Good Quality of Life After More Than a Decade of Living Donor Liver Transplantation

Abstract

BACKGROUND: Receptors of living donor liver transplantation (LDLT) have higher rate of postoperative biliary and vascular complications that may reduce posttransplant quality of life (QOL) due to the need of invasive and repetitive treatments. OBJECTIVE: The purpose of our study is to assess the various aspects of QOL of receptors undergoing LDLT after 10 years of transplantation and to identify potential factors that might be associated with impaired QOL. METHODS: Data of all patients with more than 10 years of LDLT were retrospectively evaluated. Patients were interviewed through a quality of life questionnaire (SF-36). RESULTS: From a total of 440 LT performed in 17 years (from September 1991 through December 2008), 78 patients underwent LDLT, of which 27 were alive and 25 answered completely the questionnaire. There were 17 (68%) men and 8 (32%) women, with a mean age of 38.6±18.5 years at the time of transplantation and mean follow up time of 15.1±1.9 years. The average MELD was 16.4±4.9 and the main indication for LT was hepatic cirrhosis caused by hepatitis B virus (32%). When compared to the general population, LDLT patients had lower mental health score (66.4 vs 74.5, P=0.0093) and higher vitality score (87.8 vs 71.9, P<0.001), functional aspects (94.6 vs 75.5, P=0.002), social aspects (93 vs 83.9, P=0.005), physical aspects (92 vs 77.5, P=0.006), and emotional aspects (97.33 vs 81.7, P<0.001). General health status (73.28 vs 70.2, P=0.074) and pain (78.72 vs 76.7, P=0.672) scores were similar in both groups. CONCLUSION: It is concluded that the various aspects LDLT recipients’ QOF are similar to those of the general population more than a decade after the transplant, except for the mental health domain which is lower.

Perspectivas da fila de espera por um transplante hepático no Paraná: uma revisão de literatura

“…Dessa forma, o Sistema Único de Saúde (SUS) é responsável por realizar 95% dos transplantes hepáticos no país, a uma taxa de 13,2 doações por milhão de habitantes 16 . Porém, no ano de 2017, uma a cada cinco pessoas que aguardavam por um fígado morreram à espera de um órgão 18,21 doadores também inferir em maiores taxas de comorbidades, podendo aumentar assim as taxas de descompensação clínica e contraindicação a um transplante 32,33,34 .…”

“…Por fim, cabe destacar o índice de mortalidade na fila de espera por um transplante hepático de 5% no Paraná no período analisado pela pesquisa, significativamente melhor que a taxa nacional. Esse índice permite uma estima de que uma a cada cinco pessoas na fila de espera por um fígado não sobrevivam à espera pelo órgão, demandando, assim, ações que visem melhorar ainda mais os resultados ou, ao menos, a manutenção dos bons indicadores no estado 21 .…”

“…Essas dificuldades citadas também são enfrentadas nas realidades brasileira e paranaense. No último trimestre de 2017, o Brasil havia registrado 1.235 pessoas na lista de espera por um fígado 21 , ao passo que, nesse mesmo ano, o Paraná registrou 156 pessoas aguardando pelo órgão, chegando a 170 em 2018. Em 2019, registrou-se uma redução nos números, para 138 pessoas, e um novo aumento em 2020, chegando a 184, até chegar aos dados mais recentes de 2021, quando 206 aguardavam por um fígado no estado.…”

Quality of Life and Liver Transplant: A Comparative Evaluation between Different Post-transplant Phases

“…Liver transplant is a procedure applied worldwide in the treatment of several chronic and acute liver diseases, therefore being a practise in constant advancement, considerably reducing the complications rates, and increasing the patients' survival chances. 1 According to the Brazilian Association of Organ Transplantation (Associação Brasileira de Transplantes de Órgãos, ABTO), during 2019 the number of organ transplantation procedures rose, with the exception of lung transplants. In the first half of 2020, despite the efforts made by the donation, and transplant teams, the numbers of transplants decreased, this reduction continued until September 2021, with an 8.9% drop when compared to 2020, making clear the influence of the pandemic caused by the SARS-CoV-2 virus (COVID-19) on transplants, adding challenges to public health since its outbreak.…”

“…Therefore, the concern with long-term quality of life after liver transplantation has already been the subject of a study, which in turn, demonstrated that recipients have quality of life indices similar to those of the general population, except for mental health, corroborating other authors who pointed out complicating factors such as depression, and anxiety that can affect the quality of life after transplantation, in addition to a slower recovery of mental health compared to physical health. 1,4,5 Other researchers have investigated how different levels of pre-liver transplant disease severity can interfere with patients' quality of life before and after transplantation. 6 The literature also has a study that correlates the impairment of the functional capacity of cirrhotic patients and pre-liver transplant quality of life, demonstrating how these factors can interfere with the quality of life while waiting for the procedure.…”