesses related to immunosuppression and 12(22%) had a history of emotional difficulties. Self-esteem and emotional health were similar to the general population but behavior and aspects of family function were lower. Following regression analysis, the factors associated with HRQL were: age at transplant, secondary chronic illness, symptom distress, headaches, history of emotional difficulties, self-esteem and family conflict. These explained 57% of the variance in physical function, 61% of psychological function and 39% of social function. HRQL is significantly reduced in adolescents after transplantation, which could be related to immunosuppression and psychosocial factors.

The Stories of Young People Living With a Liver Transplant

“…In their comments the participants referred to areas of life that are not captured by generic QoL instruments, e.g., relationships, bullying, treatment adherence. Also, although differences were noted according to stage of adolescence, this is not apparent using quantitative methods (Taylor et al, 2009), indicating a lack of responsiveness on the part of the QoL instruments. This suggests that currently available PROMs might not be suitable for use with young people after liver transplantation.…”

Liver transplantation in children: state of the art and future perspectives

“…However, they had similar QOL when compared with other children and adolescents with different chronic illnesses. A follow-up study from the same group focused on adolescents and found them to have significantly lower QOL (self-reported) across multiple domains, similar to adolescents with other chronic illnesses 10. Further, the authors proposed that the necessity of lifelong immunosuppression directly or indirectly may in part be responsible for the reduced QOL.…”

The adolescent and liver transplantation

“…Twenty-two percent of them reported a history of emotional difficulties. When the data were assessed by regression analysis, the factors associated with quality of life were age at transplantation, secondary illnesses, symptom distress, headaches, history of emotional difficulties, self-esteem, and family conflicts [72]. It therefore seems that we should look at numerous factors in adolescents, such as the presence of other diseases and medical complications due to immunosuppression, as well as assessing family relations before and after liver transplantation.…”