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Ragni MV, Callis J, Daoud N, Hu B, Manuel M, Santos J, Schwartz J, Friedman KD, Kouides P, Kuriakose P, Leavitt AD, Lim MY, Machin N, Recht M, Chrisentery-Singleton T. Observational cohort study of long-term outcomes of liver transplantation in haemophilia. Haemophilia 2024; 30:87-97. [PMID: 38111071 DOI: 10.1111/hae.14910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/23/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Gene therapy is now a reality for individuals with haemophilia, yet little is known regarding the quality-of-life impact of factor correction. As few data exist, and recognizing the analogy to liver transplantation (OLTX), we identified OLTX+ and OLTX- men in the ATHNdataset to compare post-OLTX factor VIII and IX on quality of life (QoL) by Haem-A-QoL and PROMIS-29. METHODS OLTX- were matched to OLTX+ by age, race, and haemophilia type and severity. Deidentified demographic data, including post-transplant factor levels, genotype and target joint disease were analysed by descriptive statistics. Haem-A-Qol and PROMIS-29 were compared in OLTX+ and OLTX- by student's t-test and univariate regression models. RESULTS Of 86 people with haemophilia A (HA) or haemophilia B (HB) cared for at 10 haemophilia treatment centers (HTCs), 21 (24.4%) OLTX+ and 65 (75.6%) OLTX- were identified. OLTX+ and OLTX- had a similar frequency of target joint disease (p = .806), HA genotypes, null versus non-null (p = .696), and HIV infection (p = .316). At a median 9.2 years post-OLTX, median FVIII, .63 IU/mL [IQR 0.52-0.97] and FIX, .91 IU/mL [IQR .63-1.32], Haem-A-QoL, PROMIS-29, and HOT scores were comparable. Severe HA/HB had lower post-OLTX 'dealing with haemophilia' scores (p = .022) and higher 'sports and leisure' (p = .010) and 'view of yourself' scores (p = .024) than OLTX+ non-severe participants. Non-caucasian OLTX+ had significantly lower scores in sports and leisure (p = .042), future expectations (p = .021) and total score (p = .010). CONCLUSION Nine years after OLTX, QoL is comparable to OLTX-, but significantly better in OLTX+ with severe than non-severe disease and in caucasians than non-caucasians.
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Affiliation(s)
- Margaret V Ragni
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, and Hemophilia Center of Western PA, Pittsburgh, Pennsylvania, USA
| | - Jessica Callis
- American Thrombosis Hemostasis Network, Rochester, New York, USA
| | - Nabil Daoud
- American Thrombosis Hemostasis Network, Rochester, New York, USA
| | - Brian Hu
- American Thrombosis Hemostasis Network, Rochester, New York, USA
| | - Matthew Manuel
- American Thrombosis Hemostasis Network, Rochester, New York, USA
| | - Jarren Santos
- American Thrombosis Hemostasis Network, Rochester, New York, USA
| | | | | | - Peter Kouides
- Mary M. Gooley Hemophilia Center, Rochester, New York, USA
| | - Philip Kuriakose
- Henry Ford Health System Bleeding and Thrombosis Center, Detroit, Michigan, USA
| | - Andrew D Leavitt
- San Francisco Hemophilia Treatment Center, University of California, San Francisco, California, USA
| | - Ming Y Lim
- Utah Center for Bleeding and Clotting Disorders, Salt Lake City, Utah, USA
| | - Nicoletta Machin
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, and Hemophilia Center of Western PA, Pittsburgh, Pennsylvania, USA
| | - Michael Recht
- American Thrombosis Hemostasis Network, Rochester, New York, USA
- Yale University Medical Center, New Haven, Connecticut, USA
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Sgrò A, Cambridge WA, McLean KA, Drake TM, Camilleri-Brennan J, Knight SR, Pius R, Wu DA, Wigmore SJ, Harrison EM. Is socioeconomic deprivation associated with worse quality of life, anxiety and depression in liver transplant recipients? A cross-sectional study in a national transplantation programme. BMJ Open 2023; 13:e070422. [PMID: 37558450 PMCID: PMC10414121 DOI: 10.1136/bmjopen-2022-070422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/02/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To identify whether socioeconomic deprivation is associated with worse health-related quality of life (HR-QoL), anxiety and depression following liver transplantation. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Liver transplant recipients within a national transplantation programme. METHODS Participants completed the condition-specific 'Short Form of Liver Disease Quality of Life' Questionnaire, the Generalised Anxiety Disorder-7 (GAD-7) Questionnaire and the Patient Health Questionnaire-9 (PHQ-9). The aggregate HR-QoL Score (range 0-100) was derived, and multivariable linear regression was performed based on sociodemographic and clinical variables to estimate its independent association with Scottish Index of Multiple Deprivation (SIMD) quintiles. The GAD-7 Questionnaire and PHQ-9 were used to screen respondents for anxiety and depression, and multivariable logistic regression was performed to estimate their independent association with SIMD quintiles. RESULTS Some 331 patients completed the questionnaires. Quintiles were equally distributed in the cohort, with no significant differences observed in underlying patient characteristics. Following multivariable adjustment, greater socioeconomic deprivation was associated with lower post-transplantation HR-QoL scores, with a difference of 9.7 points (95% CI: 4.6 to 14.9, p<0.001) between the most and least deprived quintiles. Recipients living in areas of least deprivation were less likely to suffer from anxiety (OR 0.05, 95% CI: 0.00 to 0.28, p=0.003) or depression (OR 0.13, 95% CI: 0.02 to 0.56, p=0.009). CONCLUSION Despite the highly selected nature of liver transplant recipients, those living in the most deprived areas have a significantly lower HR-QoL and are more likely to suffer from anxiety and depression.
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Affiliation(s)
- Alessandro Sgrò
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William A Cambridge
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Kenneth A McLean
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Thomas M Drake
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Stephen R Knight
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Riinu Pius
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Diana A Wu
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Stephen J Wigmore
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
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Kaplan A, Korenjak M, Brown RS. Post-liver transplantation patient experience. J Hepatol 2023; 78:1234-1244. [PMID: 37208108 DOI: 10.1016/j.jhep.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 05/21/2023]
Abstract
Given improvements in post-transplant patient and graft survival, there is a growing need to focus on patient experience and health-related quality of life (HRQOL). Though liver transplantation can be life-saving, it can also be associated with significant morbidity and complications. Patient HRQOL improves after transplantation, but it may not improve to that of age-matched cohorts. Understanding patient experience and the factors that contribute to it, including physical and psychological health, immunosuppression and medication adherence, return to employment or school, financial burden, and expectations, helps when thinking creatively about potential interventions to improve HRQOL.
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Affiliation(s)
- Alyson Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY, USA
| | | | - Robert S Brown
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY, USA.
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Lieber SR, Kim HP, Baldelli L, Nash R, Teal R, Magee G, Desai CS, Loiselle MM, Lee SC, Singal AG, Marrero JA, Barritt AS, Evon DM. Early Survivorship After Liver Transplantation: A Qualitative Study Identifying Challenges in Recovery From the Patient and Caregiver Perspective. Liver Transpl 2022; 28:422-436. [PMID: 34529886 PMCID: PMC10548343 DOI: 10.1002/lt.26303] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 02/04/2023]
Abstract
Survivorship after liver transplantation (LT) is a novel concept providing a holistic view of the arduous recovery experienced after transplantation. We explored components of early survivorship including physical, emotional, and psychological challenges to identify intervention targets for improving the recovery process of LT recipients and caregivers. A total of 20 in-person interviews were conducted among adults 3 to 6 months after LT. Trained qualitative research experts conducted interviews, coded, and analyzed transcripts to identify relevant themes and representative quotes. Early survivorship comprises overcoming (1) physical challenges, with the most challenging experiences involving mobility, driving, dietary modifications, and medication adherence, and (2) emotional and psychological challenges, including new health concerns, financial worries, body image/identity struggles, social isolation, dependency issues, and concerns about never returning to normal. Etiology of liver disease informed survivorship experiences including some patients with hepatocellular carcinoma expressing decisional regret or uncertainty in light of their post-LT experiences. Important topics were identified that framed LT recovery including setting expectations about waitlist experiences, hospital recovery, and ongoing medication requirements. Early survivorship after LT within the first 6 months involves a wide array of physical, emotional, and psychological challenges. Patients and caregivers identified what they wish they had known prior to LT and strategies for recovery, which can inform targeted LT survivorship interventions.
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Affiliation(s)
- Sarah R. Lieber
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern, Dallas, TX
| | - Hannah P. Kim
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Luke Baldelli
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Rebekah Nash
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Randall Teal
- Connected Health Applications and Interventions, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gabrielle Magee
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Chirag S. Desai
- Division of Transplantation, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Marci M. Loiselle
- Division of Behavioral Medicine, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Simon C. Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical, Dallas, TX
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern, Dallas, TX
| | - Jorge A. Marrero
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern, Dallas, TX
| | - A. Sidney Barritt
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Donna M. Evon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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Lachman JR, Green CL, Adams SB, Nunley JA, DeOrio JK, Easley ME. Improvement in Health-Related Quality of Life After Total Ankle Arthroplasty Compares Well With Other Successful Orthopaedic and Nonorthopaedic Procedures. Foot Ankle Spec 2021; 14:427-437. [PMID: 32396466 DOI: 10.1177/1938640020917782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Ankle arthritis is a major cause of disability. Orthopaedic literature suggests improvement in health-related quality of life (HRQOL) after total ankle arthroplasty (TAA). This has not been compared with improvements observed in successful orthopaedic and nonorthopaedic procedures, including anterior cervical discectomy/fusion (ACDF), total knee arthroplasty (TKA), coronary artery bypass grafting (CABG), and orthotopic liver transplant (OLT). We hypothesize that the effects after TAA are comparable to several successful surgical procedures. Methods. 500 consecutive TAA patients were included and grouped with 2 other large series. Short Form-36 (SF36) were collected at standardized intervals. A systematic literature review identified studies comparing preoperative and postoperative SF36 physical (PCS) and mental component summary (MCS) scores. Using meta-analyses, we pooled the data for each procedure to compare with the TAA group. Results. Patients in all cohorts had preoperative SF36 MCS and PCS scores that were significantly lower than that in the general population. Improvements in HRQOL after TAA were not statistically different from improvements reported in PCS and MCS after ACDF, TKA, and OLT. However, improvement in PCS after TAA was better than that observed after CABG. Conclusions. Disability with ankle arthritis is severe. Disability associated with cervical disc disease, knee arthrosis, coronary artery disease, and liver failure is also severe, with surgical intervention providing major improvements in HRQOL postoperatively. The improvement in HRQOL after TAA did not differ statistically from ACDF, TKA, CABG, and OLT. Our investigation suggests that the HRQOL benefits of TAA meet benchmarks set by some of modern medicine's best.Levels of Evidence: Level III: Systematic review.
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Affiliation(s)
- James R Lachman
- St Luke's University Health Network, Quakertown, Pennsylvania (JRL).,Duke University Department of Biostatistics and Bioinformatics, Durham, North Carolina (CLG).,Duke University School of Medicine, Durham, North Carolina (SBA, JAN, JKD, MEE)
| | - Cynthia L Green
- St Luke's University Health Network, Quakertown, Pennsylvania (JRL).,Duke University Department of Biostatistics and Bioinformatics, Durham, North Carolina (CLG).,Duke University School of Medicine, Durham, North Carolina (SBA, JAN, JKD, MEE)
| | - Samuel B Adams
- St Luke's University Health Network, Quakertown, Pennsylvania (JRL).,Duke University Department of Biostatistics and Bioinformatics, Durham, North Carolina (CLG).,Duke University School of Medicine, Durham, North Carolina (SBA, JAN, JKD, MEE)
| | - James A Nunley
- St Luke's University Health Network, Quakertown, Pennsylvania (JRL).,Duke University Department of Biostatistics and Bioinformatics, Durham, North Carolina (CLG).,Duke University School of Medicine, Durham, North Carolina (SBA, JAN, JKD, MEE)
| | - James K DeOrio
- St Luke's University Health Network, Quakertown, Pennsylvania (JRL).,Duke University Department of Biostatistics and Bioinformatics, Durham, North Carolina (CLG).,Duke University School of Medicine, Durham, North Carolina (SBA, JAN, JKD, MEE)
| | - Mark E Easley
- St Luke's University Health Network, Quakertown, Pennsylvania (JRL).,Duke University Department of Biostatistics and Bioinformatics, Durham, North Carolina (CLG).,Duke University School of Medicine, Durham, North Carolina (SBA, JAN, JKD, MEE)
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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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Wahid NA, Rosenblatt R, Brown RS. A Review of the Current State of Liver Transplantation Disparities. Liver Transpl 2021; 27:434-443. [PMID: 33615698 DOI: 10.1002/lt.25964] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/16/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022]
Abstract
Equity in access is one of the core goals of the Organ Procurement and Transplant Network (OPTN). However, disparities in liver transplantation have been described since the passage of the National Organ Transplant Act, which established OPTN in the 1980s. During the past few decades, several efforts have been made by the United Network for Organ Sharing (UNOS) to address disparities in liver transplantation with notable improvements in many areas. Nonetheless, disparities have persisted across insurance type, sex, race/ethnicity, geographic area, and age. African Americans have lower rates of referral to transplant centers, females have lower rates of transplantation from the liver waiting list than males, and public insurance is associated with worse posttransplant outcomes than private insurance. In addition, pediatric candidates and older adults have a disadvantage on the liver transplant waiting list, and there are widespread regional disparities in transplantation. Given the large degree of inequity in liver transplantation, there is a tremendous need for studies to propose and model policy changes that may make the liver transplant system more just and equitable.
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Affiliation(s)
- Nabeel A Wahid
- Department of Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Russell Rosenblatt
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY
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Åberg F. Quality of life after liver transplantation. Best Pract Res Clin Gastroenterol 2020; 46-47:101684. [PMID: 33158471 DOI: 10.1016/j.bpg.2020.101684] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/31/2020] [Indexed: 01/31/2023]
Abstract
Liver transplantation (LT) enables rapid transition from critical illness and poor prognosis back to health. After LT, health-related quality of life (HRQoL) generally becomes comparable to that of the general population, although some deficits in mainly physical domains are frequent. However, recipients continue to have symptoms related to immunosuppression, complications, and other things, which impact HRQoL and the recipient's ability to regain independence and re-establish function in everyday life. Less than half of LT recipients return to work. Reportedly, HRQoL seems to deteriorate slightly over the long-term, but still remains satisfactory. Physical fatigue is common, but recent studies show that structured exercise programs improve both fatigue and HRQoL. Emerging evidence also suggests that continued patient information, structured psychosocial support systems, and caregiver involvement might further help improve long-term HRQoL. More research is needed to gain better understanding of the factors affecting long-term HRQoL, and how to best improve HRQoL.
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Affiliation(s)
- Fredrik Åberg
- Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki University, Helsinki, Finland; The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
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9
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Presumed Consent: A Potential Tool for Countries Experiencing an Organ Donation Crisis. Dig Dis Sci 2019; 64:1346-1355. [PMID: 30519849 DOI: 10.1007/s10620-018-5388-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is currently an inadequate supply of allografts to meet the number of transplant candidates worldwide. A number of controversial policies, including implementation of a presumed consent organ donation system, have been considered to rectify the organ donation crisis. AIMS A secondary retrospective data analysis aimed to assess the impact of switching to a presumed consent organ donation model on organ donation rates. METHODS Deceased organ donation rates were compared before and after countries adopted presumed consent. RESULTS Six countries met entry criteria. All six countries had an increase in liver donation rates, while 4 out of the six countries had an increase in kidney donation rates. The overall mean (± SD) liver donation rate was 3.23 (± 0.97) per million population (pmp) before the transition and 6.46 (± 1.81) pmp after the transition (p < 0.0001). The overall mean (± SD) kidney donation rate was 17.94 (± 3.34) pmp before the transition and 26.58 (± 4.23) pmp after the transition (p < 0.0001). The percentage increase in liver and kidney donation rates varied among countries, ranging from 28 to 1186%. CONCLUSION The transition from explicit to presumed consent was associated with a significant increase in liver donation rates in all countries that met our criteria, while the effect on kidney donation rates was partially realized. Although presumed consent alone is unlikely to explain the increase in donation rates, the adoption of such a policy may prove to be a worthwhile risk for countries experiencing consistently low organ donation rates.
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Dąbrowska-Bender M, Kozaczuk A, Pączek L, Milkiewicz P, Słoniewski R, Staniszewska A. Patient Quality of Life After Liver Transplantation in Terms of Emotional Problems and the Impact of Sociodemographic Factors. Transplant Proc 2018; 50:2031-2038. [PMID: 30177104 DOI: 10.1016/j.transproceed.2018.03.113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/15/2018] [Accepted: 03/23/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Liver transplantation is recognized as an effective and necessary treatment of chronic as well as acute hepatic failure. The assessment of quality of life (QoL) after transplantation represents an ancillary tool to evaluate the efficacy of solid organ transplantation in addition to graft and patient survival rates and complications. The global assessment of QoL after transplantation usually confirms improvement compared to pretransplant conditions. PURPOSE An attempt to evaluate the quality of life of patients after liver transplantation, with particular reference to sociodemographic factors and emotional problems. MATERIALS AND METHODS The study group included 121 patients (55 women and 66 men) at the age of 19 to 71 years who underwent surgery in the Central Teaching Hospital of the Medical University of Warsaw and the Infant Jesus Teaching Hospital in Warsaw, and were subsequently treated in an outpatient transplant clinic. The scoring procedure for the areas analyzed was based on the 36-Item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). RESULTS Higher patients age was correlated with lower quality of life of patients after liver transplantation, including physical functioning (patients >40 years of age declared lower physical performance, and patients <30 years of age indicated greatest limitations in their kind of work or other activities). The frequency of pain was also age-dependent (mostly patients >50 years of age). Women more often than men had worrying thoughts, were feeling tense or wound up, and had sudden feelings of anxiety or panic. By contrast, older people often declared that they felt to be slowed down. CONCLUSIONS To reduce pain and to improve physical performance of the study patients, rehabilitation procedures should be considered. Patients indicating symptoms associated with anxiety and depression should be referred to a clinical psychologist.
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Affiliation(s)
- M Dąbrowska-Bender
- Department of Clinical Dietetics, Medical University of Warsaw, Warsaw, Poland.
| | - A Kozaczuk
- Medical University of Warsaw, Warsaw, Poland
| | - L Pączek
- Department of Immunology, Transplant Medicine and Internal Diseases, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - P Milkiewicz
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - R Słoniewski
- Department of Public Health, Medical University of Warsaw, Warsaw, Poland
| | - A Staniszewska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
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Wayda B, Clemons A, Givens RC, Takeda K, Takayama H, Latif F, Restaino S, Naka Y, Farr MA, Colombo PC, Topkara VK. Socioeconomic Disparities in Adherence and Outcomes After Heart Transplant: A UNOS (United Network for Organ Sharing) Registry Analysis. Circ Heart Fail 2018; 11:e004173. [PMID: 29664403 DOI: 10.1161/circheartfailure.117.004173] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 01/26/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is mixed evidence of racial and socioeconomic disparities in heart transplant outcomes. Their underlying cause-and whether individual- or community-level traits are most influential-remains unclear. The current study aimed to characterize socioeconomic disparities in outcomes and identify time trends and mediators of these disparities. METHODS AND RESULTS We used United Network for Organ Sharing registry data and included 33 893 adult heart transplant recipients between 1994 and 2014. Socioeconomic status (SES) indicators included insurance, education, and neighborhood SES measured using a composite index. Black race and multiple indicators of low SES were associated with the primary outcome of death or retransplant, independent of baseline clinical characteristics. Blacks had lower HLA and race matching, but further adjustment for these and other graft characteristics only slightly attenuated the association with black race (HR, 1.25 after adjustment). This and the associations with neighborhood SES (HR, 1.19 for lowest versus highest decile), Medicare (HR, 1.17), Medicaid (HR, 1.29), and college education (HR, 0.90) remained significant after full adjustment. When comparing early (1994-2000) and late (2001-2014) cohorts, the disparities associated with the middle (second and third) quartiles significantly decreased over time, but those associated with lowest SES quartile and black race persisted. Low neighborhood SES was also associated with higher risks of noncompliance (HR, 1.76), rejection (HR, 1.28), hospitalization (HR, 1.13), and infection (HR, 1.10). CONCLUSIONS Racial and socioeconomic disparities exist in heart transplant outcomes, but the latter may be narrowing over time. These disparities are not explained by differences in clinical or graft characteristics.
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Affiliation(s)
- Brian Wayda
- From the Division of Cardiology, Department of Medicine (B.W., A.C., R.C.G., F.L., S.R., M.A.F., P.C.C., V.K.T.) and Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Autumn Clemons
- From the Division of Cardiology, Department of Medicine (B.W., A.C., R.C.G., F.L., S.R., M.A.F., P.C.C., V.K.T.) and Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Raymond C Givens
- From the Division of Cardiology, Department of Medicine (B.W., A.C., R.C.G., F.L., S.R., M.A.F., P.C.C., V.K.T.) and Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Koji Takeda
- From the Division of Cardiology, Department of Medicine (B.W., A.C., R.C.G., F.L., S.R., M.A.F., P.C.C., V.K.T.) and Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Hiroo Takayama
- From the Division of Cardiology, Department of Medicine (B.W., A.C., R.C.G., F.L., S.R., M.A.F., P.C.C., V.K.T.) and Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Farhana Latif
- From the Division of Cardiology, Department of Medicine (B.W., A.C., R.C.G., F.L., S.R., M.A.F., P.C.C., V.K.T.) and Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Susan Restaino
- From the Division of Cardiology, Department of Medicine (B.W., A.C., R.C.G., F.L., S.R., M.A.F., P.C.C., V.K.T.) and Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Yoshifumi Naka
- From the Division of Cardiology, Department of Medicine (B.W., A.C., R.C.G., F.L., S.R., M.A.F., P.C.C., V.K.T.) and Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Maryjane A Farr
- From the Division of Cardiology, Department of Medicine (B.W., A.C., R.C.G., F.L., S.R., M.A.F., P.C.C., V.K.T.) and Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Paolo C Colombo
- From the Division of Cardiology, Department of Medicine (B.W., A.C., R.C.G., F.L., S.R., M.A.F., P.C.C., V.K.T.) and Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Veli K Topkara
- From the Division of Cardiology, Department of Medicine (B.W., A.C., R.C.G., F.L., S.R., M.A.F., P.C.C., V.K.T.) and Division of Cardiothoracic Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY.
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12
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Lee IC, Chiu YH, Lee CY. Exploration of the importance of geriatric frailty on health-related quality of life. Psychogeriatrics 2016; 16:368-375. [PMID: 26756915 DOI: 10.1111/psyg.12179] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The ageing of the population is a demographic trend globally. Promoting the health of elderly persons has become a crucial priority. However, knowledge about the relationship between frailty and quality of life (QoL) remains limited. This research aimed to investigate the association between elderly frailty and QoL, and to identify whether frailty or current health status more significantly affects the QoL of elderly persons. METHODS This research began in 2012, and by the end of the study in April 2013, 375 samples had been collected. Structured questionnaires and the face-to-face questionnaire interviews were used. Multiple linear regression, t-test, and one-way anova were administered. RESULTS Elderly individuals who were hospitalized performed worse in the physical health QoL domain, whereas those who regularly attended outpatient follow-ups performed worse in the mental health QoL domain. QoL was only partially affected in both groups. All QoL domains were affected in elderly individuals with symptoms of frailty. Age, marital status, and financial status significantly affect health-related QoL. CONCLUSION Geriatric frailty significantly affects general QoL. Early screening of frailty-related conditions among the elderly can prompt early and proper intervention for this population.
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Affiliation(s)
- I-Chen Lee
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Hsien Chiu
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Ying Lee
- Department of Family Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
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13
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Tumin D, Hayes D, Washburn WK, Tobias JD, Black SM. Medicaid enrollment after liver transplantation: Effects of medicaid expansion. Liver Transpl 2016; 22:1075-84. [PMID: 27152888 DOI: 10.1002/lt.24480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/17/2016] [Accepted: 04/24/2016] [Indexed: 02/07/2023]
Abstract
Liver transplantation (LT) recipients in the United States have low rates of paid employment, making some eligible for Medicaid public health insurance after transplant. We test whether recent expansions of Medicaid eligibility increased Medicaid enrollment and insurance coverage in this population. Patients of ages 18-59 years receiving first-time LTs in 2009-2013 were identified in the United Network for Organ Sharing registry and stratified according to insurance at transplantation (private versus Medicaid/Medicare). Posttransplant insurance status was assessed through June 2015. Difference-in-difference multivariate competing-risks models stratified on state of residence estimated effects of Medicaid expansion on Medicaid enrollment or use of uninsured care after LT. Of 12,837 patients meeting inclusion criteria, 6554 (51%) lived in a state that expanded Medicaid eligibility. Medicaid participation after LT was more common in Medicaid-expansion states (25%) compared to nonexpansion states (19%; P < 0.001). Multivariate analysis of 7279 patients with private insurance at transplantation demonstrated that after the effective date of Medicaid expansion (January 1, 2014), the hazard of posttransplant Medicaid enrollment increased in states participating in Medicaid expansion (hazard ratio [HR] = 1.5; 95% confidence interval [CI] = 1.1-2.0; P = 0.01), but not in states opting out of Medicaid expansion (HR = 0.8; 95% CI = 0.5-1.3; P = 0.37), controlling for individual characteristics and time-invariant state-level factors. No effects of Medicaid expansion on the use of posttransplant uninsured care were found, regardless of private or government insurance status at transplantation. Medicaid expansion increased posttransplant Medicaid enrollment among patients who had private insurance at transplantation, but it did not improve overall access to health insurance among LT recipients. Liver Transplantation 22 1075-1084 2016 AASLD.
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Affiliation(s)
- Dmitry Tumin
- Department of Pediatrics, Wexner Medical Center, The Ohio State University, Columbus, OH.,Department of Comprehensive Transplant Center, Wexner Medical Center, The Ohio State University, Columbus, OH.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH.,Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Don Hayes
- Department of Pediatrics, Wexner Medical Center, The Ohio State University, Columbus, OH.,Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH.,Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH.,Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH
| | - W Kenneth Washburn
- Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH.,Department of Comprehensive Transplant Center, Wexner Medical Center, The Ohio State University, Columbus, OH.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH.,Division of Transplantation, Nationwide Children's Hospital, Columbus, OH
| | - Joseph D Tobias
- Department of Anesthesiology, College of Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH.,Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Sylvester M Black
- Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH.,Department of Comprehensive Transplant Center, Wexner Medical Center, The Ohio State University, Columbus, OH.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH.,Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH
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14
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Kensinger CD, Feurer ID, O'Dell HW, LaNeve DC, Simmons L, Pinson CW, Moore DE. Patient-reported outcomes in liver transplant recipients with hepatocellular carcinoma. Clin Transplant 2016; 30:1036-45. [PMID: 27291713 DOI: 10.1111/ctr.12785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND The effect of awarding MELD exception points for hepatocellular carcinoma (HCC) on patient-reported outcomes (PROs) is unknown. We evaluated the physical and mental health-related quality of life (HRQOL) and symptoms of anxiety and depression in liver transplant recipients with HCC compared to patients without HCC. METHODS The single-center sample measured PROs before and after transplant, which included 1521 multisurvey measurement points among 502 adults (67% male, 28% HCC, follow-up time: <1-131 months). Data were analyzed using multivariable mixed-effects models. RESULTS Longitudinal PRO values did not differ between persons who received HCC exception points and those who did not have HCC. Patients with HCC who did not receive exception points had reduced physical HRQOL (P=.016), a late decline in mental HRQOL, and delayed reduction in anxiety (time-by-outcome interaction P<.050) compared to patients with HCC who received exception points. CONCLUSION Transplant recipients who received HCC exception points had PROs that were comparable to those of patients without HCC, and reported better physical HRQOL and reduced symptoms of anxiety compared to patients with HCC who did not receive exception points. These analyses demonstrate the impact of HCC exception points on PROs, and may help inform policy regarding HCC exception point allocation.
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Affiliation(s)
- Clark D Kensinger
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Transplant Center, Nashville, TN, USA
| | - Irene D Feurer
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Transplant Center, Nashville, TN, USA.,Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | | | | | - C Wright Pinson
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Transplant Center, Nashville, TN, USA
| | - Derek E Moore
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. .,Vanderbilt Transplant Center, Nashville, TN, USA.
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15
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Aguiar MIFD, Braga VAB, Garcia JHP, Lima CAD, Almeida PCD, Souza AMAE, Rolim ILTP. Quality of life in liver transplant recipients and the influence of sociodemographic factors. Rev Esc Enferm USP 2016; 50:411-8. [DOI: 10.1590/s0080-623420160000400006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 04/20/2016] [Indexed: 11/22/2022] Open
Abstract
Abstract OBJECTIVE To verify the influence of sociodemographic factors on the quality of life of patients after liver transplant. METHOD Cross-sectional study with 150 patients who underwent liver transplant at a referral center. A sociodemographic instrument and the Liver Disease Quality of Life questionnaire were applied. The analysis of variance (ANOVA) was performed, as well as multiple comparisons by the Tukey test and Games-Howell tests when p <0.05. RESULTS Old age had influence on domains of symptoms of liver disease (p = 0.049), sleep (p = 0.023) and sexual function (p = 0.03). Men showed better significant mean values than women for the loneliness dimension (p = 0.037). Patients with higher educational level had higher values for the domain of stigma of liver disease (p = 0.014). There was interference of income in the domains of quality of social interaction (p = 0.033) and stigma of the disease (p = 0.046). CONCLUSION In half of the quality of life domains, there was influence of some sociodemographic variable.
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16
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Mendes KDS, Lopes NLC, Fabbris MA, Castro-e-Silva Júnior OD, Galvão CM. Caracterização sociodemográfica e clínica de candidatos a transplante de fígado. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Resumo Objetivo Com o propósito de gerar evidências que contribuam para a prática clínica do enfermeiro na implementação de intervenções direcionadas para a melhoria do cuidado, o presente estudo teve como objetivo analisar dados sociodemográficos e clínicos de candidatos ao transplante de fígado. Métodos Estudo transversal, prospectivo, conduzido em hospital terciário do interior paulista. No início da coleta de dados, 77 pacientes estavam registrados na lista de espera, entretanto o cadastro é dinâmico. Assim, o tipo de amostra foi de conveniência com a participação de 85 candidatos. Resultados A maioria da amostra era do sexo masculino, casada e cursou até o ensino fundamental. O valor médio do Model for End-stage Liver Disease foi de 15,75 pontos, 70,60% dos candidatos estavam acima do peso, sendo a causa viral a principal etiologia da doença hepática crônica. As principais manifestações clínicas apresentadas pelos participantes foram varizes esofágicas, fadiga e ginecomastia nos homens. Conclusão O conhecimento das características de candidatos a transplante de fígado poderá subsidiar o direcionamento de ações de enfermagem com vistas à adoção de condutas individualizadas possibilitando a melhoria da atenção à saúde.
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17
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Kotarska K, Wunsch E, Jodko L, Raszeja-Wyszomirska J, Bania I, Lawniczak M, Bogdanos D, Kornacewicz-Jach Z, Milkiewicz P. Factors Affecting Exercise Test Performance in Patients After Liver Transplantation. HEPATITIS MONTHLY 2016; 16:e34356. [PMID: 27226801 PMCID: PMC4875566 DOI: 10.5812/hepatmon.34356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/20/2016] [Accepted: 02/24/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiovascular diseases are a leading cause of morbidity and mortality in solid organ transplant recipients. In addition, low physical activity is a risk factor for cardiac and cerebrovascular complications. OBJECTIVES This study examined potential relationships between physical activity, health-related quality of life (HRQoL), risk factors for cardiovascular disease, and an exercise test in liver-graft recipients. PATIENTS AND METHODS A total of 107 participants (62 men/45 women) who had received a liver transplantation (LT) at least 6 months previously were evaluated. Physical activity was assessed using three different questionnaires, while HRQoL was assessed using the medical outcomes study short form (SF)-36 questionnaire, and health behaviors were evaluated using the health behavior inventory (HBI). The exercise test was performed in a standard manner. RESULTS Seven participants (6.5%) had a positive exercise test, and these individuals were older than those who had a negative exercise test (P = 0.04). A significant association between a negative exercise test and a higher level of physical activity was shown by the Seven-day physical activity recall questionnaire. In addition, HRQoL was improved in various domains of the SF-36 in participants who had a negative exercise test. No correlations between physical activity, the exercise test and healthy behaviors, as assessed via the HBI were observed. CONCLUSIONS Exercise test performance was affected by lower quality of life and lower physical activity after LT. With the exception of hypertension, well known factors that affect the risk of coronary artery disease had no effect on the exercise test results.
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Affiliation(s)
- Katarzyna Kotarska
- Department of Physical Culture and Health Promotion, University of Szczecin, Szczecin, Poland
| | - Ewa Wunsch
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland
| | - Lukasz Jodko
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Joanna Raszeja-Wyszomirska
- Hepatology and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Izabela Bania
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | | | - Dimitrios Bogdanos
- Institute of Liver Studies, School of Medicine, King’s College Hospital, London, UK
| | | | - Piotr Milkiewicz
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland
- Hepatology and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
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18
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The impact of osteoporosis on health-related quality of life in patients after liver transplantation - a pilot study. GASTROENTEROLOGY REVIEW 2016; 10:215-21. [PMID: 26759628 PMCID: PMC4697035 DOI: 10.5114/pg.2015.52343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 12/12/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022]
Abstract
Introduction Liver transplantation (LT) is now a well-established procedure with 5-year survival rates over 70%, and one of its ultimate goals is the improvement of patient health-related quality of life (HRQOL). Osteoporosis remains a serious potential complication of LT, leading to fragility fractures, pain, and functional impairment. Aim To assess the degree of osteoporosis and the impact of fragility fractures on HRQOL in patients with chronic liver diseases treated with LT. Material and methods Twenty-seven patients (14 female, 13 male) at a median period of 3.5 years post LT participated in the study. HRQOL was assessed by Short Form-36 and PBC-40 instruments. Bone mineral density (BMD) in the lumbar spine and hip neck were measured by dual-energy X-ray absorptiometry. Physical activity was assessed by questionnaire. Data on the duration of the liver disease, time from LT, and fragility fractures were also collected. Results As many as 74.1% of the patients had reduced BMD (t-score < -1.0 SD) in the hip. Mean values of the spine and hip BMD z-scores were -1.1 and -0.9 SD, respectively. Time after LT, percentage of lean tissue, and physical activity were positively associated with BMD. The prevalence of fractures was 48%. We did not find significant differences in age, gender, body composition parameters, physical activity, BMD, and HRQOL scores between the subjects with and without fractures. Conclusions We found a high prevalence of fragility fractures and a decreased BMD in LT recipients. Patients with a history of fractures had similar HRQOL scores to those without fractures.
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Psychosocial Status of Liver Transplant Candidates in Iran and Its Correlation with Health-Related Quality of Life and Depression and Anxiety. J Transplant 2015; 2015:329615. [PMID: 26649189 PMCID: PMC4662971 DOI: 10.1155/2015/329615] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 09/14/2015] [Indexed: 01/21/2023] Open
Abstract
Objectives. The study was aimed at providing a psychosocial profile for Iranian liver transplant candidates referred to an established liver transplantation program. Material and Methods. Patients assessed for liver transplant candidacy in Imam Khomeini Hospital (Tehran, Iran) between March 2013 and September 2014 were included. The following battery of tests were administered: Psychosocial Assessment of Candidates for Transplant (PACT), the Short-Form health survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). Results. Psychosocial assessment in 205 liver transplant candidates revealed significant impairments in several SF-36 domains; social functioning was the least and physical functioning was the most impaired domains. The prevalence of cases with probable anxiety and depressive disorders, according to HADS, was 13.8% and 5.6%, respectively. According to PACT, 24.3% of the assessed individuals were considered good or excellent candidates. In 11.2%, transplantation seemed poor candidate due to at least one major psychosocial or lifestyle risk factor. Poor candidate quality was associated with impaired health-related quality of life and higher scores on anxiety and depression scales (p < 0.05). Conclusions. Transplant programs could implement specific intervention programs based on normative databases to address the psychosocial issues in patients in order to improve patient care, quality of life, and transplant outcomes.
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20
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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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A moral dilemma argument against clinical trials of incentives for kidney donation. Transplant Res 2015. [PMID: 26199722 PMCID: PMC4509566 DOI: 10.1186/s13737-015-0025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Commercial transplant tourism results in significant harm to both kidney donors and recipients. However, proponents of incentives for kidney donation assert that proper oversight of the process prevents these harms and also that transplant numbers can be safely increased so that the moral burden of poor end-stage kidney disease outcomes can be alleviated. In a moral dilemma analysis, the principle of preventing donor harm can be dissociated from the principles of providing benefits to the recipient and to society. It is plausible that an incentivized donor is fundamentally different from an uncompensated donor. Incentivized donors can experience harms unrelated to lack of regulation because their characteristics are determined by the incentive superimposed upon a poverty circumstance. Moreover, creating a system of incentivized donation without established national registries for capturing all long-term donor outcomes would be morally inconsistent, since without prior demonstration that donor outcomes are not income or wealth-dependent, a population of incentivized donors cannot be morally created in a clinical trial. Socioeconomic factors adversely affect outcome in other surgical populations, and interventions on income or wealth in these populations have not been studied. Coercion will be increased in families not affected by kidney disease, where knowledge of a new income source and not of a potential recipient is the incentive. In the case of elective surgery such as kidney donation, donor non-maleficence trumps donor autonomy, recipient beneficence, and beneficence to society when there is a conflict among these principles. Yet, we are still faced with the total moral burden of end-stage kidney disease, which belongs to the society that cannot provide enough donor kidneys. Acting according to one arm of the dilemma to prevent donor harm does not erase obligations towards the other, to provide recipient benefit. To resolve the moral burden, as moral agents, we must rearrange our institutions by increasing available donor organs from other sources. The shortage of donor kidneys creates a moral burden for society, but incentives for donation will only increase the total moral burden of end-stage kidney disease.
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Konidis SV, Hrycko A, Nightingale S, Renner E, Lilly L, Therapondos G, Fu A, Avitzur Y, Ng VL. Health-related quality of life in long-term survivors of paediatric liver transplantation. Paediatr Child Health 2015; 20:189-94. [PMID: 26038635 DOI: 10.1093/pch/20.4.189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Long-term survival after paediatric liver transplantation is now the rule rather than the exception. Improving long-term outcomes after transplantation must consider not only the quantity but also the quality of life years restored. OBJECTIVES To characterize health-related quality of life (HRQOL) of LT recipients ≥15 years after paediatric LT. METHODS Recipients of a paediatric LT performed before December 1996 in a single institution with continuous follow-up at either the paediatric or adult partner centre were identified. Patients with severe developmental or neurological impairment were excluded. HRQOL was assessed using the Pediatric Quality of Life Inventory 4.0, the Medical Outcomes Study Short Form-36 version 2 and the Pediatric Liver Transplant Quality of Life Tool. RESULTS A total of 27 (67% male) subjects (mean age 24.3±6.7 years [median 23.2 years; range 16.6 to 40.3 years]) participated. The median age at transplant was 1.7 years (range 0.5 to 17.0 years). Seven (26%) participants underwent retransplantation. Seventeen (63%) participants were engaged in full-time work/study. Mean Short Form-36 version 2 scores included physical (49.6±11.1) and mental (45.3±12.5) subscale scores. The mean score for the disease-specific quality of life tool for paediatric liver transplant recipients (the Pediatric Liver Transplant Quality of Life Tool) was 64.70±15.2. The physical health of the young adults strongly correlated with level of involvement in work/study (r=0.803; P<0.05). CONCLUSIONS The self-reported HRQOL of participants <18 years of age was comparable with a standardized healthy population. In contrast, participants between 18 and 25 years of age had HRQOL scores that were more similar to a group with chronic illness. Participants engaged in full-time work/study experienced enhanced physical health.
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Affiliation(s)
- Stacey V Konidis
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto; ; Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario
| | - Alexander Hrycko
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto
| | - Scott Nightingale
- Department of Gastroenterology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Eberhard Renner
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario
| | - Leslie Lilly
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario
| | - George Therapondos
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Ann Fu
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto
| | - Yaron Avitzur
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto
| | - Vicky Lee Ng
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto
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Quillin RC, Wilson GC, Wima K, Hohmann SF, Sutton JM, Shaw JJ, Paquette IM, Woodle ES, Abbott DE, Shah SA. Neighborhood level effects of socioeconomic status on liver transplant selection and recipient survival. Clin Gastroenterol Hepatol 2014; 12:1934-41. [PMID: 24907503 DOI: 10.1016/j.cgh.2014.05.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/21/2014] [Accepted: 05/21/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Previous studies have reported that patients of higher socioeconomic status (SES) have increased access to liver transplantation and reduced waitlist mortality than patients of lower SES. However, little is known about the association between SES and outcomes after liver transplantation. METHODS By using a link between the University HealthSystem Consortium and the Scientific Registry of Transplant Recipients databases, we identified 12,445 patients who underwent liver transplantation from 2007 through 2011. We used a proportional hazards model to assess the effect of SES on patient survival, controlling for characteristics of recipients, donors, geography, and center. RESULTS Compared with liver recipients in the lowest SES quintile, those in the highest quintile were more likely to be male, Caucasian, have private insurance, and undergo transplantation when they had lower Model for End-Stage Liver Disease scores. In proportional hazards model analysis, liver recipients of the lowest SES were at an increased risk for death within a median of 2 years after transplantation (hazard ratio, 1.17; 95% confidence interval, 1.02-1.35). CONCLUSIONS Patients of lower SES appear to face barriers to liver transplantation, but perioperative outcomes (length of stay, in-hospital mortality, or 30-day readmission) do not differ significantly from those of patients of higher SES. However, fewer patients of low SES survive for 2 years after transplantation, independent of features of the recipient, donor, surgery center, or location.
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Affiliation(s)
- R Cutler Quillin
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Gregory C Wilson
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Koffi Wima
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Samuel F Hohmann
- University Health Consortium and Department Health Systems Management, Rush University, Chicago, Illinois
| | - Jeffrey M Sutton
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Joshua J Shaw
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Ian M Paquette
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - E Steve Woodle
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Daniel E Abbott
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Shimul A Shah
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio.
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24
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Kotarska K, Raszeja-Wyszomirska J, Wunsch E, Chmurowicz T, Kempińska-Podhorodecka A, Wójcicki M, Milkiewicz P. Relationship Between Pretransplantation Liver Status and Health-Related Quality of Life After Grafting: A Single-Center Prospective Study. Transplant Proc 2014; 46:2770-3. [DOI: 10.1016/j.transproceed.2014.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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25
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Weng LC, Huang HL, Wang YW, Lee WC, Chen KH, Yang TY. The effect of self-efficacy, depression and symptom distress on employment status and leisure activities of liver transplant recipients. J Adv Nurs 2013; 70:1573-83. [PMID: 24237349 DOI: 10.1111/jan.12315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2013] [Indexed: 01/01/2023]
Abstract
AIM To examine the effect of self-efficacy, subjective work ability, depression and symptom distress on and to provide a description of, the employment and leisure activities of liver transplant recipients. BACKGROUND Return to work and leisure activities have become an important aspect of life for liver transplant recipients worldwide. An investigation of the factors that influence the employment status and leisure activities has been recommended as a means to help transplant recipients restore their productivity. DESIGN This was a cross-sectional, descriptive and correlational study in 2010. METHODS A convenience sampling method was used. Data were collected using a set of questionnaires that were administered retrospectively. A total of 106 liver transplant patients were included in this study. RESULTS The post-transplantation employment rate was 45.2%. The positive predictors of employment were higher subjective work ability and higher symptom distress. Gender (female), monthly family income (<US $2,000), depression and unemployment pre-transplantation were negatively associated with employment status. Of the 106 patients, 62 (58.5%) were in the low-diversity group (score of less than 3) of leisure activities. Monthly family income of <US $2,000 was associated with a low diversity of participation in leisure activities. CONCLUSION Subjective work ability and symptom distress were positive predictors of employment, while depression was a negative predictor. Nurses in the transplant team should focus on increasing a sense of confidence, decreasing depressive symptoms and monitoring the severity of symptoms to improve the employment status of liver transplant recipients.
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Affiliation(s)
- Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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26
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Togashi J, Sugawara Y, Akamatsu N, Tamura S, Yamashiki N, Kaneko J, Sakamoto Y, Aoki T, Hasegawa K, Kokudo N. Quality of life after adult living donor liver transplantation: A longitudinal prospective follow-up study. Hepatol Res 2013; 43:1052-63. [PMID: 23369201 DOI: 10.1111/hepr.12060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 12/23/2012] [Accepted: 12/25/2012] [Indexed: 12/15/2022]
Abstract
AIM Patient survival after living donor liver transplantation (LDLT) has improved, but improvement of the health-related quality of life (HRQOL) of LDLT recipients is also an important issue. The aim of this study was to assess the HRQOL of LDLT recipients from the preoperative period to 18 months following transplantation by prospectively evaluating Short Form-36 Version 2 (SF-36v2) scores. METHODS Complete longitudinal SF-36v2 scores were collected from 35 consecutive LDLT recipients prior to surgery and at 3, 6, 12 and 18 months after transplantation. RESULTS HRQOL scores were severely impaired in all dimensions preoperatively. Although the scores improved significantly up to 18 months after transplantation, they remained lower than those of healthy controls in the majority of domains. Impaired scores preoperatively were significantly associated with severity of liver disease represented by a higher Model for End-Stage Liver Disease (MELD) score and Child-Turcotte-Pugh class C, and scores in such patients improved significantly after LDLT in every dimension at 12 months, indicating that the greater the impairment at the pretransplant stage, the greater the improvement in both physical and mental conditions. Preoperative lower HRQOL scores and higher MELD scores were independently associated with significant physical and mental score gains during the first year after LDLT. CONCLUSION The findings of the present study may facilitate the development of measures aimed at improving recipient's post-transplant life and establishing realistic expectations for LDLT recipients.
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Affiliation(s)
- Junichi Togashi
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Tokyo, Japan
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27
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Scott PJ. Measuring participation outcomes following life-saving medical interventions: the Role Checklist Version 2: Quality of Performance. Disabil Rehabil 2013; 36:1108-12. [PMID: 24044685 DOI: 10.3109/09638288.2013.833302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To establish the Role Checklist Version 2: Quality of Performance as a measure of past, present and desired future role incumbency, role value and self-perception of the quality of role performance for 10 roles consistent with the ICF Participation Domains. METHODS Discuss the literature on the measurement of participation; present a conceptually based case for similarities in content between the RC V2: QP; and illustrate through a case example its efficacy as a balanced measure of performance. RESULTS Despite different origins, the ICF domain areas: Chapters 6-9 correspond to the roles included in the RC V2: QP. The measure is shown sensitive to change in quality of performance through insider self-report serving in the case provided, as an early indicator of deterioration in physical status. CONCLUSION A balanced measure of the insider and outsider perspective of participation, the case of one liver transplant recipient illustrates how the RC V2: QP serves to reflect participation outcomes thus, adding an available measure of the ICF construct of participation. Implications for Rehabilitation The Role Checklist Version 2: Quality of Performance is consistent with the ICF performance qualifier of participation. The insider view of participation is strengthened in this Second version of the Role Checklist. The Role Checklist Version 2: Quality of Performance provides a general measure of participation that can be used across populations.
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Affiliation(s)
- Patricia J Scott
- Department of Occupational Therapy, Indiana University , Indianapolis, IN , USA
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28
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Rangnekar AS, Ellerbe C, Durkalski V, McGuire B, Lee WM, Fontana RJ. Quality of life is significantly impaired in long-term survivors of acute liver failure and particularly in acetaminophen-overdose patients. Liver Transpl 2013; 19:991-1000. [PMID: 23780824 PMCID: PMC3775983 DOI: 10.1002/lt.23688] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 05/22/2013] [Indexed: 12/13/2022]
Abstract
Functional outcomes for long-term survivors of acute liver failure (ALF) are not well characterized. The aim of this prospective study was to determine health-related quality of life in long-term adult ALF survivors. Acute Liver Failure Study Group registry participants completed the Centers for Disease Control and Prevention Health-Related Quality of Life 14 and Short Form 36 (SF-36) questionnaires at 1- and/or 2-year follow-up study visits. Responses were compared among ALF subgroups and to those for available general US population controls. Among the 282 adult ALF patients, 125 had undergone liver transplantation (LT), whereas 157, including 95 acetaminophen overdose (APAP) patients and 62 non-APAP patients, were spontaneous survivors (SSs). APAP SS patients reported significantly lower general health scores and more days of impaired mental and physical health, activity limitations due to poor health, pain, depression, and anxiety in comparison with the other groups (P ≤ 0.001). There were no significant differences in coma grade or in the use of mechanical ventilation or intracranial pressure monitoring among the patient groups during their ALF hospitalization, but APAP SSs had significantly higher rates of psychiatric disease and substance abuse (P < 0.001). In comparison with the general US population, a greater proportion of the combined SS patients reported fair or poor health and ≥14 days of impaired physical/mental health and activity limitations due to poor health. In addition, a greater proportion of LT recipients reported ≥14 days of impaired physical/mental health. Similar results were observed with the SF-36 across the 3 ALF subgroups and in comparison with population controls. In conclusion, long-term adult survivors of ALF reported significantly lower quality of life scores than US population controls. Furthermore, APAP SS patients reported the lowest quality of life scores, possibly because of higher rates of premorbid psychiatric and substance abuse disorders.
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Affiliation(s)
- Amol S. Rangnekar
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109-0362
| | - Caitlyn Ellerbe
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Valerie Durkalski
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Brendan McGuire
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - William M. Lee
- Division of Digestive & Liver Diseases, Department of Internal Medicine, University of Texas Southwestern, Dallas, TX
| | - Robert J. Fontana
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109-0362
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The impact of liver transplantation on the phenotype of primary biliary cirrhosis patients in the UK-PBC cohort. J Hepatol 2013; 59:67-73. [PMID: 23466308 PMCID: PMC6976302 DOI: 10.1016/j.jhep.2013.02.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/24/2013] [Accepted: 02/25/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND & AIMS Liver transplantation improves survival in end-stage primary biliary cirrhosis (PBC), but the benefit for systemic symptoms including fatigue is less clear. The aim of this study was to utilise the comprehensive UK-PBC Research Cohort, including 380 post-transplant patients and 2300 non-transplanted patients, to answer key questions regarding transplantation for PBC. METHODS Cross-sectional study of post-transplant PBC patients and case-matched non-transplanted patients. Detailed clinical information was collected, together with patient systemic symptom impact data using validated assessment tools. RESULTS Over 25% of patients in the transplant cohort were grafted within 2 years of PBC diagnosis suggesting advanced disease at presentation. Transplanted patients were significantly younger at presentation than non-transplanted (mean 7 years) and >35% of all patients in the UK-PBC cohort who presented under 50 years had already undergone liver transplantation at the study censor point (>50% were treatment failures (post-transplant or unresponsive to UDCA)). Systemic symptom severity (fatigue and cognitive symptoms) was identical in female post-transplant patients and matched non-transplanted controls and unrelated to disease recurrence or immunosuppression type. In males, symptoms were worse in transplanted than in non-transplanted patients. CONCLUSIONS Age at presentation is a major risk factor for progression to transplant (as well as UDCA non-response) in PBC. Although both confirmatory longitudinal studies, and studies utilising objective as well as subjective measures of function, are needed if we are to address the question definitively, we found no evidence of improved systemic symptoms after liver transplantation in PBC and patients should be advised accordingly. Consideration needs to be given to enhancing rehabilitation approaches to improve function and life quality after liver transplant for PBC.
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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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31
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Mabrouk M, Esmat G, Yosry A, El-Serafy M, Doss W, Zayed N, El-Sahhar M, Awny S, Omar A. Health-related quality of life in Egyptian patients after liver transplantation. Ann Hepatol 2012. [DOI: 10.1016/s1665-2681(19)31414-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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32
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Aberg F, Höckerstedt K, Roine RP, Sintonen H, Isoniemi H. Influence of liver-disease etiology on long-term quality of life and employment after liver transplantation. Clin Transplant 2012; 26:729-35. [PMID: 22404665 DOI: 10.1111/j.1399-0012.2012.01597.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2011] [Indexed: 12/11/2022]
Abstract
The etiology of liver disease would expectedly affect health-related quality of life (HRQoL) and employment after liver transplantation (LT), but studies are scarce. We sent the 15D HRQoL instrument and an employment questionnaire to all 401 adult LT patients alive in Finland in 2007. The response rate was 89% (n = 353; mean of eight yr since LT). In age-adjusted analysis, patients transplanted for primary sclerosing cholangitis (PSC; n = 56), primary biliary cirrhosis (PBC; n = 72), acute liver failure (ALF; n = 76), alcoholic cirrhosis (n = 38), or liver tumor (n = 22) exhibited comparable HRQoL, whereas the combined group of miscellaneous chronic liver diseases (n = 89) exhibited significantly higher HRQoL scores (p = 0.003). Among working-aged patients (20-65 yr at LT), employment rates were highest in the PSC (56%) group and lowest in the ALF (39%) and PBC (29%) groups. In age-adjusted logistic regression, patients with PSC or alcoholic cirrhotics were 2.4- and 2.5-fold more likely to resume work after LT than patients with PBC. In conclusion, HRQoL scores late after LT were in general relatively high and comparable among disease groups. Patients with PSC or alcoholic cirrhosis were most likely to resume work after LT. The relatively low employment among patients with ALF may merit enhanced rehabilitation efforts.
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Affiliation(s)
- Fredrik Aberg
- Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland.
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33
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Bajaj JS, Thacker LR, Wade JB, Sanyal AJ, Heuman DM, Sterling RK, Gibson DP, Stravitz RT, Puri P, Fuchs M, Luketic V, Noble N, White M, Bell D, Revicki DA. PROMIS computerised adaptive tests are dynamic instruments to measure health-related quality of life in patients with cirrhosis. Aliment Pharmacol Ther 2011; 34:1123-32. [PMID: 21929591 PMCID: PMC3989141 DOI: 10.1111/j.1365-2036.2011.04842.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cirrhotic patients have an impaired health-related quality of life (HRQOL), which is usually analysed using static paper-pencil questionnaires. The Patient Reported Outcomes Measurement Information System (PROMIS) computerised adaptive testing (CAT) are flexible, freely available, noncopyrighted, HRQOL instruments with US-based norms across 11 domains. CAT presents five to seven questions/domain depending on the patient's response, from large validated question banks. This provides brevity and precision equivalent to the entire question bank. AIM To evaluate PROMIS CAT tools against 'legacy instruments' for cirrhotics and their informal caregivers. METHODS A total of 200 subjects: 100 cirrhotics (70 men, 53% decompensated) and 100 caregivers were administered the PROMIS and legacy instruments [Sickness Impact Profile (SIP), Beck depression/anxiety inventories, Pittsburgh Sleep-Quality Index (PSQI) and Epworth Sleepiness scale (ESS)] concurrently. Both legacy and PROMIS results for patients were compared with caregivers and US norms. These were also compared between compensated and decompensated patients. Preference for SIP or PROMIS was inquired of a selected group (n = 70, 50% patients). Test - retest reliability was assessed in another group of 20 patients. RESULTS Patients had significant impairment on all PROMIS domains apart from anger and anxiety compared with caregivers and US norms (P < 0.02 to <0.0001). Decompensated patients had significantly worse sleep, pain, social and physical function scores compared with compensated ones, similar to legacy instruments. There was a statistically significant correlation between PROMIS and their corresponding legacy instruments. The majority (71%) preferred PROMIS over SIP. PROMIS tools had significant test - retest reliability (ICC range 0.759-0.985) when administered 12 ± 6 days apart. CONCLUSION PROMIS computerised adaptive testing tools had significant concurrent and discriminant validity, test - retest reliability and subject preference for assessing HRQOL in cirrhotic patients.
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Affiliation(s)
- J. S. Bajaj
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - L. R. Thacker
- Biostatistics, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - J. B. Wade
- Psychology, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - A. J. Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - D. M. Heuman
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - R. K. Sterling
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - D. P. Gibson
- Psychology, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - R. T. Stravitz
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - P. Puri
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - M. Fuchs
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - V. Luketic
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - N. Noble
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - M. White
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - D. Bell
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA
| | - D. A. Revicki
- Department of Psychiatry, Georgetown University Medical Center and Center for Health Outcomes Research, United Biosource Corporation, Bethesda, MD, USA
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