Changes in quality of life and functional capacity after lung transplantation: A single-center experience

Abstract

Lung transplantation (LT) increases the life expectancy of patients affected by end stage pulmonary disease; specifically, its ultimate aims are to improve survival and health related quality of life (HRQoL). The aim of the present longitudinal study was to determine the HRQoL trajectory and changes in functional capacity from time of entry in the waiting list for LT to 2 year after LT. The study included sixty-nine outpatients enrolled in a single medical center when they entered the waiting list for LT and who subsequently received it. They were then followed up over 2 years after LT. HRQoL was assessed by the physical and mental component summary (PCS and MCS) scores of the 36-item Short Form Health Survey (SF-36) and Saint George's Respiratory Questionnaire (SGRQ). Psychological distress was evaluated with the General Health Questionnaire (GHQ), and functional capacity was investigated using the six-minute walk test (6MWT) and forced expiratory volume (FEV1). Patients showed low SF-36 PCS (30.5±7.8) and SGRQ total (61.8±17.5) scores at entry in the waiting list, but exhibited significant changes over time after LT (p<0.001). Furthermore, patients who showed an increase of at least 50% in SF36 PCS and SGRQ scores at 6 months survived longer. Both FEV1 and 6MWT distance as well as GHQ scores significantly changed over time, with improvements occurring in the first 6 months after LT but no major changes thereafter. Out of the 69 patients enrolled, 32 died over a median follow-up of 51 months. Although mortality tended to be slightly higher for patients with lower HRQoL at the baseline assessment, this difference was not statistically significant. HRQoL evaluations appear critical in the follow-up of LT candidates, in particularly SGRQ, because of its specificity in targeting respiratory symptoms and functional wellbeing.

Health-related quality of life and stress-related post-transplant trajectories of lung transplant recipients: a three-year follow-up of the Swiss Transplant Cohort Study

“…Specifically, results from longitudinal studies reported a significant improvement in the HRQoL in LTx-recipients, especially within the first six months post-transplant, with a relatively stable HRQoL thereafter [14,15]. Nonetheless, the individual trajectories of HRQoL over time are less clear in LTx-recipients, as their health is often hampered by numerous post-operative complications and the side effects of immunosuppressive therapy [16,17]. Indeed, few studies have examined distinct HRQoL trajectories within the same patients over time.…”

A systematic review of patient-reported outcome measures (PROMs) in cystic fibrosis

“…A similar finding was observed in the SF-36, which was used in four European studies on adult populations. 50 55 63 64 The instrument demonstrated robust reliability with Cronbach alpha of 0.95 64 and discriminated between CF and non-CF populations. 55 64 However, Abbott et al 50 found a high proportion of participants reporting no problems and that the instrument was less sensitive to clinical deterioration than the CFQoL.…”

“… 73 Other HRQoL surveys focused on mental health identified were the Patient Health Questionnaire-9, General Health Questionnaire and Generalised Anxiety Disorder-7. Each was used in one study and found to have acceptable reliability; 64 74 however, validity was not assessed.…”

The impact of bronchial artery embolisation on the quality of life of patients with haemoptysis: a prospective observational study

“…The HRQoL survey was performed as a selfassessment by patients themselves using the SF-8, which is a shortened version of the SF-36 health survey. The SF-8 is the most popular assessment tool, and it is widely used for evaluating HRQoL related to many diseases [18,19]. Previous studies have confirmed the validity and reliability of the Japanese version of the SF-8 [20,21].…”