Quality of life, risk assessment, and safety research in liver transplantation

Abstract

Purpose of review In this review, we briefly summarize three fruitful, emerging areas in liver transplantation research: quality of life; risk assessment; and patient safety. Our goal is to highlight recent findings in these areas, with a call for increased integration of social scientists and transplant clinicians to address how best to shape policy and improve outcomes. Recent findings After liver transplantation, recipients generally experience clinically significant, sustained improvement in their physical, social and emotional well-being. However, a sizeable minority of patients do experience excess morbidity that may benefit from ongoing surveillance and/or intervention. There is growing body of research that describes risks associated with liver transplantation, which can be useful aids to better inform decision making by patients, clinicians, payers, and policy makers. In contrast, there has been a relative lack of empirical data on transplant patient safety vulnerabilities, placing the field of surgery in stark contrast to other high risk industries, where such assessments inform continuous process improvement. Summary Health services and outcomes research has grown in importance in the liver transplantation literature, but several important questions remain unanswered that merit programmatic, interdisciplinary research.

Quality of life after liver transplantation: State of the art

“…Relational status however, does impact QoL. Married patients have a better QoL after liver transplantation than single or non-married patients [8,19,28] . This might be explained by a better social support.…”

“…The influence of gender on QoL remains a matter of debate, and data are conflicting [8,11,18] . Relational status however, does impact QoL.…”

“…Patients regaining professional activities after only one year had a better QoL on the long term with less emotional problems [1,3,8,10,28] . A possible bias could be that only patients in good general condition will resume Ref.…”

“…This can be explained by the presence of comorbidities, the severity of the disease and the transplant procedure [3,8,[10][11][12][13][14] . HRQoL tends to increase rapidly during the first two years, and remains stable afterwards once almost normal values have been reached [8,15] . Some authors report a more fluctuating evolution with a rapid increase of QoL during the first six months, followed by a stabilization during the remainder of the first year and a rebound effect during the second year due to adaption to certain psychosocial conditions.…”

“…However, once survival is granted, the real outcome parameter to address the success of liver transplantation on the long term is quality of life (QoL). QoL can be defined as "an overall sense of well-being, including aspects of happiness and satisfaction with life as a whole, which is measurable through mental well being, physical functioning and overall health status" [8] . The World Health Organization defines health as a "state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".…”