Gastroenterology

Gastroenterology

Volume 139, Issue 5, November 2010, Pages 1619-1629.e4
Gastroenterology

Clinical—Liver, Pancreas, and Biliary Tract
In a 12-Year Study, Sustainability of Quality of Life Benefits After Liver Transplantation Varies With Pretransplantation Diagnosis

https://doi.org/10.1053/j.gastro.2010.06.043Get rights and content

Background & Aims

As life-extending benefits of liver transplantation (LTX) are realized, the focus of improving outcomes after LTX transitioned from merely extending quantity of life to improving quality of life (QOL). Numerous cross-sectional studies have shown that QOL improves within 1 year after LTX; however, the long-term prospective pattern of QOL is not known. We assessed the sustainability of early QOL benefits after LTX.

Methods

Patients who underwent LTX (n = 381) were followed for 12 years. We collected clinical information, survival data, and data on 5 QOL domains: physical distress (PHY), psychological distress (PSY), social/role function (SRF), personal function (PF), and general health perception (GHP). Mixed model analysis was used to determine whether initial gains in QOL were sustained long term. Outcomes were analyzed according to the primary liver diagnosis.

Results

After 12 years, liver recipients had marked declines in PHY (P < .001), SRF (P = .006), and GHP (P < .001) scores, whereas improvements in PSY (P = .09) and PF (P = .09) were sustained. Women had worse outcomes in PHY and PF than men. Patients with autoimmune disease had decreased QOL PHY, SRF, PF, and GHP domains. Patients with alcoholic liver disease and hepatitis C initially had lower QOL in all domains, with the greatest decreases in PHY (P < .001) and PF (P = .03).

Conclusions

Although QOL improves within 1 year after patients receive liver transplants, not all groups of patients achieve or sustain the same level of QOL for 12 years. QOL decreases with time in most areas. Efforts should be made to improve QOL and function in the initial recovery period in liver transplant recipients.

Section snippets

Setting and Participants

A total of 916 patients received liver transplants between April 15, 1990, and June 30, 1994, at 1 of 3 medical centers: Mayo Clinic, Rochester, Minnesota; University of Nebraska, Omaha, Nebraska; or University of California at San Francisco. Clinical follow-up data were collected prospectively through June 30, 1995. Vital status and QOL were collected through November 2002. All data were obtained from the NIDDK-Liver Transplant Database (LTD). The original study was coordinated at the

Results

Of the 381 recipients, 53% were male and 85% were white. The mean age was 40 years, MELD score was 16.9, and follow-up time was 9.7 years. The primary causes for transplantation were PSC (24%) and PBC (17%); 63/381 (16.5%) of the population died before year 12 (25% because of liver failure, 18% because of malignancy, and 57% because of other causes). Recurrence of disease was found in only 66 (17%) recipients. As expected, 89% were in those persons who received a transplant for HCV or ALD+C.

Discussion

It has long been known that the QOL of liver transplant recipients, both global and domain-specific areas, improve from before to after LTX.3 An earlier analysis of the NIDDK-LTD QOL data also showed similar improvements from before to after LTX.5 However, the QOL of liver transplant recipients is more likely to be equal to other medically ill populations but not equal to healthy people.3, 23 A recent systematic review of QOL continues to suggests that, although general QOL strikingly improves

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    Conflicts of interest The authors disclose no conflicts.

    Funding This work was supported by National Institute of Diabetes and Digestive and Kidney DiseasesN01-DK-0-2251 grant DK 55883; this work was prepared for the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database.

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    Copyright © 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.