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Dąbrowska-Bender M, Kozaczuk A, Pączek L, Milkiewicz P, Słoniewski R, Staniszewska A. Patient Quality of Life After Liver Transplantation in Terms of Emotional Problems and the Impact of Sociodemographic Factors. Transplant Proc 2018; 50:2031-2038. [PMID: 30177104 DOI: 10.1016/j.transproceed.2018.03.113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/15/2018] [Accepted: 03/23/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Liver transplantation is recognized as an effective and necessary treatment of chronic as well as acute hepatic failure. The assessment of quality of life (QoL) after transplantation represents an ancillary tool to evaluate the efficacy of solid organ transplantation in addition to graft and patient survival rates and complications. The global assessment of QoL after transplantation usually confirms improvement compared to pretransplant conditions. PURPOSE An attempt to evaluate the quality of life of patients after liver transplantation, with particular reference to sociodemographic factors and emotional problems. MATERIALS AND METHODS The study group included 121 patients (55 women and 66 men) at the age of 19 to 71 years who underwent surgery in the Central Teaching Hospital of the Medical University of Warsaw and the Infant Jesus Teaching Hospital in Warsaw, and were subsequently treated in an outpatient transplant clinic. The scoring procedure for the areas analyzed was based on the 36-Item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). RESULTS Higher patients age was correlated with lower quality of life of patients after liver transplantation, including physical functioning (patients >40 years of age declared lower physical performance, and patients <30 years of age indicated greatest limitations in their kind of work or other activities). The frequency of pain was also age-dependent (mostly patients >50 years of age). Women more often than men had worrying thoughts, were feeling tense or wound up, and had sudden feelings of anxiety or panic. By contrast, older people often declared that they felt to be slowed down. CONCLUSIONS To reduce pain and to improve physical performance of the study patients, rehabilitation procedures should be considered. Patients indicating symptoms associated with anxiety and depression should be referred to a clinical psychologist.
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Affiliation(s)
- M Dąbrowska-Bender
- Department of Clinical Dietetics, Medical University of Warsaw, Warsaw, Poland.
| | - A Kozaczuk
- Medical University of Warsaw, Warsaw, Poland
| | - L Pączek
- Department of Immunology, Transplant Medicine and Internal Diseases, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - P Milkiewicz
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - R Słoniewski
- Department of Public Health, Medical University of Warsaw, Warsaw, Poland
| | - A Staniszewska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
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Cohen CI, Vengassery A, Garcia Aracena EF. A Longitudinal Analysis of Quality of Life and Associated Factors in Older Adults with Schizophrenia Spectrum Disorder. Am J Geriatr Psychiatry 2017; 25:755-765. [PMID: 28431868 DOI: 10.1016/j.jagp.2017.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/08/2017] [Accepted: 01/18/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Self-perceived quality of life (QOL) is an important outcome indicator in schizophrenia and a predictor of symptomatic and functional improvement. This study provides the first large scale longitudinal study of the fluctuations, predictors, and impact of QOL in older adults with schizophrenia spectrum disorder (SSD). METHODS The sample consisted of 104 community-dwelling persons with SSD aged 55 and over (mean age: 61years) who developed the disorder prior to age 45. Mean follow-up was 52.5 months (range 12-116 months); 55% were men; 55% were white. We identified 22 potential predictor variables and used the Quality of Life Index (QLI) to assess QOL. RESULTS There were no significant group differences in the QLI at baseline and follow-up. However, 33%, 24% and 43% of persons exhibited > 0.5 effect size increase or decrease, or no change, respectively. In multivariable analysis, there were 5 baseline predictors of QLI at follow-up: QLI, Center for Epidemiological Studies-Depression Scale (CES-D) scores, religiousness, perceived well-being versus others/past self, and time from initial interview. Baseline QLI predicted 5 variables at follow-up: the Positive and Negative Syndrome Scale (PANSS) anxiety score, PANSS positive score, CES-D score, insight, and perceived well-being versus others/past self. CONCLUSION In many persons with SSD, QOL is not static in later life and one third improved their QOL. Effectively treating depressive symptoms and encouraging religious participation may improve QOL. QOL had two pivotal roles: As a relatively independent dynamic outcome measure and as a critical variable affecting clinical outcomes such as anxiety, depressive and positive symptoms.
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Affiliation(s)
- Carl I Cohen
- SUNY Downstate Medical Center, Department of Psychiatry, Brooklyn, NY.
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Jones JB. Liver Transplant Recipients' First Year of Posttransplant Recovery: A Longitudinal Study. Prog Transplant 2016; 15:345-52. [PMID: 16477817 DOI: 10.1177/152692480501500406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A longitudinal study of 20 liver transplant recipients was conducted to investigate their posttransplant recovery experience. Data were collected using semistructured interviews at 6 weeks, 6 months, and 1 year after transplantation. Qualitative analysis of data revealed physical, psychological, social, economic, and spiritual dimensions of recovery. Findings reflect ongoing improvement of physical health and functionality for most recipients. Those with continuing health problems often suffered from preexisting health conditions. Psychological adjustment was uneven, with intermittent periods of fear, anxiety, and depression. Some recipients reported short-lived split identities and personality changes. Social support of family was critical in the hospital and at home. Economic issues became primary by the 1-year interview, with all recipients questioning whether they could afford ongoing healthcare and medicines. Spiritual needs were met in secular and nonsecular activities. Findings suggest that healthcare personnel should attend to the lived experience of liver transplant recipients.
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Dąbrowska-Bender M, Michałowicz B, Pączek L. Assessment of the Quality of Life in Patients After Liver Transplantation as an Important Part of Treatment Results. Transplant Proc 2016; 48:1697-702. [DOI: 10.1016/j.transproceed.2015.12.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/26/2015] [Accepted: 12/30/2015] [Indexed: 10/21/2022]
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Ordin YS, Dicle A, Wellard S. Quality of life in recipients before and after liver transplantation in Turkey. Prog Transplant 2011. [PMID: 21977888 DOI: 10.7182/prtr.21.3.pl837214k0276260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Liver transplantation has become the treatment of choice for patients with end-stage liver disease. Most studies show a positive effect on quality of life after liver transplantation, but most studies are based on data from Western countries and little is known about quality of life in liver transplant recipients in Turkey or other developing countries. OBJECTIVE To investigate liver transplant recipients' quality of life and factors affecting it, before and 3 months after transplantation in western Turkey. DESIGN Descriptive and comparative, with data collected prospectively. SETTING Two medical centers in Western Turkey. PATIENTS Sixty-five adult recipients of a liver transplant between May 15 and December 31,2007. INSTRUMENTS Quality of life was measured by using the Nottingham Health Profile Turkish version, and sociodemographic and clinical data were collected from patients' records. RESULTS Scores on all subscales of the Nottingham Health Profile differed significantly from before to after liver transplantation. The differences between the mean scores for quality of life before and after transplantation varied significantly with the patients' sex and disease severity.
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Affiliation(s)
- Yaprak S Ordin
- Surgical Nursing Department, School of Nursing, Dokuz Eylul University, Inciralti, Turkey.
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Ordin YS, Dicle A, Wellard S. Quality of Life in Recipients before and after Liver Transplantation in Turkey. Prog Transplant 2011; 21:260-7. [DOI: 10.1177/152692481102100312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yaprak S. Ordin
- Dokuz Eylul University, Inciralti, Turkey (YSO, AD), University of Ballarat, Ballarat, Australia (SW)
| | - Aklime Dicle
- Dokuz Eylul University, Inciralti, Turkey (YSO, AD), University of Ballarat, Ballarat, Australia (SW)
| | - Sally Wellard
- Dokuz Eylul University, Inciralti, Turkey (YSO, AD), University of Ballarat, Ballarat, Australia (SW)
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Nåden D, Bjørk IT. Patients’ experiences in hospital following a liver transplantation. Scand J Caring Sci 2011; 26:169-77. [DOI: 10.1111/j.1471-6712.2011.00911.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Oliveira ADS, Santos VLCDG. Responsividade dos instrumentos de avaliação de qualidade de vida de Ferrans e Powers: uma revisão bibliográfica. ACTA PAUL ENFERM 2011. [DOI: 10.1590/s0103-21002011000600019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Este estudo objetivou realizar uma revisão bibliográfica sobre a responsividade ou sensibilidade às mudanças dos instrumentos de avaliação de qualidade de vida de Ferrans & Powers (IQVFP), nas versões genérica e específica. Os artigos foram localizados por meio das bases de dados Pubmed/Medline, Lilacs e SciELO e no próprio sítio eletrônico das autoras, utilizando as palavras-chaves: quality of life, responsiveness, sensitivity to change, Ferrans and Powers Index, measure tool. Dos 31 artigos encontrados, 20 foram acessados na íntegra. Quanto aos objetivos, 85% relacionavam QV e intervenções e 15% sobre responsividade, sendo a maioria desenvolvida com pacientes cardíacos (11/ 55%). Dentre os três estudos sobre responsividade, em dois foram testadas as propriedades psicométricas de confiabilidade e responsividade. O outro tratava de revisão de literatura. Concluiu-se que o número de pesquisas que testou a responsividade dos instrumentos de IQVFP é reduzido, havendo necessidade de novos estudos que avaliem essa propriedade de medida.
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Abstract
More than 75,000 deceased donor liver transplants have been performed in the United States since 1984, thus giving many people another chance at life. Liver transplantation is often scrutinized because of its high cost and limited resources (i.e., organs). Measuring recipient's quality of life posttransplant is one outcome to determine whether liver transplantation is making a difference. Limited information is available from a longitudinal perspective that studies the same recipient over time. The purpose of this study was to describe liver transplant recipients' quality of life pretransplant and 1 and 2 years posttransplant. Patients completed the Quality of Life form at initial evaluation for liver transplant at 1 and 2 years posttransplant. Data from 139 recipients were extracted from a database maintained by a large transplant center in the southwest United States. Repeated-measures analysis of variance showed a statistically significant difference in quality of life at 1 and 2 years posttransplant as compared with quality-of-life scores pretransplant. The major finding was a statistically significant difference in quality of life between men and women, with men reporting higher overall quality-of-life scores. Liver transplantation does make a difference in improving quality of life. Further investigation is suggested to explore the difference of quality of life between genders.
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Quality of life after liver transplantation. A systematic review. J Hepatol 2008; 48:567-77. [PMID: 18279999 DOI: 10.1016/j.jhep.2007.12.013] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 12/19/2007] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIMS Although many studies have reported significant improvements in quality of life (QOL) after liver transplantation (LT), consistent data on areas of improvement are lacking. To perform a systematic review on medical literature of QOL after LT paying particular attention to studies that utilized the most commonly adopted study instrument, Short Form-36 (SF-36). METHODS To collect studies focused on QOL in adult LT recipients, from 1963 to 2007, cited in Pub Med, Embase or Cochrane databases. From an initial identification of 613 articles, we selected 44 longitudinal studies with pre- and post-LT data that we assessed using a sign test, and 19 used SF-36, which we analyzed separately. RESULTS Longitudinal data showed remarkable improvement of common domains of QOL comparing pre- and post-transplant items. However, analysis of 16 SF-36 cross-sectional studies comparing post-LT patient domains with control population showed significantly higher ratings for controls in six while no differences were found in two. CONCLUSIONS This review suggests that whereas general QOL improves after LT, when compared with healthy controls, LT recipients have significant deficits in QOL. Consequently, the previously reported QOL benefits after LT may have been overstated.
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Chisholm MA, Spivey CA, Nus AV. Influence of economic and demographic factors on quality of life in renal transplant recipients. Clin Transplant 2007; 21:285-93. [PMID: 17425759 DOI: 10.1111/j.1399-0012.2007.00640.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The purpose of this study was to determine the influence of annual income, Medicare status, and demographic variables on the health-related quality of life (HQoL) of renal transplant recipients. METHODS A cross-sectional survey was mailed to 146 Georgia renal transplant recipients who had functional grafts. Data were collected using the SF-12 Health Survey (version 2), a demographics survey, and 2003 tax documents. One-way ANOVAs and Pearson's R correlations were used to examine relationships between annual income, Medicare status, demographic variables and SF-12 scores. Significant variables were included in stepwise multiple regression analyses. RESULTS Data from 130 participants (89% response rate) were collected. Recipients with no Medicare coverage had significantly higher scores on the Physical Functioning and Role Physical SF-12 scales (p = 0.005) compared to recipients with Medicare. Annual income was positively correlated with General Health (p < 0.05). Age and race were significant predictors of Vitality (p = 0.004) and Physical Component Summary (p < 0.001) scores. Age, race, and Medicare status were significant predictors of Physical Functioning and Role Physical scores (p < 0.001). Age, annual income, race, and years post-transplant were significant predictors of General Health score (p < 0.001). Age was the sole predictor of Bodily Pain score (p = 0.002), and marital status was the sole predictor of Social Functioning score (p = 0.005). CONCLUSIONS Interventions designed to offset financial barriers may be needed to bolster renal transplant recipients' HQoL.
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Affiliation(s)
- Marie A Chisholm
- Pharmacy Practice and Science, University of Arizona College of Pharmacy, USA.
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Taylor R, Franck LS, Gibson F, Dhawan A. A critical review of the health-related quality of life of children and adolescents after liver transplantation. Liver Transpl 2005; 11:51-60; discussion 7-9. [PMID: 15690536 DOI: 10.1002/lt.20294] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We critically examined research on health-related quality of life (HRQL) in children and adolescents after liver transplantation. The specific aims were to identify research studies on HRQL after liver transplantation, to critique the methodological quality of the studies, to estimate overall HRQL after transplant, and to make recommendations for future research. Databases searched included Medline, Cumulative Index to Nursing and the Allied Health Literature, PsycINFO, EMBASE, Allied and Complementary Medicine, Institute for Scientific Information Web of Science, and Applied Social Sciences Index and Abstracts. Searches also were made on related Web sites and proceedings of transplantation and associated conferences. Eligible studies involved children between birth and 18 years of age who received isolated orthotopic, auxiliary, or living related liver transplantation. HRQL was assessed through 2 or more of the domains of physical health, psychological functioning, social functioning, family functioning, or general well-being. Eligible studies were abstracted, assessed for methodological quality, and synthesized using the sign test to provide an indication of the effect of liver transplantation on each HRQL domain. The synthesis of findings suggested an improvement in HRQL in comparison with pretransplant status; there was a trend toward a worse HRQL in comparison with the healthy population and better than those with other chronic illnesses. In conclusion, liver transplantation in childhood has a negative impact on some aspects of HRQL. However, this finding is tentative because of the small number of studies and variable study quality found.
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Affiliation(s)
- Rachel Taylor
- Institute of Liver Studies, King's College Hospital, London SE5 9RS, UK.
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Bonaguidi F, Giovanna Trivella M, Michelassi C, Filipponi F, Mosca F, L'Abbate A. Personality change as defensive responses of patients evaluated for liver transplant. Psychol Rep 2001; 88:1211-21. [PMID: 11597078 DOI: 10.2466/pr0.2001.88.3c.1211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients affected by endstage liver disease and awaiting liver transplant suffer very stressful conditions. The aim of this study was to evaluate the person ality and behavioral responses of a group of liver transplant candidates, 95 men (M age 50 yr.) and of a group of 18 normal men (M age 49 yr.). The 16 Personality Factor Questionnaire of Cattell, and the PSY Inventory for Behavioral Assessment were administered to assess personality and behavior. On the 16PF Questionnaire, patients had significantly different mean scores from normal subjects on Scale B- (low mental capacity), G (conformity), N (shrewdness), and Q1- (conservatism). They also showed a somewhat lower but not a statistically significant mean on Scale E (submissiveness). In addition, on the four second-order factors of the 16PF (Anxiety, Control, Pathemia, and Extraversion) patients had a significantly higher mean on Control. With respect to PSY Inventors factors, patients showed impairment in energy, sleep, sexual disturbances, and obsessive behaviors. It appears these patients with endstage liver disease, who were evaluated for liver transplant, showed psychological regressive functioning, i.e., high control and dependency on medical staff, submissiveness, which are interpretable as defensive responses to upcoming transplant.
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Affiliation(s)
- F Bonaguidi
- CNR Institute of Clinical Physiology, Pisa, Italy.
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BONAGUIO FRANCO. PERSONALITY CHANGE AS DEFENSIVE RESPONSES OF PATIENTS EVALUATED FOR LIVER TRANSPLANT. Psychol Rep 2001. [DOI: 10.2466/pr0.88.3.1211-1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bravata DM, Olkin I, Barnato AE, Keeffe EB, Owens DK. Health-related quality of life after liver transplantation: a meta-analysis. LIVER TRANSPLANTATION AND SURGERY : OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES AND THE INTERNATIONAL LIVER TRANSPLANTATION SOCIETY 1999; 5:318-31. [PMID: 10388505 DOI: 10.1002/lt.500050404] [Citation(s) in RCA: 160] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The goal of this study is to assess health-related quality of life (HRQL) after orthotopic liver transplantation (OLT). Structured MEDLINE and Embase literature searches identified 5473 potentially relevant articles. Thirty-two additional references were collected from the bibliographies. Of the 5505 identified articles, 49 studies reporting data on 3576 transplant recipients met our inclusion criteria, which were an assessment of quality of life (QOL) in adult patients reported as either pretransplantation and posttransplantation data or with a comparison group and written in English. We combined posttransplantation QOL scores from 15 studies that reported data from the same QOL scales to assess the magnitude of the effect of OLT on QOL scales. We also performed a sign test on the 49 studies to evaluate the direction (positive or negative) of the effect of transplantation on QOL. Transplantation resulted in an improvement of 32% in Karnofsky scores, 11% in Sickness Impact Profile scores, and 20% to 50% in the domains of the Nottingham Health Profile. The sign test showed significant improvement in posttransplantation physical health (P <.0004), sexual functioning (P <.008), daily activities (P <.02), general HRQL (P <.02), and social functioning (P <.05), but not psychological health (P <.08). In general, the HRQL of the 3576 patients was impaired pretransplantation and improved posttransplantation. Transplant recipients reported large gains in those aspects of QOL most affected by physical health and smaller improvements in areas affected by psychological functioning.
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Affiliation(s)
- D M Bravata
- Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA
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Gross CR, Malinchoc M, Kim WR, Evans RW, Wiesner RH, Petz JL, Crippin JS, Klintmalm GB, Levy MF, Ricci P, Therneau TM, Dickson ER. Quality of life before and after liver transplantation for cholestatic liver disease. Hepatology 1999; 29:356-64. [PMID: 9918910 DOI: 10.1002/hep.510290229] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Liver transplantation (LT) is an established therapy for patients with end-stage primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). In this report, we describe the health status and quality of life (QOL) in patients with these cholestatic liver diseases before and after LT. A QOL questionnaire was completed by 157 adult patients with PBC or PSC before and 1 year after liver transplantation at the Mayo Clinic or Baylor University Medical Center. This questionnaire measured four aspects of QOL, including symptoms; physical, social, and emotional functioning; health perceptions; and overall QOL. Changes in these QOL parameters before and after LT were described, and regression analysis was used to assess the relationships between clinical and QOL factors. There were no differences in QOL parameters between patients with PBC and PSC. QOL following transplantation was substantially better than before transplantation. This was observed in all four aspects of QOL. The degree of improvement as measured by effect size (difference in mean scores divided by the pretransplantation standard deviation) was 0.53 for symptoms (P <.01), 1.16 for function (P <.01), 2.37 for health satisfaction (P <.01), and 1.16 for overall QOL (P <.01). Patients' overall QOL before transplantation was significantly related to subjective and objective health status indicators and clinical factors such as ascites and renal dysfunction. QOL at 1-year follow-up, however, could not be adequately predicted by the pretransplantation subjective health status and clinical factors. Patients with end-stage cholestatic disease undergoing LT experience substantial improvement in all aspects of QOL addressed in this study. The patients' QOL 1 year after LT could not be predicted by pretransplantation variables used in this study.
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Affiliation(s)
- C R Gross
- University of Minnesota, Minneapolis, MN, USA.
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Geevarghese SK, Bradley AE, Wright JK, Chapman WC, Feurer I, Payne JL, Hunter EB, Pinson CW. Outcomes analysis in 100 liver transplantation patients. Am J Surg 1998; 175:348-53. [PMID: 9600275 DOI: 10.1016/s0002-9610(98)00053-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is an increasing demand for outcomes analysis, including quality of life and financial analysis, following medical interventions and surgical procedures. We analyzed outcomes for 100 consecutive patients undergoing liver transplantation during a period of case management revision. METHODS Patient survival was calculated by Kaplan-Meier actuarial methods. The Karnofsky performance status was objectively assessed for surviving patients up to 6 years after transplantation and was evaluated by repeated measures analysis of variance and covariance. Subjective evaluation of quality of life over time was obtained using the Psychosocial Adjustment to Illness Scale. The correlations between time and scale were calculated. Financial data were accumulated from billing records. RESULTS Six-month, 1-year, 2-year, and 3- through 5-year survival was 86%, 84%, 83%, and 78%, respectively. Karnofsky performance status confirmed poor functional status preoperatively with a mean of 53 +/- 2, but significantly improving to 72 +/- 2 at 3 months, 80 +/- 2 at 6 months, 90 +/- 1 at 1 year, 92 +/- 1 at 2 years, 94 +/- 1 at 3 years, 96 +/- 1 at 4 years, and 97 +/- 1 at 5 years (P <0.001). Psychosocial Adjustment to Illness Scale scores demonstrated significant improvement following transplantation overall (r = -0.33), improving most in sexual relationships (r = -0.41), and domestic environment (r = -0.35; P <0.001). Median length of stay for the first half of the patients was 19 days declining to 11 days for the second half. Median hospital charges declined from $105,000 to $90,000. CONCLUSIONS Quality of life parameters assessed both by care givers (Karnofsky) and by patients (Psychosocial Adjustment to Illness Scale) improved dramatically following transplantation and over time, demonstrating that liver transplantation effectively restores a good quality of life. Outcomes can be improved while reducing length of stay and charges through modifications in case management.
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Affiliation(s)
- S K Geevarghese
- Division of Liver Transplantation and Hepatobiliary Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-4753, USA
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