Quality of life (QoL) after deceased donor liver transplantation is increasingly recognized as a major outcome parameter. We reviewed recent publications in this rapidly evolving field in order to summarize recent achievements in the field and to define opportunities and perspectives for research and improvement of patient care. QoL does improve after liver transplantation according to a typical pattern. During the first year, there is a significant improvement in QoL. After one year, the improvement does stabilise and tends to decline slightly. In addition to the physical condition, different psychological parameters (such as depression, anxiety, sexual function) and sociodemographic elements (professional state, sex, marital state) seem to impact QoL. Opportunities for further research are the use of dedicated questionnaires and identification of influencing factors for QoL. Core tip: Quality of life (QoL) after deceased donor liver transplantation (LT) is increasingly recognized as a major outcome parameter. This review summarizes a broad spectrum of factors that influence QoL in LT and elucidates the evolution in time of physical and mental QoL after LT. Furthermore attention is given to areas for further investigation and the use of self-report QoL questionnaires in LT. This way, we want to offer a recent and complete overview in this rapidly evolving field.

The prevalence of obesity and metabolic diseases such as type 2 diabetes and nonalcoholic fatty liver disease (NAFLD) has risen dramatically over the past decades.At present, bariatric surgery is the most effective treatment for this global health problem, through effects on food intake, gut hormone secretion, metabolic signaling pathways, and adipose tissue dysfunction. The liver occupies a central role in carbohydrate, protein, and lipid metabolism. Notably, a reduction in hepatic fat content and an improvement in hepatic insulin resistance are among the earliest beneficial effects of bariatric surgery, which has therefore emerged as an attractive treatment option for NAFLD. However, as the scope and popularity of weight loss surgery have expanded, new questions have arisen regarding its safety in patients with liver cirrhosis, the outcome of liver transplantation in patients with a history of bariatric surgery, and over incidental reports of liver failure following surgery. Studies in humans and rodents have also linked bariatric surgery to an increased risk of developing alcohol use disorder, a major risk factor for liver disease. This review integrates data from clinical and translational research to delineate both the beneficial impact of bariatric surgery on the liver and the potential risks involved.

Purpose Illness cognitions regarding helplessness and acceptance are known to play a role in health-related quality of life (HRQoL). Our study examined the evolution of these illness cognitions and the physical (PQoL) and mental QoL (MQoL) in liver transplantation (LT) patients over time in relation to pre-and postoperative clinical factors. Methods We performed an analytical cross-sectional study using self-report questionnaires at 4 timeframes: preLT, postLT 0-3 m , postLT 1y , and postLT 2y . T-test was used to identify the influence of different clinical factors related to the LT on postLT 2y QoL and illness cognition. Linear mixed models were used to determine evolution. Results PostLT patients showed significant less helplessness and more acceptance cognitions. PQoL and MQoL decreased postLT 0-3 m, then started to increase and are highest at postLT 1y. Patients with preLT ascites showed significantly less helplessness postLT 2y , while patients with a low preLT MELD score < 20 showed a significant better MQoL postLT 2y . Biliary complications and re-transplantation were associated with more helplessness and a worse PQoL postLT 1y-2y . Length of stay in ICU and hospital was negatively correlated with illness cognitions and PQoL and MQoL postLT 1y. Conclusions Our findings confirm that liver transplant patients have improvement of illness cognitions and mental and physical HRQoL at 1 and 2 years after liver transplantation. A postoperative period without complications and with short stay in ICU and in hospital, is important to achieve PQoL and feeling less helpless, while the MQoL is influenced by acceptance and preLT PQoL. Multidisciplinary approach preLT and postLT should be standard care. Keywords Liver transplantation • Health-related quality of life • Illness cognitions • Acceptance • Length of stay Abbreviations AIH Auto-immune hepatitis. ALD Alcoholic liver disease. ALF Acute liver failure. CMV Cytomegalovirus.

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