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Funuyet-Salas J, Martín-Rodríguez A, Pérez-San-Gregorio MÁ, Vale L, Robinson T, Anstee QM, Romero-Gómez M. Health-related quality of life in non-alcoholic fatty liver disease: A cross-cultural study between Spain and the United Kingdom. PLoS One 2024; 19:e0300362. [PMID: 38709751 PMCID: PMC11073709 DOI: 10.1371/journal.pone.0300362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/24/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND It is unclear what biopsychosocial factors influence the impact of NAFLD on health-related quality of life (HRQoL), and if these factors are equally important predictors between different nationalities. METHODS HRQoL (CLDQ) was measured in both Southern European (Spain, n = 513) and Northern European (United Kingdom -UK-, n = 224) cohorts of patients with NAFLD in this cross-sectional study. For each cohort, participant data were recorded on histological grade of steatohepatitis, stage of fibrosis and biopsychosocial variables. Regression analysis was used to explore which of these variables predicted HRQoL. Moderated mediation models were conducted using SPSS PROCESS v3.5 macro. RESULTS Participants with severe fibrosis reported more fatigue, systemic symptoms and worry, and lower HRQoL than those with none/mild fibrosis, regardless of place of origin. In addition, body mass index (BMI) and gender were found to be significant predictors of HRQoL in both Spanish and UK participants. Female gender was associated with worse emotional function, higher BMI and more fatigue, which predicted lower participants' HRQoL. UK participants showed more systemic symptoms and worry than Spanish participants, regardless of liver severity. The negative effects of gender on HRQoL through emotional function, BMI and fatigue were reported to a greater degree in UK than in Spanish participants. CONCLUSIONS UK participants showed a greater impairment in HRQoL as compared to Spanish participants. Higher fibrosis stage predicted lower HRQoL, mainly in the Spanish cohort. Factors such as female gender or higher BMI contributed to the impact on HRQoL in both cohorts of patients and should be considered in future multinational intervention studies in NAFLD.
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Affiliation(s)
| | - Agustín Martín-Rodríguez
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | - María Ángeles Pérez-San-Gregorio
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | - Luke Vale
- Faculty of Medical Sciences, Population Health Sciences Institute, Health Economics Group, Newcastle University, Newcastle upon Tyne, United Kingdom
- National Institute for Health Research (NIHR) Newcastle In Vitro Diagnostics Co-Operative and NIHR Applied Research Collaboration North East and North Cumbria, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Tomos Robinson
- Faculty of Medical Sciences, Population Health Sciences Institute, Health Economics Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Quentin M. Anstee
- Faculty of Medical Sciences, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Manuel Romero-Gómez
- Institute of Biomedicine of Seville, UCM Digestive Diseases and Ciberehd, Virgen del Rocío University Hospital, University of Seville, Seville, Spain
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Jones O, Claasen MPAW, Ivanics T, Choi WJ, Gavaria F, Rajendran L, Ghanekar A, Hirschfield G, Gulamhusein A, Shwaartz C, Reichman T, Sayed BA, Selzner M, Bhat M, Tsien C, Jaeckel E, Lilly L, McGilvray ID, Cattral MS, Selzner N, Sapisochin G. Pursuing living donor liver transplantation improves outcomes of patients with autoimmune liver diseases: An intention-to-treat analysis. Liver Transpl 2024:01445473-990000000-00360. [PMID: 38619393 DOI: 10.1097/lvt.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/01/2024] [Indexed: 04/16/2024]
Abstract
Living donor liver transplantation (LDLT) offers the opportunity to decrease waitlist time and mortality for patients with autoimmune liver disease (AILD), autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis. We compared the survival of patients with a potential living donor (pLDLT) on the waitlist versus no potential living donor (pDDLT) on an intention-to-treat basis. Our retrospective cohort study investigated adults with AILD listed for a liver transplant in our program between 2000 and 2021. The pLDLT group comprised recipients with a potential living donor. Otherwise, they were included in the pDDLT group. Intention-to-treat survival was assessed from the time of listing. Of the 533 patients included, 244 (43.8%) had a potential living donor. Waitlist dropout was higher for the pDDLT groups among all AILDs (pDDLT 85 [29.4%] vs. pLDLT 9 [3.7%], p < 0.001). The 1-, 3, and 5-year intention-to-treat survival rates were higher for pLDLT versus pDDLT among all AILDs (95.7% vs. 78.1%, 89.0% vs. 70.1%, and 87.1% vs. 65.5%, p < 0.001). After adjusting for covariates, pLDLT was associated with a 38% reduction in the risk of death among the AILD cohort (HR: 0.62, 95% CI: 0.42-0.93 [ p <0.05]), and 60% among the primary sclerosing cholangitis cohort (HR: 0.40, 95% CI: 0.22-0.74 [ p <0.05]). There were no differences in the 1-, 3, and 5-year post-transplant survival between LDLT and DDLT (AILD: 95.6% vs. 92.1%, 89.9% vs. 89.4%, and 89.1% vs. 87.1%, p =0.41). This was consistent after adjusting for covariates (HR: 0.97, 95% CI: 0.56-1.68 [ p >0.9]). Our study suggests that having a potential living donor could decrease the risk of death in patients with primary sclerosing cholangitis on the waitlist. Importantly, the post-transplant outcomes in this population are similar between the LDLT and DDLT groups.
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Affiliation(s)
- Owen Jones
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Marco P A W Claasen
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tommy Ivanics
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden
| | - Woo Jin Choi
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Felipe Gavaria
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Luckshi Rajendran
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anand Ghanekar
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Gideon Hirschfield
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Aliya Gulamhusein
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Chaya Shwaartz
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Trevor Reichman
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Blayne Amir Sayed
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Markus Selzner
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Mamatha Bhat
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Cynthia Tsien
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Elmar Jaeckel
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Les Lilly
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Ian D McGilvray
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Mark S Cattral
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Nazia Selzner
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
| | - Gonzalo Sapisochin
- HBP & Multi Organ Transplant Program, Ajmera Transplant Center, University Health Network Toronto, Toronto, Ontario, Canada
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Donlan J, Zeng C, Indriolo T, Li L, Zhu E, Zhou J, Pintro K, Horick N, Edelen M, Chung RT, El-Jawahri A, Ufere NN. The Edmonton Symptom Assessment System is a valid, reliable, and responsive tool to assess symptom burden in decompensated cirrhosis. Hepatol Commun 2024; 8:e0385. [PMID: 38497942 PMCID: PMC10948137 DOI: 10.1097/hc9.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND While there is a growing need for interventions addressing symptom burden in patients with decompensated cirrhosis (DC), the lack of validated symptom assessment tools is a critical barrier. We investigated the psychometric properties of the revised Edmonton Symptom Assessment System (ESAS-r) in a longitudinal cohort of patients with DC. METHODS Adult outpatients with DC were prospectively recruited from a liver transplant center and completed ESAS-r at baseline and week 12. We examined reliability, floor/ceiling effects, structural validity, and known-groups validity. We examined the convergent and predictive validity of ESAS-r with health-related quality of life using the Short Form Liver Disease Quality of Life (SF-LDQOL) and responsiveness to changes in anxiety and depression using the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 from baseline to week 12. RESULTS From August 2018 to September 2022, 218 patients (9% Child-Pugh A, 59% Child-Pugh B, and 32% Child-Pugh C) were prospectively recruited and completed the ESAS-r, SF-LDQOL, Patient Health Questionnaire-9, and Hospital Anxiety and Depression Scale at baseline and week 12 (n = 135). ESAS-r had strong reliability (Cronbach's alpha 0.86), structural validity (comparative fit index 0.95), known-groups validity (Child-Pugh A: 25.1 vs. B: 37.5 vs. C: 41.4, p = 0.006), and convergent validity (r = -0.67 with SF-LDQOL). Floor effects were 9% and ceiling effects were 0.5%. Changes in ESAS-r scores from baseline to week 12 significantly predicted changes in SF-LDQOL (β = -0.36, p < 0.001), accounting for 30% of the variation. ESAS-r was strongly responsive to clinically meaningful changes in SF-LDQOL, Patient Health Questionnaire-9, and Hospital Anxiety and Depression Scale. CONCLUSIONS ESAS-r is a reliable, valid, and responsive tool for assessing symptom burden in patients with DC and can predict changes in health-related quality of life. Future directions include its implementation as a key outcome measure in cirrhosis care and clinical trials.
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Affiliation(s)
- John Donlan
- Harvard Medical School, Boston, Massachusetts, USA
| | - Chengbo Zeng
- Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Teresa Indriolo
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lucinda Li
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Enya Zhu
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joyce Zhou
- Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kedie Pintro
- MGH Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nora Horick
- MGH Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria Edelen
- Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Raymond T. Chung
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nneka N. Ufere
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
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Shehadah A, Yu Naing L, Bapaye J, Malik S, Mohamed M, Khalid N, Munoz A, Jadhav N, Mushtaq A, Okolo P, Eskridge E. Early palliative care referral may improve end-of-life care in end-stage liver disease patients: A retrospective analysis from a non-transplant center. Am J Med Sci 2024; 367:35-40. [PMID: 37923293 DOI: 10.1016/j.amjms.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/22/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Patients with end-stage liver disease (ESLD) who are not transplant candidates often have a trajectory of rapid decline and death similar to patients with stage IV cancer. Palliative care (PC) services have been shown to be underutilized for such patients. Most studies examining the role of PC in ESLD have been done at transplant centers. Thus, determining the utilization and benefit of PC at a non-transplant tertiary center may help establish a standard of care in the management of patients with ESLD not eligible for transplant. METHODS We conducted a retrospective analysis of adult (>18 years) patients with ESLD admitted to Rochester Regional Health (RRH) system hospitals from 2012 to 2021. Patients were divided into groups based on the presence or absence of PC involvement. Baseline characteristics were recorded. The impact of PC was assessed by comparing the number of hospitalizations before and after the involvement of PC, comparing code status changes, health care proxy (HCP) assignments, Aspira catheter placements, and frequency of repeated paracentesis. RESULTS In our analysis of 576 patients, 41.1% (237 patients) received a PC consult (PC group), while 58.9% (339 patients) did not (no-PC group). Baseline characteristics were comparable. However, their mean number of admissions significantly decreased (15.66 vs. 3.49, p < 0.001) after PC involvement. Full code status was more prevalent in the no-PC group (67.8% vs. 18.6%, p < 0.001), while comfort care code status was more common in the PC group (59.9% vs. 20.6%, p < 0.001). Changes in code status were significantly higher in the PC group (77.6% vs. 29.2%, p < 0.001). The PC group had a significantly higher mortality rate (83.1% vs. 46.4%, p < 0.01). Patients in the PC group had a higher likelihood of having an assigned HCP (63.7% vs. 37.5%, p < 0.001). PC referral was associated with more frequent use of an Aspira catheter (5.9% vs. 0.9%, p < 0.001) and more frequent paracentesis (30.8% vs. 16.8%, p < 0.001). CONCLUSIONS In conclusion, our study provides compelling evidence of the diverse advantages of palliative care for patients with end-stage liver disease, including reduced admissions, improved goals of care, code status modifications, enhanced healthcare proxy assignments, and targeted interventions. These findings highlight the potential significance of early integration of palliative care in the disease trajectory to provide comprehensive, patient-centered care that addresses the unique needs and preferences of individuals with advanced liver disease.
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Affiliation(s)
- Ahmed Shehadah
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, United States.
| | - Le Yu Naing
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, United States
| | - Jay Bapaye
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, United States
| | - Sheza Malik
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, United States
| | - Mohamed Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, United States
| | - Nida Khalid
- Department of Gastroenterology, Rochester General Hospital, Rochester, New York, United States
| | - Anisleidys Munoz
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, United States
| | - Nagesh Jadhav
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, United States
| | - Asim Mushtaq
- Department of Gastroenterology, Rochester General Hospital, Rochester, New York, United States
| | - Patrick Okolo
- Department of Gastroenterology, Rochester General Hospital, Rochester, New York, United States
| | - Etta Eskridge
- Department of Palliative Care, Rochester General Hospital, Rochester, New York, United States
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5
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Bowers SP, Brennan PN, Dillon JF. Systematic review: the role of frailty in advanced chronic liver disease. Aliment Pharmacol Ther 2023; 57:280-289. [PMID: 36433627 DOI: 10.1111/apt.17324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/13/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Frailty is a known predictor of outcome and mortality in patients undergoing liver transplantation. However, most patients remain unsuitable transplant candidates. It is not yet known if the assessment of frailty in non-transplant candidates can aid prognostication. AIM To collate and interrogate the various frailty tools presently used to predict mortality in the non-transplant cirrhosis setting. METHODS A comprehensive review of MEDLINE and EMBASE databases for articles published from inception to March 2022 was undertaken, excluding those where patients underwent transplantation or had hepatocellular carcinoma. RESULTS We identified 12 observational cohort studies, featuring 9 frailty indices. These were from various global healthcare settings and of fair or good quality. Most were objective tools utilising clinician-based assessments. All frailty scores predicted prognosis, with variability in the method of application, and utilisation in long- or short-term mortality. Three studies directly compared different indices in the same population. There was some evidence that simple tools could perform as well, if not better, than more complex, time-consuming scores. CONCLUSIONS Various frailty tools can reproducibly evaluate mortality in patients with cirrhosis who are ineligible for transplant. However, further prospective head-to-head comparative studies are needed. In addition to determining model utility, studies should focus on important relative considerations which may limit widespread implementation including, ease of use and limited resources, given the global disparity of liver care provision. These tools may positively identify specific patient cohorts at risk of impending deterioration, thereby stratifying those patients likely to benefit from early integration with palliative care.
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Affiliation(s)
- Sarah P Bowers
- NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
- Department of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Paul N Brennan
- Department of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
- Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, UK
| | - John F Dillon
- NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
- Department of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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Shanahan W, Jacob B, McCarthy C, McDonnell B, MacNicholas R. An exploratory analysis of patient factors influencing acceptance of extended criteria liver grafts. Ann Hepatol 2022; 27:100686. [PMID: 35192962 DOI: 10.1016/j.aohep.2022.100686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES There is a shortage of ideal donor organs with consequential increasing waitlist times, drop-off, and mortality. Teams have thus extended the donor criteria. Little is known about patients' actual choices and what factors may influence their decisions regarding different extended criteria liver grafts. PATIENTS AND METHODS The documented acceptance or refusal of seven extended criteria liver graft types of patients consented for transplant in a single institution over a 2-year period was reviewed. Patient factors including sex, age, indication, aetiology, and model for end-stage liver disease (MELD) score were analysed using logistic regression. RESULTS Most patients were willing to accept most graft types. MELD score did not impact the acceptance or refusal of any graft type. Older patients and those with hepatocellular carcinoma (HCC) or ascites had significantly higher rates of acceptance. Hepatitis B or C disease aetiology was predictive of willingness to accept a similarly infected graft, respectively. HCC was predictive of acceptance of grafts from donors with a cancer history. CONCLUSIONS In general, patients embrace the available extended criteria donors. Our analysis suggests that consent should be revisited as patients deteriorate or ameliorate on the waitlist, especially if in the form of ascites or HCC but not necessarily MELD score.
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Affiliation(s)
- William Shanahan
- National Liver Transplant Unit, St Vincent's University Hospital, Merrion Road, Dublin, Ireland.
| | | | - Colm McCarthy
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Brian McDonnell
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Ross MacNicholas
- National Liver Transplant Unit, St Vincent's University Hospital, Merrion Road, Dublin, Ireland
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7
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Bagheri Lankarani K, Honarvar B, Akbari M, Bozorgnia N, Rabiey Faradonbeh M, Bagherpour M, Nikeghbalian S, Shamsaeefar A, Malekhosseini SA. Quality of Life and Its Determinants in Liver Transplantation Candidates: A Missed Link in Liver Care Program during the Waiting Time for Liver Transplantation. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:227-235. [PMID: 35634527 PMCID: PMC9126895 DOI: 10.30476/ijms.2021.88302.1895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/08/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022]
Abstract
Background The health-related quality of life (HRQOL) in the before liver transplantation (LT) stage has not been studied as much as that after the LT stage. We aimed to assess HRQOL and its determinants before the LT stage. Methods As a cross-sectional study, HRQOL of all adult patients (n=632) referred to the LT center of Shiraz, Iran in 2018-2019 were assessed. Demographic, socioeconomic, medical, and paraclinical data were requested. Physical (PCS) and mental (MCS) aspects of HRQOL were assessed using the SF36 questionnaire. Univariable, multivariable (linear regression), and confirmatory factor analysis were performed utilizing SPSS 20 and Mplus 6.1 software. P<0.05 was considered to be significant. Results The mean age of the patients was 47.6±12.3 years, while 414 (65.6%) were men, and the mean, score of the model for end-stage liver disease (MELD) was 18.36±5.58. The mean score of QOL, PCS, and MCS was 50.01±21.73, 46.23±23.23, and 53.78±23.91 (out of 100), respectively. Vitality had the most association with HRQOL, while role limitations had the lowest. The multivariable analysis revealed that unemployment (P<0.001), anemia (P=0.005), weight loss (P=0.005), diabetes mellitus (DM) (P=0.009), low MELD score (P=0.027), and drug use (P=0.03) were the significant determinants of HRQOL, respectively. Conclusion The present study showed that HRQOL in the LT candidates was at the intermediate level, while their PCS and MCS are at the low and moderate levels, respectively. Furthermore, physical performance, job status, anemia, weight loss, MELD score, DM, and drug use should be considered as the significant determinants of HRQOL in the LT candidates.
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Affiliation(s)
- Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behnam Honarvar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Akbari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naghmeh Bozorgnia
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Rabiey Faradonbeh
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Bagherpour
- Department of Industrial Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Saman Nikeghbalian
- Shiraz Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Shamsaeefar
- Shiraz Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran
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8
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Hui Y, Li N, Yu Z, Li C, Wang X, Li Y, Sun M, Yang W, Guo G, Fan X, Lin L, Cui B, Chen X, Wang B, Zhang J, Sun C. Health-Related Quality of Life and Its Contributors According to a Preference-Based Generic Instrument in Cirrhosis. Hepatol Commun 2022; 6:610-620. [PMID: 34558226 PMCID: PMC8870013 DOI: 10.1002/hep4.1827] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/25/2021] [Accepted: 09/05/2021] [Indexed: 01/13/2023] Open
Abstract
It is essential to determine contributors around impairment in health-related quality of life (HRQoL) in patients with cirrhosis aiming at improving health care and therapeutic strategy. Studies simultaneously incorporating disease severity based on biochemical parameters and other physical/psychological effects (i.e., sleep disturbance and frailty) are heterogeneous and the subject of the present study. We analyzed and compared HRQoL, using the EuroQol Group 5 Dimension (EQ-5D) questionnaire and the utility index retrieved, in patients with cirrhosis and across groups stratified by sleep disturbance or frailty phenotype. Sleep disturbance and frailty were determined by the Pittsburgh Sleep Quality Index (PSQI) and Frailty Index, respectively. Multiple linear regression was implemented to clarify contributors of poor HRQoL. In this cohort of 227 patients with mean age of 61.7 years and 47.2% male, more than half of the study population represented impairment in HRQoL in at least one domain, according to EQ-5D. Furthermore, sleep disturbance and frailty have proved to be independently associated with poor HRQoL in two separate regression models, whereas conventional scoring systems such as Child-Pugh classification and Model for End-Stage Liver Disease are not closely relevant. Intriguingly, not all health domains within EQ-5D correlated well with PSQI and Frailty Index, with the exception of usual activities. Pain and anxiety/depression were the most frequently affected HRQoL domains even in patients without sleep disturbance or frailty. Conclusion: Impaired HRQoL is prevalent in patients with decompensated cirrhosis. Sleep disturbance and frailty are independently associated with poor HRQoL. It is imperative to timely intervene with these symptoms and deliver tailored health care.
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Affiliation(s)
- Yangyang Hui
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Nan Li
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina
| | - Zihan Yu
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Chaoqun Li
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Department of Internal MedicineTianjin Hexi HospitalTianjinChina
| | - Xiaoyu Wang
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Yifan Li
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Mingyu Sun
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Wanting Yang
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Gaoyue Guo
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Xiaofei Fan
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Lin Lin
- Department of GastroenterologyTianjin Medical University General Hospital Airport HospitalTianjin Airport Economic AreaTianjinChina
| | - Binxin Cui
- Department of GastroenterologyTianjin Medical University General Hospital Airport HospitalTianjin Airport Economic AreaTianjinChina
| | - Xin Chen
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Bangmao Wang
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Jie Zhang
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Chao Sun
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina.,Department of GastroenterologyTianjin Medical University General Hospital Airport HospitalTianjin Airport Economic AreaTianjinChina
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9
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Abstract
OBJECTIVES Although patients with cirrhosis often experience debilitating symptoms, few are referred for palliative care. Frailty is increasingly incorporated in liver transplantation evaluation and has been associated with symptom burden in other populations. We hypothesized that frail patients with cirrhosis are highly symptomatic and thus are likely to benefit from palliative care. METHODS Patients with cirrhosis undergoing outpatient liver transplantation evaluation completed the Liver Frailty Index (grip strength, chair stands and balance) and a composite of validated measures including the Edmonton Symptom Assessment Scale, distress and quality of life (QOL) measures. RESULTS Of 233 patients (median age 61 years, 43% women), 22% were robust, 59% prefrail and 19% frail. Overall, 38% of patients reported ≥1 severe symptoms based on preestablished Edmonton Symptom Assessment Scale criteria. Higher frailty categories were associated with increased prevalence of pain, dyspnea, fatigue, nausea, poor appetite, drowsiness, depression and poor well-being (test for trend, all P < 0.05). Frail patients were also more likely to report psychological distress and poor QOL (all P < 0.01). In univariate analysis, each 0.5 increase in liver frailty index was associated with 44% increased odds of experiencing ≥1 severe symptoms [95% confidence interval (CI), 1.2-1.7, P < 0.001], which persisted (odds ratio, 1.3, 95% CI, 1.0-1.6, P = 0.004) even after adjusting for Model for End Stage Liver Disease-Sodium, ascites, hepatic encephalopathy and age. CONCLUSION In patients with cirrhosis, frailty is strongly associated with physical/psychological symptoms, including pain and depression and poor QOL. Frail patients with cirrhosis may benefit from palliative care co-management to address symptoms and improve QOL.
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10
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Cristin DJ, Forman LM, Jackson WE. Beyond Survival: Targeting Health-Related Quality of Life Outcomes After Liver Transplantation. Clin Liver Dis (Hoboken) 2021; 17:359-364. [PMID: 34136142 PMCID: PMC8177828 DOI: 10.1002/cld.1059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 10/25/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- David J. Cristin
- Division of Gastroenterology and HepatologyUniversity of Colorado Anschutz Medical CenterAuroraCO
| | - Lisa M. Forman
- Division of Gastroenterology and HepatologyUniversity of Colorado Anschutz Medical CenterAuroraCO
| | - Whitney E. Jackson
- Division of Gastroenterology and HepatologyUniversity of Colorado Anschutz Medical CenterAuroraCO
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11
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Factors Affecting Quality of Life in Liver Transplant Candidates: An Observational Study. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Health-related quality of life (HRQOL) before and after liver transplant (LT) is an important outcome in LT candidates as, in these patients, HRQOL is commonly impaired. However, evidence regarding factors that influence HRQOL in patients with end-stage liver disease is inconclusive. The aim of the present study was to identify factors associated with poor HRQOL. An observational study was conducted over LT candidates. The 36-item Short Form Health Survey (widely used to assess HRQOL) and the Hospital Anxiety and Depression Scale were administered to 211 patients during the pre-transplant assessment. Baseline demographic and clinical data were also collected. Multiple regression analysis was performed to investigate risk factors for poor HRQOL. Female sex (lower B = 7.99 95%C = 0.07–15.92, higher B = 18.09 95%CI = 7.56–28.62), encephalopathy (lower B = −9.45, 95%CI = −14.59–−4.31, higher B = −6.69, 95%CI = −13.13 to −0.25), higher MELD scores (lower B = −1.14, 95%CI = −1.67 to −0.61, higher B = −0.33, 95%CI = −0.65 to −0.12), anxiety (lower B = −3.04 95%C = −4.71 to −1.36, higher B = −1.93 95%CI = −3.39 to −0.47)and depression (lower B = −3.27 95%C = −4.46 to −2.08, higher B = −1.02 95%CI = −1.90 to −0.13) symptoms were associated to poorer HRQOL. Psychosocial interventions should be addressed to liver transplant candidates, especially to women, patients with anxiety, depression or episodes of encephalopathy, in order to prevent the impact that these conditions can have on HRQOL.
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12
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Rabiee A, Ximenes RO, Nikayin S, Hickner A, Juthani P, Rosen RH, Garcia-Tsao G. Factors associated with health-related quality of life in patients with cirrhosis: a systematic review. Liver Int 2021; 41:6-15. [PMID: 32998172 DOI: 10.1111/liv.14680] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 09/03/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with cirrhosis have a poor health-related quality of life (HRQoL). Recognizing factors that affect HRQoL is key in delivering patient-centred care. AIM To identify factors most commonly associated with a poor HRQoL in adults with cirrhosis in a systematic review of the literature. METHODS Four databases (MEDLINE, EMBASE, CENTRAL and PsycINFO) were searched from inception to March 2020, using terms related to patient-reported outcomes plus cirrhosis. Studies that analysed an association between at least one factor and HRQoL in adult patients with cirrhosis were included. Abstract and full-text screening was performed by two reviewers. Data were collected on factors evaluated in each study and the significance of their association with HRQoL. RESULTS A total of 10647 citations were reviewed, of which 109 met eligibility criteria. 76% of the studies used a generic instrument while only 45% used liver-specific instruments. Among identified factors, demographic factors and cirrhosis aetiology were not generally associated with poor HRQoL except for poor social support. Depression, poor sleep and muscle cramps affected HRQoL in all the studies that evaluated them. Among comorbidities, frailty, falls, malnutrition and cognitive impairment were also associated with poor HRQoL in the majority of studies. Among cirrhosis-specific decompensating events, only hepatic encephalopathy (HE) was consistently associated with impairment in HRQoL (75% of studies). CONCLUSION Many factors impact poor HRQoL in patients with cirrhosis such as depression, muscle cramps, poor sleep, falls, frailty and malnutrition. Among cirrhosis decompensating events, HE was the complication most commonly associated with a poor HRQoL.
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Affiliation(s)
- Anahita Rabiee
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Rafael O Ximenes
- Division of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Sina Nikayin
- Department of Psychiatry, Westchester Medical Center, Valhalla, NY, USA
| | - Andy Hickner
- Interprofessional Health Sciences Library, Seton Hall University, South Orange, NJ, USA
| | | | | | - Guadalupe Garcia-Tsao
- Section of Digestive Diseases, Yale School of Medicine and VA-CT Healthcare System, New Haven, CT, USA
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13
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Psychological, Cognitive, and Laboratory Characteristics of End-Stage Liver Disease Patients. HEPATITIS MONTHLY 2020. [DOI: 10.5812/hepatmon.96433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Background: End-Stage Liver Disease (ESLD) causes several clinical and psychological comorbidities. Some accompanying psychiatric disturbances have significant effects on the patients’ quality of life. Objectives: Thus, we aimed to evaluate some psychological characteristics of ESLD patients. Methods: A cross-sectional study was conducted on 91 ESLD patients aged 18 - 70 years. We assessed the patients using the California Verbal Learning Test (CVLT), Fatigue Severity Scale, Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale. Also, we measured the demographic and some laboratory data of the participants. The data were analyzed by SPSS version 21 software, and P values of less than 0.05 were considered significant. Results: The study included 68 men and 23 women with a mean age of 41.9 ± 13.72 years (range 19 - 68). The mean scores of fatigue (40.6 ± 14.8) and anxiety (12.98 ± 2.76) were more than the normal range. The most significant association was seen between age and CVLT items (attention (P = 0.01), immediate memory (P < 0.001), short delay free recall (0.01), and short delay cued recall (0.03). Conclusions: End-stage liver disease patients had anxiety, fatigue, and memory disorders in addition to their poor clinical conditions. Although the main treatment of ESLD is liver transplantation but the psychological and cognitive problems before transplantation in these patients are prognostic factors for post-operation compliance and follow up.
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14
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Abstract
OBJECTIVES Patients with cirrhosis experience a worsened quality of life; this may be quantified by the use of health-related QoL (HRQoL) constructs, such as the chronic liver disease questionnaire (CLDQ) and EuroQoL Group-visual analog scale (EQ-VAS). In this multicenter prospective study, we aimed to evaluate HRQoL as a predictor of unplanned hospital admission/early mortality, identify HRQoL domains most affected in cirrhosis, and identify predictors of low HRQoL in patients with cirrhosis. METHODS Multivariable logistic regression was used to determine independent association of HRQoL with primary outcome and identify predictors of low HRQoL. HRQoL was also compared with population norms. RESULTS In this cohort of 402 patients with cirrhosis, mean model for end-stage liver disease was 12.5 (4.9). More than 50% of the cohort had low HRQoL, considerably lower than population norms. HRQoL (measured by either CLDQ or EQ-VAS) was independently associated with the primary outcome of short-term unplanned hospitalization/mortality. Every 1-point increase in the CLDQ and every 10-point increase in the EQ-VAS reduced the risk of reaching this outcome by 30% and 13%, respectively. Patients with cirrhosis had lower HRQoL scores than population norms across all domains of the CLDQ. Younger age, female sex, current smoker, lower serum albumin, frailty, and ascites were independently associated with low CLDQ. DISCUSSION Patients with cirrhosis experience poor HRQoL. HRQoL is independently associated with increased mortality/unplanned hospitalizations in patients with cirrhosis and could be an easy-to-use prognostic screen that patients could complete in the waiting room before their appointment.
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15
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Mikolajczyk AE, Rao VL, Diaz GC, Renz JF. Can reporting more lead to less? The role of metrics in assessing liver transplant program performance. Clin Transplant 2020; 33:e13385. [PMID: 30666739 DOI: 10.1111/ctr.13385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/05/2018] [Accepted: 08/16/2018] [Indexed: 01/05/2023]
Abstract
Appropriate metrics for performance analysis is an active topic of debate within the transplant community. This study explores current proposals on metric expansion as well as potential metrics and prospective collaborations that have not received widespread discussion within the transplant community. The premature introduction of additional, nonvalidated metrics risks behaviors that may undermine donor utilization and patient access to transplantation.
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Affiliation(s)
- Adam E Mikolajczyk
- Department of Medicine, Section of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, Illinois
| | - Vijaya L Rao
- Department of Medicine, Section of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, Illinois
| | - Geraldine C Diaz
- Department of Anesthesiology, SUNY Downstate Medical Center, Brooklyn, New York
| | - John F Renz
- Department of Surgery, Section of Transplantation, University of Chicago, Chicago, Illinois
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16
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Abstract
BACKGROUND Current EASL/AASLD guidelines recommend treatment of covert hepatic encephalopathy (HE) only in symptomatic patients, for example, in those with impaired quality of life or with affected driving abilities. GOALS Because testing for impaired quality of life is time consuming, the aim of the present study was to identify simple clinical predictors for poor quality of life in patients with covert HE (CHE). STUDY In total, 139 cirrhotic in- and outpatients without a history of overt hepatic encephalopathy were enrolled. Diagnosis of HE grade 1 (HE1) was diagnosed clinically according to the West-Haven Criteria. Critical flicker frequency and the Psychometric Hepatic Encephalopathy Score were used to detect minimal HE (MHE). Chronic Liver Disease Questionnaire was used to assess health-related quality of life (HrQoL). RESULTS CHE was detected in 51 (36.7%) patients. Multivariate analysis identified a history of falls in the previous year (P=0.003) and female gender (P=0.030) as independent predictors of reduced HRQoL in patients with CHE. Comparison of patients with and without a history of falls revealed relevant differences in the subdomains-abdominal symptoms, fatigue, systemic symptoms, emotional functions and worries. CONCLUSIONS A history of falls and female gender are associated with impaired HRQoL in patients with CHE. These data indicate that a history of falls should be considered as a treatment indication in patients with CHE to improve HRQoL and ultimately prognosis.
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17
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Esteban JPG, Rein L, Szabo A, Saeian K, Rhodes M, Marks S. Attitudes of Liver and Palliative Care Clinicians toward Specialist Palliative Care Consultation for Patients with End-Stage Liver Disease. J Palliat Med 2019; 22:804-813. [DOI: 10.1089/jpm.2018.0553] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Lisa Rein
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kia Saeian
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mary Rhodes
- Section of Palliative Care, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sean Marks
- Section of Palliative Care, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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18
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The Use of Donation After Circulatory Death Organs for Simultaneous Liver-kidney Transplant: To DCD or Not to DCD? Transplantation 2019; 103:1159-1167. [DOI: 10.1097/tp.0000000000002434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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19
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Macdonald S, Jepsen P, Alrubaiy L, Watson H, Vilstrup H, Jalan R. Quality of life measures predict mortality in patients with cirrhosis and severe ascites. Aliment Pharmacol Ther 2019; 49:321-330. [PMID: 30585338 DOI: 10.1111/apt.15084] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/16/2018] [Accepted: 11/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Severe ascites is associated with both a poor health-related quality of life (HRQL) and a mortality in excess of that captured by current prognostic clinical scores. AIM To determine the association between HRQL and mortality in patients with severe ascites. METHODS The HRQL data from previously published randomised controlled trials examining the efficacy of satavaptan in ascites were retrospectively evaluated. RESULTS Of the 496 patients randomised who completed the SF-36, 405 patients had complete datasets and were included in the analysis (difficult-to-treat ascites, n = 164 or refractory ascites, n = 241). Overall, patients reported poor HRQL, in particular the physical component score (PCS) of SF-36. The physical component score (PCS) correlated with the mental component score (MCS) of SF-36 (Spearman rank correlation = 0.68) but not with markers of severity of liver disease. The PCS, but not the MCS, was significantly lower in patients who died (P = 0.01 and P = 0.84, respectively). After confounder-adjustment, the hazard ratio for a 10-point increase in the physical component score was 0.83 (95% CI; 0.72-0.97) for all-cause mortality and 0.84 (95% CI; 0.71-0.99) for cirrhosis-related deaths only, indicating that patients with better physical HRQL live longer on average. CONCLUSIONS Poor physical component score (PCS) of SF-36 is an independent predictor of 12-month mortality in patients with severe ascites independent of current prognostic clinical scores. It holds promise not only in prognostic modelling but also as an endpoint in the evaluation of therapies targeting ascites.
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Affiliation(s)
- Stewart Macdonald
- Liver Failure Group, Institute for Liver and Digestive Health, University College London, London, UK
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hugh Watson
- Infectious Diseases Unit, Sanofi-Aventis R&D, Marcy l'Etoile, France
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Rajiv Jalan
- Liver Failure Group, Institute for Liver and Digestive Health, University College London, London, UK
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20
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Peng JK, Hepgul N, Higginson IJ, Gao W. Symptom prevalence and quality of life of patients with end-stage liver disease: A systematic review and meta-analysis. Palliat Med 2019; 33:24-36. [PMID: 30345878 PMCID: PMC6291907 DOI: 10.1177/0269216318807051] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND: End-stage liver disease is a common cause of morbidity and mortality worldwide, yet little is known about its symptomatology and impact on health-related quality of life. AIM: To describe symptom prevalence and health-related quality of life of patients with end-stage liver disease to improve care. DESIGN: Systematic review. DATA SOURCES: We searched eight electronic databases from January 1980 to June 2018 for studies investigating symptom prevalence or health-related quality of life of adult patients with end-stage liver disease. No language restrictions were applied. Meta-analyses were performed where appropriate. RESULTS: We included 80 studies: 35 assessing symptom prevalence, 41 assessing health-related quality of life, and 4 both. The instruments assessing symptoms varied across studies. The most frequently reported symptoms were as follows: pain (prevalence range 30%–79%), breathlessness (20%–88%), muscle cramps (56%–68%), sleep disturbance (insomnia 26%–77%, daytime sleepiness 29.5%–71%), and psychological symptoms (depression 4.5%–64%, anxiety 14%–45%). Erectile dysfunction was prevalent (53%–93%) in men. The health-related quality of life of patients with end-stage liver disease was significantly impaired when compared to healthy controls or patients with chronic liver disease. Compared with compensated cirrhosis, decompensation led to significant worsening of both components of the 36-Item Short Form Survey although to a larger degree for the Physical Component Summary score (decrease from average 6.4 (95% confidence interval: 4.0–8.8); p < 0.001) than for the Mental Component Summary score (4.5 (95% confidence interval: 2.4–6.6); p < 0.001). CONCLUSION: The symptom prevalence of patients with end-stage liver disease resembled that of patients with other advanced conditions. Given the diversity of symptoms and significantly impaired health-related quality of life, multidisciplinary approach and timely intervention are crucial.
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Affiliation(s)
- Jen-Kuei Peng
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.,2 Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,3 Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Nilay Hepgul
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Irene J Higginson
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Wei Gao
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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21
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Ridola L, Nardelli S, Gioia S, Riggio O. Quality of life in patients with minimal hepatic encephalopathy. World J Gastroenterol 2018; 24:5446-5453. [PMID: 30622374 PMCID: PMC6319138 DOI: 10.3748/wjg.v24.i48.5446] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023] Open
Abstract
Minimal hepatic encephalopathy (MHE) represents the mildest type of hepatic encephalopathy (HE). This condition alters the performance of psychometric tests by impairing attention, working memory, psychomotor speed, and visuospatial ability, as well as electrophysiological and other functional brain measures. MHE is a frequent complication of liver disease, affecting up to 80% of tested patients, depending of the diagnostic tools used for the diagnosis. MHE is related to falls, to an impairment in fitness to drive and the development of overt HE, MHE severely affects the lives of patients and caregivers by altering their quality of life (QoL) and their socioeconomic status. MHE is detected in clinically asymptomatic patients through appropriate psychometric tests and neurophysiological methods which highlight neuropsychological alterations such as video-spatial orientation deficits, attention disorders, memory, reaction times, electroencephalogram slowing, prolongation of latency evoked cognitive potentials and reduction in the critical flicker frequency. Several treatments have been proposed for MHE treatment such as non-absorbable disaccharides, poorly absorbable antibiotics such rifaximin, probiotics and branched chain amino acids. However, because of the multiple diagnosis methods, the various endpoints of treatment trials and the variety of agents used in trials, to date the treatment of MHE is not routinely recommended apart from on a case-by-case basis. Aim of this review is analyze the burden of MHE on QoL of patients and provide a brief summary of therapeutic approaches.
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Affiliation(s)
- Lorenzo Ridola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina 04100, Italy
| | - Silvia Nardelli
- Department of Clinical Medicine, Sapienza University of Rome, Rome 00185, Italy
| | - Stefania Gioia
- Department of Clinical Medicine, Sapienza University of Rome, Rome 00185, Italy
| | - Oliviero Riggio
- Department of Clinical Medicine, Sapienza University of Rome, Rome 00185, Italy
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22
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Kabar I, Hüsing-Kabar A, Maschmeier M, Völler C, Dümke M, Schmidt HH, Heinzow H. Pictorial Representation of Illness and Self Measure (PRISM): A Novel Visual Instrument to Quantify Suffering in Liver Cirrhosis Patients and Liver Transplant Recipients. Ann Transplant 2018; 23:674-680. [PMID: 30262798 PMCID: PMC6248009 DOI: 10.12659/aot.910278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The level of suffering of chronically ill patients does not necessarily correlate with illness severity. In this study, we evaluated the burden of suffering and its impact on health-related quality of life in liver transplant recipients and liver cirrhosis patients. Material/Methods The Pictorial Representation of Illness and Self Measure (PRISM) was used to explore levels of suffering in outpatients of Münster University Hospital, Germany. Self-illness separation scores were analyzed as a measure of disease-specific burden of suffering. Health-related quality of life was measured using the Short Form Health Survey (SF-36). Results Data from 201 subjects were statistically analyzed. Median Self-illness separation scores for liver transplant recipients and patients with liver cirrhosis were 13.5 (minimum/maximum: 0.2/25.6) cm and 6.3 (0.1/25.6) cm (p<0.001), respectively. The median SF-36 Mental Component Summary and Physical Component Summary scores were 46.4 (12.5/66.2) and 40.1 (12.3/61.1), respectively. Higher health-related quality of life was associated with greater self–illness separation. Liver transplant recipients showed normal Mental Component Summary scores compared with the general German population; patients with liver cirrhosis had significantly lower Mental Component Summary scores. Physical Component Summary scores were significantly higher in liver transplant recipients than in patients with liver cirrhosis, but still lower than in the general population. Conclusions PRISM is a novel, simple tool for measuring the illness burden in liver transplant recipients and patients with liver cirrhosis. This measure may help to identify patients at a higher risk of psychological disorders.
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Affiliation(s)
- Iyad Kabar
- Department of Gastroenterology and Hepatology, Münster University Hospital, Münster, Germany
| | - Anna Hüsing-Kabar
- Department of Gastroenterology and Hepatology, Münster University Hospital, Münster, Germany
| | - Miriam Maschmeier
- Department of Gastroenterology and Hepatology, Münster University Hospital, Münster, Germany
| | - Carolin Völler
- Department of Gastroenterology and Hepatology, Münster University Hospital, Münster, Germany
| | - Marina Dümke
- Department of Gastroenterology and Hepatology, Münster University Hospital, Münster, Germany
| | - Hartmut H Schmidt
- Department of Gastroenterology and Hepatology, Münster University Hospital, Münster, Germany
| | - Hauke Heinzow
- Department of Gastroenterology and Hepatology, Münster University Hospital, Münster, Germany
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23
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Rao VL, Mikolajczyk AE, Diaz GC, Renz JF. Pro: Patient and allograft survival remain the best metric to gauge successful liver transplantation. Clin Liver Dis (Hoboken) 2018; 11:59-61. [PMID: 30992789 PMCID: PMC6385945 DOI: 10.1002/cld.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/20/2017] [Accepted: 01/08/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Vijaya L. Rao
- Department of Medicine, Section of GastroenterologyHepatology and NutritionChicagoIL
| | - Adam E. Mikolajczyk
- Department of Medicine, Section of GastroenterologyHepatology and NutritionChicagoIL
| | - Geraldine C. Diaz
- Department of Anesthesia and Critical CareThe University of Chicago Medical CenterChicagoIL
| | - John F. Renz
- Department of Surgery, Section of TransplantationThe University of Chicago Medical CenterChicagoIL
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24
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Ridola L, Cardinale V, Riggio O. The burden of minimal hepatic encephalopathy: from diagnosis to therapeutic strategies. Ann Gastroenterol 2018; 31:151-164. [PMID: 29507462 PMCID: PMC5825945 DOI: 10.20524/aog.2018.0232] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/29/2017] [Indexed: 12/12/2022] Open
Abstract
Minimal hepatic encephalopathy (MHE) is the mildest form of hepatic encephalopathy (HE). It affects the performance of psychometric tests focused on attention, working memory, psychomotor speed, and visuospatial ability, as well as electrophysiological and other functional brain measures. MHE is a frequent complication of liver disease, affecting up to 80% of tested patients. By being related to falls, an impairment in fitness to drive and the development of overt HE, MHE severely affects the lives of patients and caregivers by altering their quality of life and their socioeconomic status. MHE is detected in clinically asymptomatic patients using appropriate psychometric tests and neurophysiological methods that highlight neuropsychological alterations, such as video-spatial orientation deficits, attention disorders, memory, reaction times, electroencephalogram slowing, prolongation of latency-evoked cognitive potentials, and reduction in the critical flicker frequency. Several treatments have been proposed for MHE treatment, including non-absorbable disaccharides, poorly absorbable antibiotics such as rifaximin, probiotics and branched-chain amino acids. However, because of the multiple diagnosis methods, the various endpoints of treatment trials and the variety of agents used in trials, the treatment of MHE is not currently recommended as routine, but only on a case-by-case basis.
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Affiliation(s)
- Lorenzo Ridola
- Department of Medico-Surgical Sciences and Biotechnologies (Lorenzo Ridola, Vincenzo Cardinale), Sapienza University of Rome, Italy
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies (Lorenzo Ridola, Vincenzo Cardinale), Sapienza University of Rome, Italy
| | - Oliviero Riggio
- Department of Clinical Medicine (Oliviero Riggio), Sapienza University of Rome, Italy
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Serigado JM, Barboza KC, Marcus P, Sigal SH. Clinical Impact of Depression in Cirrhosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s11901-018-0386-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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26
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Sundaram V, Lim J, Tholey DM, Iriana S, Kim I, Manne V, Nissen NN, Klein AS, Tran TT, Ayoub WS, Schlansky B. The Braden Scale, A standard tool for assessing pressure ulcer risk, predicts early outcomes after liver transplantation. Liver Transpl 2017; 23:1153-1160. [PMID: 28512923 DOI: 10.1002/lt.24789] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/29/2017] [Accepted: 05/07/2017] [Indexed: 12/13/2022]
Abstract
The Braden Scale is a standardized tool to assess pressure ulcer risk that is reported for all hospitalized patients in the United States per requirements of the Center for Medicare and Medicaid Services. Previous data have shown the Braden Scale can predict both frailty and mortality risk in patients with decompensated cirrhosis. Our aim was to evaluate the association of the Braden Scale score with short-term outcomes after liver transplantation (LT). We performed a retrospective cohort study of deceased donor LT recipients at 2 centers and categorized them according to the Braden Scale at hospital admission as low (>18), moderate (16-18), or high risk (<16) for pressure ulcer. We created logistic and Poisson multiple regression models to evaluate the association of Braden Scale category with in-hospital and 90-day mortality, length of stay (LOS), nonambulatory status at discharge, and discharge to a rehabilitation facility. Of 341 patients studied, 213 (62.5%) were low risk, 59 (17.3%) were moderate risk, and 69 (20.2%) were high risk. Moderate- and high-risk patients had a greater likelihood for prolonged LOS, nonambulatory status, and discharge to a rehabilitation facility, as compared with low-risk patients. High-risk patients additionally had increased risk for in-hospital and 90-day mortality after LT. Multiple regression modeling demonstrated that high-risk Braden Scale score was associated with prolonged LOS (IRR, 1.56; 95% confidence interval [CI], 1.47-1.65), nonambulatory status at discharge (odds ratio [OR], 4.15; 95% CI, 1.77-9.71), and discharge to a rehabilitation facility (OR, 5.51; 95% CI, 2.57-11.80). In conclusion, the Braden Scale, which is currently assessed in all hospitalized patients in the United States, independently predicted early disability-related outcomes and greater LOS after LT. Liver Transplantation 23 1153-1160 2017 AASLD.
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Affiliation(s)
- Vinay Sundaram
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jane Lim
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA
| | - Danielle M Tholey
- Department of Medicine, Division of Gastroenterology, Oregon Health and Science University, Portland, OR
| | - Sentia Iriana
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA
| | - Irene Kim
- Department of Surgery, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Vignan Manne
- Department of Medicine, Akron General Hospital, Akron, OH
| | - Nicholas N Nissen
- Department of Surgery, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Andrew S Klein
- Department of Surgery, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Tram T Tran
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Walid S Ayoub
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Barry Schlansky
- Department of Medicine, Division of Gastroenterology, Oregon Health and Science University, Portland, OR
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Guaraldi G, Dolci G, Zona S, Tarantino G, Serra V, Ballarin R, Franceschini E, Codeluppi M, Brothers TD, Mussini C, Di Benedetto F. A frailty index predicts post-liver transplant morbidity and mortality in HIV-positive patients. AIDS Res Ther 2017; 14:37. [PMID: 28779758 PMCID: PMC5545092 DOI: 10.1186/s12981-017-0163-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/28/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We hypothesized that frailty acts as a measure of health outcomes in the context of LT. The aim of this study was to explore frailty index across LT, as a measure of morbidity and mortality. This was a retrospective observational study including all consecutive 47 HIV+patients who received LT in Modena, Italy from 2003 to June 2015. METHODS frailty index (FI) was constructed from 30 health variables. It was used both as a continuous score and as a categorical variable, defining 'most frail' a FI > 0.45. FI change across transplant (deltaFI, ΔFI) was calculated as the difference between year 1 FI (FI-Y1) and pre-transplant FI (FI-t0). The outcomes measures were mortality and "otpimal LT" (defined as being alive without multi-morbidity). RESULTS Median value of FI-t0 was 0.48 (IQR 0.42-0.52), FI-Y1 was 0.31 (IQR 0.26-0.41). At year five mortality rate was 45%, "optimal transplant" rate at year 1 was 38%. All the patients who died in the post-LT were most frail in the pre-LT. ΔFI was a predictor of mortality after correction for age and MELD (HR = 1.10, p = 0.006) and was inversely associated with optimal transplant after correction for age (HR = 1.04, p = 0.01). CONCLUSIONS We validated FI as a valuable health measure in HIV transplant. In particular, we found a relevant correlation between FI strata at baseline and mortality and a statistically significant correlation between, ΔFI and survival rate.
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Ahmed A, Gonzalez SA, Cholankeril G, Perumpail RB, McGinnis J, Saab S, Beckerman R, Younossi ZM. Treatment of patients waitlisted for liver transplant with all-oral direct-acting antivirals is a cost-effective treatment strategy in the United States. Hepatology 2017; 66:46-56. [PMID: 28257591 DOI: 10.1002/hep.29137] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/13/2017] [Accepted: 02/24/2017] [Indexed: 12/15/2022]
Abstract
UNLABELLED All-oral direct acting antivirals (DAAs) have been shown to have high safety and efficacy in treating patients with hepatitis C virus (HCV) awaiting liver transplant (LT). However, there is limited empirical evidence comparing the health and economic outcomes associated with treating patients pre-LT versus post-LT. The objective of this study was to analyze the cost-effectiveness of pre-LT versus post-LT treatment with an all-oral DAA regimen among HCV patients with hepatocellular carcinoma (HCC) or decompensated cirrhosis (DCC). We constructed decision-analytic Markov models of the natural disease progression of HCV in HCC patients and DCC patients waitlisted for LT. The model followed hypothetical cohorts of 1,000 patients with a mean age of 50 over a 30-year time horizon from a third-party US payer perspective and estimated their health and cost outcomes based on pre-LT versus post-LT treatment with an all-oral DAA regimen. Transition probabilities and utilities were based on the literature and hepatologist consensus. Sustained virological response rates were sourced from ASTRAL-4, SOLAR-1, and SOLAR-2. Costs were sourced from RedBook, Medicare fee schedules, and published literature. In the HCC analysis, the pre-LT treatment strategy resulted in 11.48 per-patient quality-adjusted life years and $365,948 per patient lifetime costs versus 10.39 and $283,696, respectively, in the post-LT arm. In the DCC analysis, the pre-LT treatment strategy resulted in 9.27 per-patient quality-adjusted life years and $304,800 per patient lifetime costs versus 8.7 and $283,789, respectively, in the post-LT arm. As such, the pre-LT treatment strategy was found to be the most cost-effective in both populations with an incremental cost-effectiveness ratio of $74,255 (HCC) and $36,583 (DCC). Sensitivity and scenario analyses showed that results were most sensitive to the utility of patients post-LT, treatment sustained virological response rates, LT costs, and baseline Model for End-Stage Liver Disease score (DCC analysis only). CONCLUSION The timing of initiation of antiviral treatment for HCV patients with HCC or DCC relative to LT is an important area of clinical and policy research; our results indicate that pre-LT treatment with a highly effective, all-oral DAA regimen provides the best health outcomes and is the most cost-effective strategy for the treatment of HCV patients with HCC or DCC waitlisted for LT. (Hepatology 2017;66:46-56).
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Affiliation(s)
- Aijaz Ahmed
- Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | - Sammy Saab
- University of California Los Angeles, Los Angeles, CA
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29
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Bhanji RA, Carey EJ, Watt KD. Review article: maximising quality of life while aspiring for quantity of life in end-stage liver disease. Aliment Pharmacol Ther 2017; 46:16-25. [PMID: 28464346 DOI: 10.1111/apt.14078] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/18/2017] [Accepted: 03/14/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND With recent advances in the management of chronic liver disease and its complications, the long-term survival in cirrhosis has improved. Therefore, the number of individuals who will spend a significant proportion of their life with end-stage liver disease (ESLD) may continue to rise. Thus, more attention to quality of life (QOL) and its integration with traditional clinical endpoints is needed. AIMS Recently, there have been many studies looking at treatment outcomes and their impact on the QOL in patients with ESLD. The aim of this review was to summarise and compare the insights gained from these intervention studies and to make concise recommendations to further promote and improve QOL in this patient population. METHODS A literature search was conducted using PubMed and Web of Science. Search terms "Quality of life" "Cirrhosis" and "end-stage liver disease" were used as MeSH terms or searched in the title of the article. RESULTS These studies uniformly show significant improvement in health-related QOL (HRQOL) with management of malnutrition, hepatic encephalopathy and ascites. Thus, early recognition and management of these complications are keys to better serve our patients. Early involvement of palliative care also leads to improved quality of end-of-life care. CONCLUSIONS Complications of cirrhosis including malnutrition, encephalopathy, ascites and variceal bleeding lead to a decrease in HRQOL. Assessment of HRQOL has an important implication for the patient. The findings of this review illuminate the importance of using consistent tools to accurately assess QOL in patients with ESLD.
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Affiliation(s)
- R A Bhanji
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - E J Carey
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA
| | - K D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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McLean KA, Camilleri-Brennan J, Knight SR, Drake TM, Ots R, Shaw CA, Wigmore SJ, Harrison EM. Decision modeling in donation after circulatory death liver transplantation. Liver Transpl 2017; 23:594-603. [PMID: 28027614 DOI: 10.1002/lt.24715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/18/2016] [Indexed: 02/07/2023]
Abstract
Donation after circulatory death (DCD) liver allografts are increasingly used for transplantation. However, the posttransplantation clinical and quality of life outcomes of DCD recipients are traditionally considered to be inferior compared with donation after brain death (DBD) allograft recipients. Decision making for such marginal organs can be difficult. This study investigated the optimal decision to accept or decline a DCD liver allograft for a patient based on their current health. A Markov decision process model was constructed to predict the 5-year clinical course of patients on the liver transplant waiting list. Clinical outcomes were determined from the UK transplant registry or appropriate literature. Quality-adjusted life years (QALYs) were determined using the condition-specific short form of liver disease quality of life (SF-LDQoL) questionnaire. There were 293/374 (78.3%) eligible patients who completed the SF-LDQoL questionnaire. A total of 73 respondents (24.9%) were before transplant and 220 were after transplant (DBD recipient, 56.3%; DCD recipient, 8.5%; ischemic cholangiopathy patient, 2.4%; retransplant recipient, 7.9%). Predictive modeling indicated that QALYs gained at 5 years were significantly higher in DCD recipients (3.77; 95% confidence interval [CI], 3.44-4.10) compared with those who remained on the waiting list for a DBD transplant with Model for End-Stage Liver Disease (MELD) scores of 15-20 (3.36; 95% CI, 3.28-3.43), or >20 (3.07; 95% CI, 3.00-3.14). There was no significant advantage for individuals with MELD scores <15 (3.55; 95% CI, 3.47-3.63). In conclusion, this model predicts that patients on the UK liver transplant waiting list with MELD scores >15 should receive an offered DCD allograft based on the QALYs gained at 5 years. This analysis only accounts for donor-recipient risk pairings seen in current practice. The optimal decision for patients with MELD scores <15 remains unclear. However, a survival benefit was observed when a DCD organ was accepted. Liver Transplantation 23 594-603 2017 AASLD.
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Affiliation(s)
- Kenneth A McLean
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | | | - Stephen R Knight
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Thomas M Drake
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Riinu Ots
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Catherine A Shaw
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Stephen J Wigmore
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Ewen M Harrison
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, Scotland
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31
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Younossi ZM, Stepanova M, Charlton M, Curry MP, O'Leary JG, Brown RS, Hunt S. Patient-reported outcomes with sofosbuvir and velpatasvir with or without ribavirin for hepatitis C virus-related decompensated cirrhosis: an exploratory analysis from the randomised, open-label ASTRAL-4 phase 3 trial. Lancet Gastroenterol Hepatol 2016; 1:122-132. [PMID: 28404069 DOI: 10.1016/s2468-1253(16)30009-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/20/2016] [Accepted: 05/26/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) treatment regimens with direct-acting antivirals have not been extensively studied in patients with decompensated cirrhosis. We assessed patient-reported outcomes (PROs) in patients with decompensated cirrhosis given a fixed-dose combination of sofosbuvir and velpatasvir with and without ribavirin. METHODS This study was an exploratory analysis of data collected in a randomised, open-label phase 3 trial (ASTRAL-4) in which patients with HCV-related decompensated cirrhosis were randomly assigned to an all-oral fixed-dose combination of sofosbuvir (400 mg) and velpatasvir (100 mg) once daily for 12 weeks, sofosbuvir and velpatasvir plus oral ribavirin (weight-based 1000 mg or 1200 mg) for 12 weeks, or sofosbuvir and velpatasvir for 24 weeks. Eligible patients were aged 18 years or older with any HCV genotype and decompensated cirrhosis at screening. PROs were collected for the intention-to-treat population using four questionnaires, Short Form (36) Health Survey version 2 (SF-36v2), the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), the Chronic Liver Disease Questionnaire-HCV Version (CLDQ-HCV), and the Work Productivity Activity Index:HCV (WPAI), which were given prospectively to patients before, during, and after treatment. The ASTRAL-4 study is registered with ClinicalTrials.gov, number NCT02201901. FINDINGS Patients were enrolled at 47 hepatology outpatient practices in the USA from Aug 19, 2014, to Dec 19, 2014. 267 patients with HCV-related decompensated cirrhosis were included. In patients given sofosbuvir and velpatasvir for 12 weeks (n=90), clinically significant improvements in PROs started 4 weeks after treatment initiation (+4·4 to +7·5 points on a 0-100 scale at treatment week 4). By the end of treatment, mean improvements in PROs of +5·3 to +16·0 points were noted in all PROs except for role emotional, mental component summary, and social wellbeing scores and work productivity metrics by WPAI:HCV. Similar end-of-treatment improvements (+3·8 to +17·0 points) were observed in patients given sofosbuvir and velpatasvir for 24 weeks (n=90). In patients given sofosbuvir and velpatasvir plus ribavirin (n=87), PRO scores decreased within 4 weeks of treatment (-3·6 to -6·9 points), although scores returned to the baseline levels by the end of treatment. After treatment cessation, significant improvements in all PROs were similar between the treatment groups (all p>0·01) and, by post-treatment week 24, improvements were between +4·9 and +21·2 points. In multivariate analysis, predictors of PRO impairment were treatment naivety, anxiety, use of anxiolytics, use of antidepressants, use of opioids, ribavirin use, the presence of ascites, encephalopathy, insomnia, and depression. INTERPRETATION A clinically significant early (within 4 weeks) and sustained improvement in PROs was observed in patients with HCV-related decompensated cirrhosis who were given sofosbuvir and velpatasvir without ribavirin. A similar regimen with ribavirin resulted in a temporary decrease in PROs, which completely resolved after 8 weeks of treatment. Accompanied by high efficacy, the favourable effect of treatment on PROs improves patients' experience in this difficult-to-treat population with HCV. FUNDING Gilead Sciences.
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Affiliation(s)
- Zobair M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
| | - Maria Stepanova
- Center for Outcomes Research in Liver Disease, Washington, DC, USA
| | - Michael Charlton
- Department of Gastroenterology, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Michael P Curry
- Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
| | - Sharon Hunt
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
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Limongi V, Dos Santos DC, Oliveira da Silva AMD, Boin IDFSF, Stucchi RSB. Exercise manual for liver disease patients. World J Transplant 2016; 6:429-436. [PMID: 27358789 PMCID: PMC4919748 DOI: 10.5500/wjt.v6.i2.429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/18/2016] [Accepted: 04/18/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To increase inspiratory muscle strength and improve the quality of life of candidates for liver transplantation.
METHODS: Twenty-three candidates for liver transplantation participated in the control group and 14 made up the intervention group. The control group consisted of 18 men and 5 women, body mass index (BMI) 27.3 ± 4.5 kg/m2 and Model for End-Stage Liver Disease (MELD) 18.2 ± 6.1. The intervention group consisted of 11 men and 3 women, BMI 28.6 ± 5.4 kg/m2 and MELD 18 ± 4.5. The presence or absence of ascites was identified in the first patient evaluation and after three months. We evaluated maximal inspiratory pressure (MIP) and maximal expiratory pressure, spirometry, root mean square (RMS) of diaphragm and rectus abdominis, and the quality of life. The exercises were performed daily by patients at home for three months and were supervised at distance monthly. The manual consisted of diaphragmatic breathing exercises, diaphragmatic isometric exercise, Threshold IMT®, lifting upper limbs with a bat and strengthening the abdomen.
RESULTS: There was significant difference (P = 0.01) between the first (initial) and the third month (final) MIP in the control group and in the intervention group, but there was no difference (P = 0.45) between the groups. The RMS of the diaphragm was lower (P = 0.001) and the functional capacity was higher (P = 0.006) in the intervention group compared to the control. The general health and mental health domains received higher scores after three months in the control group (P = 0.01) and the intervention group (P = 0.004), but there was no significant difference between them. The comparison between the presence of initial ascites with the presence of ascites was performed after three months in the control group (P = 0.083) and intervention group (P = 0.31). There was no significant difference, in relation to the presence of ascites after three months between groups (P = 0.21). In the intervention group, patients with ascites at the end of the time period had decreased scores on the social aspects SF-36 domain (P = 0.023) compared to those who had no ascites.
CONCLUSION: The proposed exercises provide an increase in the inspiratory muscle strength and improve functional capacity, consequently bettering the quality of life of liver disease patients.
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Benzing C, Krezdorn N, Förster J, Hinz A, Krenzien F, Atanasov G, Schmelzle M, Hau HM, Bartels M. Health-related quality of life and affective status in liver transplant recipients and patients on the waiting list with low MELD scores. HPB (Oxford) 2016; 18:449-55. [PMID: 27154809 PMCID: PMC4857066 DOI: 10.1016/j.hpb.2016.01.546] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 01/14/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study seeks to examine the impact of orthotopic liver transplantation (OLT) on Health-Related Quality of Life (HRQoL) and mental health in patients with different MELD scores. METHODS Patients who has undergone orthotopic liver transplant (OLT) or were on the waiting list for OLT were submitted to HRQoL and depression/anxiety assessment by questionnaire: Short-Form 36 (SF-36), Questions on Life Satisfaction (FLZ-M), Patient Health Questionnaire-4 (PHQ-4). Data were analysed following division of patients into three groups: pretransplant patients with a MELD score <10, ≥10, and OLT recipients. RESULTS The surveys were sent to 940 consecutive patients within one week in June 2013. Of these 940 patients, 869 (92.4%) met the inclusion criteria. In total, 291 (33.5%) eligible questionnaires (OLT group: 235, MELD <10: 25; MELD _10: 31) were suitable for analysis. General health (GH), vitality (VIT), and mental health (MH) were lower in both pretransplant groups compared to the OLT group (all p < 0.05). Anxiety and depression were higher in the MELD <10 group than in the OLT group (anxiety: p < 0.05; depression: p < 0.01). DISCUSSION Patients with low MELD scores seem to benefit from OLT with regards to HRQoL and mental health.
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Affiliation(s)
- Christian Benzing
- Department of General, Visceral and Transplantation Surgery, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany,Department of General, Visceral, Thoracic and Vascular Surgery, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany,Correspondence Christian Benzing, Department of General, Visceral and Transplantation Surgery, Campus Virchow, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: +49 (0) 30 450 652 359. Fax: +49 (0) 30 450 552 900.
| | - Nicco Krezdorn
- Department of Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neubergstr. 1, 30625 Hannover, Germany
| | - Julia Förster
- Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Felix Krenzien
- Department of General, Visceral and Transplantation Surgery, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany,Department of General, Visceral, Thoracic and Vascular Surgery, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Georgi Atanasov
- Department of General, Visceral and Transplantation Surgery, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany,Department of General, Visceral, Thoracic and Vascular Surgery, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Schmelzle
- Department of General, Visceral and Transplantation Surgery, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany,Department of General, Visceral, Thoracic and Vascular Surgery, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Michael Bartels
- Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
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Alt Y, Grimm A, Schlegel L, Grambihler A, Kittner JM, Wiltink J, Galle PR, Wörns MA, Schattenberg JM. The Impact of Liver Cell Injury on Health-Related Quality of Life in Patients with Chronic Liver Disease. PLoS One 2016; 11:e0151200. [PMID: 26990427 PMCID: PMC4798400 DOI: 10.1371/journal.pone.0151200] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/24/2016] [Indexed: 12/20/2022] Open
Abstract
Background Patients with chronic liver disease often suffer from unspecific symptoms and report severe impairment in the quality of life. The underlying mechanisms are multifactorial and include disease-specific but also liver related causes. The current analysis evaluated the association of hepatocellular apoptosis in non-viral chronic liver disease and health-related quality of life (HRQL). Furthermore we examined factors, which influence patient's physical and mental well-being. Methods A total of 150 patients with non-infectious chronic liver disease were included between January 2014 and June 2015. The German version of the Chronic Liver Disease Questionnaire (CLDQ-D), a liver disease specific instrument to assess HRQL, was employed. Hepatocellular apoptosis was determined by measuring Cytokeratin 18 (CK18, M30 Apoptosense ELISA). Results Female gender (5.24 vs. 5.54, p = 0.04), diabetes mellitus type II (4.75 vs. 5.46, p<0.001) and daily drug intake (5.24 vs. 6.01, p = 0.003) were associated with a significant impairment in HRQL. HRQL was not significantly different between the examined liver diseases. Levels of CK18 were the highest in patients with NASH compared to all other disease entities (p<0.001). Interestingly, CK18 exhibited significant correlations with obesity (p<0.001) and hyperlipidemia (p<0.001). In patients with cirrhosis levels of CK18 correlated with the MELD score (r = 0.18, p = 0.03) and were significantly higher compared to patients without existing cirrhosis (265.5 U/l vs. 186.9U/l, p = 0.047). Additionally, CK18 showed a significant correlation with the presence and the degree of hepatic fibrosis (p = 0.003) and inflammation (p<0.001) in liver histology. Finally, there was a small negative association between CLDQ and CK18 (r = -0.16, p = 0.048). Conclusion Different parameters are influencing HRQL and CK18 levels in chronic non-viral liver disease and the amount of hepatocellular apoptosis correlates with the impairment in HRQL in chronic non-viral liver diseases. These findings support the role of liver-protective therapies for the improvement of the quality of life in chronic liver disease.
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Affiliation(s)
- Yvonne Alt
- I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Anna Grimm
- I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Liesa Schlegel
- I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Annette Grambihler
- I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jens M. Kittner
- I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Peter R. Galle
- I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Marcus A. Wörns
- I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jörn M. Schattenberg
- I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- * E-mail:
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Aguiar MIFD, Braga VAB, Almeida PCD, Garcia JHP, Lima CAD. Gravidade da doença hepática e qualidade de vida no transplante de fígado. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Resumo Objetivo Analisar a influência da gravidade da doença hepática na qualidade de vida dos pacientes antes e depois do transplante de fígado. Métodos Estudo descritivo com 150 receptores de transplante hepático, maiores de 18 anos. A gravidade foi avaliada pelo Child e MELD e aplicado o Liver Disease Quality of Life. Foi utilizado teste t ou Mann-Whitney para comparação das médias dos domínios e ANOVA ou Kruskal-Wallis para comparação entre grupos. Resultados Antes do transplante, os pacientes com Child C obtiveram menores escores de qualidade de vida do que os com Child A. Pacientes com MELD menor ou igual a 15 tiveram aumento significativo das médias em 10 domínios, enquanto os pacientes com MELD superior a 15 tiveram aumento nos 12 domínios. Conclusão Houve influência negativa da gravidade pelo CTP na qualidade de vida antes do transplante. O MELD não interferiu significativamente nos resultados pós-transplante, mesmo com elevação das médias.
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Kaplan DE, Dai F, Skanderson M, Aytaman A, Baytarian M, D’Addeo K, Fox R, Hunt K, Knott A, Mehta R, Pedrosa M, Pocha C, Valderrama A, Taddei T. Recalibrating the Child-Turcotte-Pugh Score to Improve Prediction of Transplant-Free Survival in Patients with Cirrhosis. Dig Dis Sci 2016; 61:3309-3320. [PMID: 27405990 PMCID: PMC5067291 DOI: 10.1007/s10620-016-4239-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/21/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Child-Turcotte-Pugh (CTP) score is a widely used and validated predictor of long-term survival in cirrhosis. However, the cutpoints for stratifying laboratory variables in CTP have never been validated. OBJECTIVE The objective of this study was to identify evidence-based cutpoints for the CTP laboratory subscores to improve its predictive capacity for transplant-free survival. DESIGN Retrospective observational study. DATA SOURCE Using a cohort of 30,897 cirrhotic US Veteran patients with at least 5 years of follow-up, we performed Cox proportional hazard survival model iterations varying the upper and lower cutpoints for INR, total bilirubin and albumin CTP subscores. Cutpoints yielding the highest Harrell's C-statistics for concordance with transplant-free survival were incorporated into a modified CTP (mCTP) score. Validation of the mCTP was performed at multiple time frames within the follow-up period of the cohort and within subsets defined by disease etiology. RESULTS Modification of CTP cutpoints increased the Harrell's C-statistic for age- and gender-adjusted Cox proportional hazard models from 0.701 ± 0.002 to 0.709 ± 0.002 and the risk ratio per unit change from 1.49 (1.48-1.50) to 1.53 (1.52-1.54). The modified cutpoints showed superiority in predicting 5-year transplant-free survival in various disease etiology subgroups. A mCTP substituting serum creatinine for INR performed superiorly for predicting 5-year transplant-free survival. CONCLUSION We propose an evidence-based recalibration of CTP score cutpoints that optimizes this model's capacity to predict transplant-free survival in patients with cirrhosis. The CTP score remains the best predictor of 5-year overall and transplant-free survival in patients with cirrhosis.
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Affiliation(s)
- David E. Kaplan
- Gastroenterology Section, Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Bldg. 21, Room A422, Philadelphia, PA 19104 USA
| | - Feng Dai
- VA Connecticut-Healthcare System, 950 Campbell Avenue, West Haven, CT 06516 USA
| | - Melissa Skanderson
- VA Connecticut-Healthcare System, 950 Campbell Avenue, West Haven, CT 06516 USA
| | - Ayse Aytaman
- VA New York Harbor Health Care System, 800 Poly Place, Brooklyn, NY 11209 USA
| | - Michelle Baytarian
- Boston VA Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130 USA
| | - Kathryn D’Addeo
- VA Connecticut-Healthcare System, 950 Campbell Avenue, West Haven, CT 06516 USA
| | - Rena Fox
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121 USA
| | - Kristel Hunt
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468 USA
| | - Astrid Knott
- Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417 USA
| | - Rajni Mehta
- VA Connecticut-Healthcare System, 950 Campbell Avenue, West Haven, CT 06516 USA
| | - Marcos Pedrosa
- Boston VA Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130 USA
| | - Christine Pocha
- Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417 USA
| | - Adriana Valderrama
- Bayer HealthCare Pharmaceuticals, 100 Bayer Blvd, Whippany, NJ 07981 USA
| | - Tamar Taddei
- VA Connecticut-Healthcare System, 950 Campbell Avenue, West Haven, CT 06516 USA
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Heits N, Meer G, Bernsmeier A, Guenther R, Malchow B, Kuechler T, Becker T, Braun F. Mode of allocation and social demographic factors correlate with impaired quality of life after liver transplantation. Health Qual Life Outcomes 2015; 13:162. [PMID: 26420554 PMCID: PMC4588670 DOI: 10.1186/s12955-015-0360-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/22/2015] [Indexed: 12/19/2022] Open
Abstract
Background Health-related Quality of life (HRQoL) is a major goal of clinical management after liver transplantation (LTx). There is still disagreement on the effects of social-demographic factors and changes in the allocation system on HRQoL. The aim of this study was to evaluate the impact of social-demographic factors, mode of organ-allocation, waiting time and hepatocellular carcinoma (HCC) on HRQoL after LTx. Methods HRQoL was assessed using the EORTC-QLQ-C30 questionnaire, which was sent to 238 recipients. Investigated parameters included age, sex, distance to transplant center, follow-up at hospital, size of hometown, highest education, marital status, having children, background liver disease, waiting time, mode of allocation, HCC, hospitalization after LTx and diagnosis of malignancy after LTx. All evaluated parameters were entered into multivariate linear regression analysis. Results Completed questionnaire were returned by 73 % of the recipients. After LTx, the HRQoL-function scales increased over time. Age, marital status, highest education, completed professional training, working status, job position, duration of waiting time to LTx, distance to transplant center, place offollow, HU-statuts, mode of organ allocation and duration of hospitalization were associated with significantly worse function- and significantly lower symptom scales. HCC as a primary disease did not affect HRQoL. Conclusions Low HRQoL correlated significantly with MELD-based organ allocation, more than 28-day hospitalization, divorced status, lower education- and non-working status, higher distance to transplant center, follow up at transplant center, HU-status, shorter waiting time to LTx and younger age. Improvement of HRQoL after LTx may require clinical management of pain, psychotherapy and financial support.
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Affiliation(s)
- Nils Heits
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany.
| | - Gunnar Meer
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany.
| | - Alexander Bernsmeier
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany.
| | - Rainer Guenther
- Institute of Department of Internal Medicine I, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany.
| | - Bjoern Malchow
- Reference Center for Quality of Life, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany.
| | - Thomas Kuechler
- Reference Center for Quality of Life, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany.
| | - Thomas Becker
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany.
| | - Felix Braun
- Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany.
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Šumskienė J, Kupčinskas L, Šumskas L. Health-related quality of life measurement in chronic liver disease patients. MEDICINA-LITHUANIA 2015; 51:201-8. [PMID: 26424183 DOI: 10.1016/j.medici.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Health-related quality of life (HRQOL) is an important health indicator in medical outcome research and clinical practice. This issue tends to attract even more attention with the recent improvements of patient survival after liver transplantation. This review article aims at providing a deeper insight into practices used for evaluating HRQOL in chronic liver diseases (CLDs) and especially cirrhosis patients during different stages of the disease including liver transplantation. MATERIALS AND METHODS A systematic review of the MEDLINE database and Cochrane library was conducted. A search using the Medical Subject Headings (MeSH) major terms "liver disease" AND "quality of life" was applied for the period from 1966 to 2012. RESULTS Our review identified 1483 publications. The searched showed that significant increase of publications (from 362 to 1018) was observed during last decade (period 2003-2012) in comparison with previous. The majority of publications were in English (n=1179). The literature search and analysis provided information on the most common generic and disease-specific HRQOL instruments, which are used in CLD patients: Medical Outcomes Study Short Form-36, the National Institute of Diabetes and Digestive and Kidney Diseases Quality of Life questionnaire, the Chronic Liver Disease questionnaire, the Liver Disease Quality of Life questionnaire, and other. CONCLUSIONS Quality of life instruments are potentially powerful tools for evaluating the functional status, presenting gains of treatment and reflecting patients' ability to return to a normal lifestyle in CLD patients. More attention should be paid by clinicians for integrated use of clinical tests together with HRQOL instruments in liver transplantation for establishing the reference levels of mental, physical, and role-social functioning.
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Affiliation(s)
- Jolanta Šumskienė
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Limas Kupčinskas
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Linas Šumskas
- Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Institute of Health Research, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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Potosek J, Curry M, Buss M, Chittenden E. Integration of palliative care in end-stage liver disease and liver transplantation. J Palliat Med 2015; 17:1271-7. [PMID: 25390468 DOI: 10.1089/jpm.2013.0167] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with end-stage liver disease (ESLD) have a life-limiting illness that causes multiple distressing symptoms and negatively affects quality of life (QOL). This population traditionally has not had much attention within the palliative care community. DISCUSSION This article provides an evidence-based review of palliative care issues that patients with ESLD and those awaiting liver transplant face, including approaches to prognosis, symptom management, advance care planning, and end-of-life care. CONCLUSION Tremendous opportunity exists to integrate palliative medicine into the care of these patients.
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Affiliation(s)
- Jamie Potosek
- 1 Department of Hematology/Oncology, Providence Regional Cancer Center , Lacey, Washington
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Abstract
Liver disease results in over four million physician visits and over 750,000 hospitalizations per year in the USA. Those with chronic liver disease frequently progress to cirrhosis, end-stage liver disease (ESLD), and death. Patients with ESLD experience numerous complications, including muscle cramps, confusion (hepatic encephalopathy), protein calorie malnutrition, muscle wasting, fluid overload (ascites, edema), bleeding (esophagogastric variceal hemorrhage), infection (spontaneous bacterial peritonitis), fatigue, anxiety, and depression. Despite significant improvements in palliation of these complications, patients still suffer reduced quality of life and must confront the fact that their disease will often inexorably progress to death. Liver transplantation is a valid option in this setting, increasing the duration of survival and palliating many of the symptoms. However, many patients die waiting for an organ or are not candidates for transplantation due to comorbid illness. Others receive a transplant but succumb to complications of the transplant itself. Patients and families must struggle with simultaneously hoping for a cure while facing a life-threatening illness. Ideally, the combination of palliative care with life-sustaining therapy can maximize the patients' quality and quantity of life. If it becomes clear that life-sustaining therapy is no longer an option, these patients are then already in a system to help them with end-of-life care.
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Affiliation(s)
- Anne M Larson
- Swedish Liver Center, 1101 Madison Street #200, Seattle, WA, 98104, USA,
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Comparison between accuracy of different scoring systems in prediction of liver cirrhosis-related complications. EGYPTIAN LIVER JOURNAL 2015. [DOI: 10.1097/01.elx.0000459079.56315.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Orr JG, Homer T, Ternent L, Newton J, McNeil CJ, Hudson M, Jones DEJ. Health related quality of life in people with advanced chronic liver disease. J Hepatol 2014; 61:1158-65. [PMID: 25010259 DOI: 10.1016/j.jhep.2014.06.034] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/19/2014] [Accepted: 06/30/2014] [Indexed: 02/06/2023]
Abstract
Cirrhosis has a long natural history with considerable symptomatic impacts, particularly in advancing disease. Measuring health related quality of life (HRQOL) in liver disease provides detail about the nature and extent of its effects on individuals. Understanding the drivers of impaired HRQOL can help identify targets for improvement through new treatments or health systems service delivery. Evaluation of novel therapies which target symptomatic improvement, should be done with suitable outcome measures, including HRQOL assessment. In this article, we provide an overview of HRQOL in advanced liver disease for the clinician. A clear description of the important HRQOL tools is given alongside a discussion of the factors, which are known to contribute to impaired HRQOL in advanced liver disease.
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Affiliation(s)
- James G Orr
- Institute of Cellular Medicine, Newcastle University, UK
| | - Tara Homer
- Institute of Health and Society, Newcastle University, UK
| | - Laura Ternent
- Institute of Health and Society, Newcastle University, UK
| | - Julia Newton
- Institute of Cellular Medicine, Newcastle University, UK
| | - Calum J McNeil
- Institute of Cellular Medicine, Newcastle University, UK
| | - Mark Hudson
- Institute of Cellular Medicine, Newcastle University, UK
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Stewart KE, Hart RP, Gibson DP, Fisher RA. Illness apprehension, depression, anxiety, and quality of life in liver transplant candidates: implications for psychosocial interventions. PSYCHOSOMATICS 2014; 55:650-8. [PMID: 24360533 PMCID: PMC3983175 DOI: 10.1016/j.psym.2013.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 10/04/2013] [Accepted: 10/07/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND End-stage liver disease is associated with diminished quality of life (QOL). Numerous physical and psychosocial problems that affect QOL are common in those undergoing evaluation for liver transplantation. OBJECTIVE Identifying which of these challenges are most closely associated with QOL would be helpful in developing priority targets for evidence-based interventions specific to those undergoing transplant evaluation. METHOD A total of 108 adults undergoing psychologic assessment for liver transplant completed clinical interview, neuropsychologic testing, and self-report inventories of depression, anxiety, cognitive appraisal characteristics, support resources, and QOL. RESULTS Multiple regression analyses revealed that while emotional symptoms (anxiety and depression) were primarily associated with mental QOL, illness apprehension was the only variable uniquely associated with physical QOL after accounting for severity of liver disease, cognitive status, emotional symptoms, and support resources. CONCLUSION Findings suggest that psychosocial interventions prioritizing reduction of illness-related fear and symptoms of anxiety/depression would likely have the greatest effect on QOL in persons with end-stage liver disease awaiting transplantation.
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Affiliation(s)
- Karen E Stewart
- Department of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA.
| | - Robert P Hart
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA
| | - Douglas P Gibson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA
| | - Robert A Fisher
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
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Jara M, Bednarsch J, Malinowski M, Lüttgert K, Orr J, Puhl G, Seehofer D, Neuhaus P, Stockmann M. Predictors of quality of life in patients evaluated for liver transplantation. Clin Transplant 2014; 28:1331-8. [PMID: 25053350 DOI: 10.1111/ctr.12426] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2014] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Health-related quality of life (HRQOL) is severely impaired in advanced liver disease. The purpose of this study was to evaluate the impact of actual liver function and disease-specific factors on HRQOL of patients evaluated for liver transplantation. PATIENTS AND METHODS Disease-specific QOL was analyzed in 142 patients evaluated for liver transplantation using the German version of the Chronic Liver Disease Questionnaire (CLDQ-D). We performed quantitative liver function tests and collected clinical and demographical data of patients after their referral to our transplant department. Values were correlated with CLDQ-D scores. RESULTS Neither model for end-stage liver disease (MELD) nor dynamic liver function test results were related to quality of life. Serum albumin concentration was a strong but not independent factor correlated with global CLDQ-D (r = 0.269, p < 0.001). Independent predictors of global CLDQ-D were ascites and butyrylcholinesterase serum concentration (B = -0.486, p < 0.001 and B = 0.196, p = 0.002, respectively). CONCLUSION Actual liver function is not related to decreased quality of life, whereas ascites and hypoproteinemia represent the major factors influencing physical and social aspects of daily life in potential liver transplant candidates.
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Affiliation(s)
- Maximilian Jara
- Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Abstract
The success of liver transplantation in the past three decades as a life-saving procedure for patients with end-stage liver disease has led to the ever-increasing disparity between the demands for liver transplantation and the supply of donor liver organs. Donor allocation and distribution remains a challenge and a moral issue as to how these organs can be equitably distributed. This article reviews the evolution of the liver allocation policy and discusses in detail the challenges clinicians face today in this area of medicine.
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Volk ML. Center differences in model for end-stage liver disease exceptions: fairness, local culture, and norms of practice. Liver Transpl 2013; 19:1287-8. [PMID: 23996965 PMCID: PMC3844108 DOI: 10.1002/lt.23736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 08/21/2013] [Indexed: 01/12/2023]
Affiliation(s)
- Michael L. Volk
- Division of Gastroenterology and Hepatology, University of Michigan Health System
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Abstract
Quality of life is a construct that reflects the positive and negative aspects of one's life, and is expanded upon by health-related quality of life (HRQL), which specifically address the impact of health on patients' well-being. Cirrhosis is the culmination of various pathways that leads into development of advanced hepatic fibrosis with its complications. This paper addresses the impact of cirrhosis on individuals HRQL. In addition, we will define what disease specific and general HRQL instruments aim to measure. We discuss the liver disease specific scales [Chronic Liver Disease Questionnaire (CLDQ), Liver Disease Quality of Life 1.0 (LDQOL)] and the most commonly used generic health profile [Short Form 36 Profile (SF-36)]. Furthermore, we examine recent literature which describes how to measure and what is known about quality of life of patients with cirrhosis. This information gives insight to health care providers concerning the impact of disease on patients if treatments are not only to improve health but also function and unexpected treatment outcomes.
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Quality of life, risk assessment, and safety research in liver transplantation: new frontiers in health services and outcomes research. Curr Opin Organ Transplant 2013; 17:241-7. [PMID: 22476225 DOI: 10.1097/mot.0b013e32835365c6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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, wherein 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.
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