Quality of life after liver transplantation: State of the art

Table 1 Summary of used articles

Ref.	Title	Study design	Population (n)	Instruments used to assess QoL	Main conclusions
Masala et al[1]	Quality of life and physical activity in liver transplantation patients: Results of a case-control study in Italy	Case-control	45 transplant patients 108 controls	SF-36 IPAQ	Transplant recipients are more subject to psychological/emotional distress and low physical function than the general population
Lankarani et al[2]	Outcomes of liver transplantation for patients with acute liver failure	Retrospective cross-sectional study	12 ALF patients 20 cirrhotic patients	N/A	Liver transplantation is safe, effective and should be considered in patients diagnosed with ALF
Drent et al[3]	Symptom experience, nonadherence and quality of life in adult liver transplant recipients	Review	N/A	N/A	Health-related quality of life is satisfactory, but below the level of the general population
O’Mahony et al[4]	The future of liver transplantation	Review	N/A	N/A	Improvements in surgical techniques, postoperative care, and donor and recipient selection have all contributed to the increased success of OLT and to higher survival rates in patients with advanced liver disease
Saidi[5]	Current status of liver transplantation	Review	N/A	N/A	New problems that include severe organ shortage, recurrence of primary disease, opportunistic infections, and development of de novo malignancies are the major problems affecting further implementation of LT
Butt et al[8]	Quality of life, risk assessment, and safety research in liver transplantation: New frontiers in health services and outcomes research	Review	N/A	N/A	Recipient quality of life is an area that has grown in importance in the published literature, but several important questions remain unanswered in these areas that merit programmatic, interdisciplinary research
Jay et al[9]	A review of quality of life instruments used in liver transplantation	Review	N/A	N/A	There are no available instruments that allow for the precise and reliable assessment of the full QoL impact of liver transplantation
Wang et al[10]	Health-related quality of life after liver transplantation: The experience from a single Chinese center	Case-control	60 post-LT, 55 benign end-stage liver disease, 50 controls	SF-36	LT patients generally have a good HRQoL although some respects of their HRQoL remains to be improved. Lower family income and poor education are important factors relating to the poor HRQoL of LT patients
Chen et al[11]	Health-related quality of life of 256 recipients after liver transplantation	RCT	256	SF-36, BAI, SDS	Age > 45 yr at time of transplant, DDLT, full-time working, no complications, anxiety and depression were possible factors influencing postoperative HRQoL in liver recipients
Braun et al[12]	Quality of life after liver transplantation	Case-control	123 recipients, 40 patients on the waiting list and a cohort of healthy controls	EORTC QLQ C30 and a liver transplant specific module	Retransplantation was accompanied by a significant loss of QoL. Cyclosporine-treated recipients displayed a better QoL compared with those treated with tacrolimus. The influence of medical parameters, such of co-morbidity or immunosuppression, needs to be further established with reference to QoL
Cannesson et al[13]	Vie quotidienne, grossesse, qualité de vie après transplantation hépatique	Review	N/A	N/A	The global perception of quality of life increases after liver transplantation, but remains lower than in healthy subjects
Burra et al[14]	Vie quotidienne, grossesse, qualité de vie après transplantation hépatique	Review	N/A	N/A	Liver transplantation is associated with an improvement in overall QoL. However, this improvement is lower than expected. QoL improves significantly early after liver trans-plantation, but it seems to decrease after the first year after transplantation
Zaydfudim et al[15]	Reduction in corticosteroids is associated with better health-related quality of life after liver transplantation	Retrospective analysis of prospective, longitudinal data	186	SF-36, BAI, and Center for Epidemiologic Studies Depression Scale	High-dose steroid use for post-transplant immunosuppression in liver transplant recipients is associated with reduced physical and mental HRQoL and increased symptoms of anxiety
Sirivatanauksorn et al[16]	Quality of life among liver transplantation patients	Case-control	57 pre-LT 95 post-LT	SF-36, CLDQ	OLT improved HRQoL of end-stage liver patients and their spouses or caregivers
Telles-Correia et al[17]	When does quality of life improve after liver transplantation? A longitudinal prospective study	Cohort study	60	SF-36	Our findings suggested that quality of life improved early after liver transplantation (1 mo). Between the first and the sixth months, there only was a significant improvement in the physical quality of life
Bownik et al[18]	When does quality of life improve after liver transplantation? A longitudinal prospective study	Review	N/A	N/A	Greater attention must be paid to patients’ postoperative expectations and the effects of social influences (such as gender, education level, and socioeconomic and ethnic background)
Duffy et al[19]	When does quality of life improve after liver transplantation? A longitudinal prospective study	Prospective, cross-sectional study	168	SF-36, liver disease quality of life	More than 50% of LT recipients survive 20 yr, achieve important socioeconomic milestones, and report quality of life superior to patients with liver disease or other chronic conditions
Narumi et al[20]	Importance of awareness of perioperative social and physical situations of living donors for liver transplantation	Case-control study	31	SF-36, Hamilton’s depression and anxiety scores	We must pay attention to depression and anxiety among living donors
Thiel et al[21]	Contributors to individual quality of life after liver transplantation	Cross-sectional study	71	SF-36, SEIQoL-DW	The five most nominated areas related to QoL are not related to health. By focusing on health, the importance of health-related factors is overrated, and the impact of non-medical effects is under- represented
Volk et al[22]	Organ quality and quality of life after liver transplantation	Retrospective cross-sectional study	171	SF-36	No association between organ quality and QOL after liver transplantation is found
Baranyi et al[24]	Overall mental distress and health-related quality of life after solid-organ transplantation: Results from a retrospective follow-up study	Retrospective follow-up	123	TERS, SCL-90-R SF-36	Transplantation recipients may face major transplantation- and treatment-related overall mental distress and impairments to their HRQoL. Further, overall mental distress is a high-risk factor in intensifying impairments to patients’ overall quality of life
Jurado et al[25]	Coping strategies and quality of life among liver transplantation candidates	Observational	93	SF-36, MCMQ	Cirrhosis etiology is not a determinant factor of quality of life, whereas the acceptance-resignation coping strategy might lead to lower self-perception of quality of life
Lobo et al[26]	Care complexity, mood, and quality of life in liver pre-transplant patients	Cross-sectional	60	SF-36, HADS, INTERMED, EuroQol	High frequency of complexity in liver transplant candidates in European hospitals, but wide between-center differences suggest that local studies in specific hospitals and/or countries may be necessary to document care needs
Martín-Rodríguez et al[27]	Affective status in liver transplant recipients as a function of self-perception of general health	Cross-sectional	168	SF-36, HADS	Transplant recipients with worse self-perception of general health presented the same anxiety-depressive levels as patients with severe liver disease in the pretransplantation phase
Santos et al[28]	Affective status in liver transplant recipients as a function of self-perception of general health	Observational, descriptive and transversal	73	SF-36, BDI, structured interviews	Psychological aspects related to transplants require psychological intervention because they can affect the recuperation process, the quality of life, and the adherence to treatment for potential transplant patients
Stilley et al[29]	Pathways of psychosocial factors, stress, and health outcomes after liver transplantation	Longitudinal	130	N/A	A number of strong bidirectional relationships exist between coping style, self-regulatory ability, hostility, the caregiver relationship and family environment, personal and transplant-related stress over the second half of the first post-transplant year, and health (especially mental) outcomes at 12 mo post-transplant
Telles-Correia et al[30]	Predictors of mental health and quality of life after liver transplantation	Cross-sectional	60	SF-36	Quality of life improved early after liver transplantation (1 mo). Between the first and the sixth months, there only was a significant improvement in the physical quality of life
Telles-Correia et al[31]	Mental health and quality of life in alcoholic liver disease patients after liver transplantation: A prospective controlled study	Cross-sectional	45	SF-36, HADS, brief coping inventory	There is a favorable adjustment of alcoholic liver disease patients after transplantation as shown in coping mechanisms evolution, which might explain the improved mental health and quality of life dimensions
Poppe et al[32]	Improving quality of life in patients with chronic kidney disease: Influence of acceptance and personality	Cross-sectional	99	SF-36, ICQ, NEO-FFI	Acceptance is an important positive variable in accounting for health-related quality of life
Åberg et al[33]	Cost of a quality-adjusted life year in liver transplantation: The influence of the indication and the model for end-stage liver disease score	Cross-sectional	333	15D	The cost/QALY ratio for LT appears favorable, but it is dependent on the assessed time period and the severity of the liver disease
Fernández-Jiménez et al[34]	Comparison of quality of life between two clinical conditions with immunosuppressive therapy: Liver transplantation and multiple sclerosis	Cross-sectional	62	SF-36	Transplant recipients belong to a population that still requires special health care. Bio-psychosocial functioning is not fully restored

IPAQ: International Physical Activity Questionnaire; ALF: Acute liver failure; LT: Liver transplantation; QoL: Quality of life; HRQoL: Health related QoL; CLDQ: Chronic liver disease questionnaire; SF-36: Short form-36; OLT: Orthotopic liver transplantation; DDLT: Deceased donor liver transplantation; BAI: Beck anxiety inventory; SDS: Sheehan disability scale; EORTC QLQ: European Organization for Research and Treatment of Cancer, quality of life questionnaire; RCT: Randomized controlled trial; SEIQoL-DW: The schedule for the evaluation of individual quality of life - direct weighting; MCMQ: Medical coping modes questionnaire; SCL-90-R: Symptom checklist-90-revised; TERS: Transplant evaluation rating scale; HADS: Hospital anxiety and depression scale; BDI: Beck depression inventory; QALY: Quality-adjusted life year; ICQ: Illness cognition questionnaire; NEO-FFI: Neuroticism-extraversion-openness five-factor inventory; N/A: Not available.