Health-Related Quality of Life After Different Types of Solid Organ Transplantation

Abstract

ObjectiveTo describe functional health and health-related quality of life (QOL) before and after transplantation; to compare and contrast outcomes among liver, heart, lung, and kidney transplant patients, and compare these outcomes with selected norms; and to explore whether physiologic performance, demographics, and other clinical variables are predictors of posttransplantation overall subjective QOL. Summary Background DataThere is increasing demand for outcomes analysis, including health-related QOL, after medical and surgical interventions. Because of the high cost, interest in transplantation outcomes is particularly intense. With technical surgical experience and improved immunosuppression, survival after solid organ transplantation has matured to acceptable levels. More sensitive measures of outcomes are necessary to evaluate further developments in clinical transplantation, including data on objective functional outcome and subjective QOL. MethodsThe Karnofsky Performance Status was assessed objectively for patients before transplantation and up to 4 years after transplantation, and scores were compared by repeated measures analysis of variance. Subjective evaluation of QOL over time was obtained using the Short Form-36 (SF-36) and the Psychosocial Adjustment to Illness Scale (PAIS). These data were analyzed using multivariate and univariate analysis of variance. A summary model of health-related QOL was tested by path analysis. ResultsTools were administered to 100 liver, 94 heart, 112 kidney, and 65 lung transplant patients. Mean age at transplantation was 48 years; 36% of recipients were female. The Karnofsky Performance Status before transplantation was 37Ϯ1 for lung, 38Ϯ2 for heart, 53Ϯ3 for liver, and 75Ϯ1 for kidney recipients. After transplantation, the scores improved to 67Ϯ1 at 3 months, 77Ϯ1 at 6 months, 82Ϯ1 at 12 months, 86Ϯ1 at 24 months, 84Ϯ2 at 36 months, and 83Ϯ3 at 48 months. When patients were stratified by initial performance score as disabled or able, both groups merged in terms of performance by 6 months after liver and heart transplantation; kidney transplant patients maintained their stratification 2 years after transplantation. The SF-36 physical and mental component scales improved after transplantation. The PAIS score improved globally. Path analysis demonstrated a direct effect on the posttransplant Karnofsky score by time after transplantation and diabetes, with trends evident for education and preoperative serum creatinine level. Although neither time after transplantation nor diabetes was directly predictive of a composite QOL score that incorporated all 15 subjective domains, recent Karnofsky score and education level were directly predictive of the QOL composite score. ConclusionsDifferent types of transplant patients have a different health-related QOL before transplantation. Performance improved after transplantation for all four types of transplants, but the trajectories were not the same. Subjective QOL measured by the SF-36 and the PAIS also improved after transplant...

Longitudinal prospective evaluation of quality of life in adult patients before and one year after liver transplantation

“…13 The somatic symptoms that we found (excess appetite, trembling, and headaches) can be considered to be the side effects of immunosuppressive drugs. It was reported that deaths related to immunosuppressive treatments from chronic rejection, opportunist infections, and lymphoma represent 40% of late mortality after LT. 23 Pinson et al 24 are convinced that results of the QOL can be used similarly to the rate of rejection to determine immunosuppression regimen or other strategies of patient management. During recent years, a dramatic improvement has been achieved in the area of electronic data transmission.…”

Long-term improvement in health-related quality of life after orthotopic liver transplantation

“…7 Desai et al's study 8 in this issue of Liver Transplantation provides valuable cross-sectional information on the quality of life of patients at least 10 years (and up to 30 years) after they underwent liver transplantation. Their patient population consists of 57 residents in the United Kingdom who received a liver transplant between 1968 and 1994 and completed a mail survey asking about their quality of life.…”

Lung transplantation for chronic obstructive pulmonary disease

“…Patients report that HRQoL is improved immediately after transplantation, and they further report that gains are sustained. [201][202][203][204][205][206][207][208][209] However, these findings may be influenced by a transplantation specific bias: there may be personal, familial, peer, and provider pressures for the patient to be convinced that the risks and costs undertaken to undergo this irreversible procedure were worthwhile. Due to the incomparable nature of HRQoL and survival, adjustments for patients with early mortality, a stubbornly persistent 10%-15% of all recipients within 6 months of transplantation 1,100 and more than 20% in selected groups, 1 cannot be done.…”

“…Due to the incomparable nature of HRQoL and survival, adjustments for patients with early mortality, a stubbornly persistent 10%-15% of all recipients within 6 months of transplantation 1,100 and more than 20% in selected groups, 1 cannot be done. Application of positive findings in the papers reviewed [201][202][203][204][205][206][207][208][209] is limited in the context of modern lung transplantation for COPD. The studies were performed over several decades; studied patients and earlier surgical methods may or may not be comparable to current patients contemplating or awaiting lung transplantation and contemporary techniques, respectively.…”