1
|
Shafiekhani M, Shahabinezhad F, Tavakoli Z, Tarakmeh T, Haem E, Sari N, Nasirabadi S, Dehghani M. Quality of life associated with immunosuppressant treatment adherence in liver transplant recipients: A cross-sectional study. Front Pharmacol 2023; 14:1051350. [PMID: 36909168 PMCID: PMC9998979 DOI: 10.3389/fphar.2023.1051350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/13/2023] [Indexed: 02/26/2023] Open
Abstract
Purpose: Transplanted organ survival after solid organ transplantation highly correlates with the adherence levels of the patients to their immunosuppressive drugs. On the other hand, one of the main goals of liver transplantation is to increase the overall quality of life (QOL) for the patient. This study is aimed to analyze the relationship between adherence and QOL in adult liver transplant recipients of the biggest liver transplant center in Asia. Methods: All of the included patients were older than 18 years and at least 6 months had passed from their liver transplantation. The adherence level was measured with BAASIS method and the QOL was assessed by SF-36 questionnaire in real-time interviews. The relationship between adherence and different aspects of QOL in addition to qualitative and quantitative influential factors on these two outcomes was calculated with statistical analysis. Results: Among the 122 included patients, 41% of the were categorized in the non-adherent group. The most important reasons for non-adherence in these patients included forgetfulness (62%), lack of medication (12%), financial problems for drug supply (9%), and side effects (2%). According to the results of the multivariate linear regression model, rejection was the only influential factor in the occurrence of non-adherence among patients (OR = 8.226 CI (1.404-48.196)). The overall mean QOL score of patients was reported 51.09 ± 21.86. The lowest is given to social functioning, while mental health has achieved the highest score. The mean QOL scores in different dimensions in patients with adherence were higher than non-adherents, which was only significant in mental health (p-value = 0.01). Additionally, in total scores related to Physical Composite Score (PSC) and Mental Composite Score (MCS), the mean MSC scores in adherent patients were significantly higher than non-adherent patients (p-value: 0.02). Although adherent patients have an overall greater QOL, the only meaningful effect on QOL total score was from income level. Conclusion: The overall QoL score has been in all parameters higher in the adherent group compared with non-adherent patients. The difference in QoL was most meaningfully significant in mental composite score among other parameters of QoL.
Collapse
Affiliation(s)
- Mojtaba Shafiekhani
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farbod Shahabinezhad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Tavakoli
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Tarakmeh
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Haem
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negar Sari
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shohreh Nasirabadi
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Dehghani
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
2
|
Gitto S, Golfieri L, Mannelli N, Tamè MR, Lopez I, Ceccato R, Montanari S, Falcini M, Vitale G, De Maria N, Presti DL, Marzi L, Mega A, Valente G, Borghi A, Foschi FG, Grandi S, Forte P, Cescon M, Di Benedetto F, Andreone P, Arcangeli G, De Simone P, Bonacchi A, Sofi F, Morelli MC, Petranelli M, Lau C, Marra F, Chiesi F, Vizzutti F, Vero V, Di Donato R, Berardi S, Pianta P, D’Anzi S, Schepis F, Gualandi N, Miceli F, Villa E, Piai G, Valente M, Campani C, Lynch E, Magistri P, Cursaro C, Chiarelli A, Carrai P, Petruccelli S, Dinu M, Pagliai G. Quality of life in liver transplant recipients during the Corona virus disease 19 pandemic: A multicentre study. Liver Int 2022; 42:1618-1628. [PMID: 38009600 PMCID: PMC9115213 DOI: 10.1111/liv.15260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2023]
Abstract
BACKGROUND Liver transplant recipients require specific clinical and psychosocial attention given their frailty. Main aim of the study was to assess the quality of life after liver transplant during the current pandemic. METHODS This multicentre study was conducted in clinically stable, liver transplanted patients. Enrollment opened in June and finished in September 2021. Patients completed a survey including lifestyle data, quality of life (Short Form health survey), sport, employment, diet. To examine the correlations, we calculated Pearson coefficients while to compare subgroups, independent samples t-tests and ANOVAs. To detect the predictors of impaired quality of life, we used multivariable logistic regression analysis. RESULTS We analysed data from 511 patients observing significant associations between quality of life's physical score and both age and adherence to Mediterranean diet (p < .01). A significant negative correlation was observed between mental score and the sedentary activity (p < .05). Female patients scored significantly lower than males in physical and mental score. At multivariate analysis, females were 1.65 times more likely to report impaired physical score than males. Occupation and physical activity presented significant positive relation with quality of life. Adherence to Mediterranean diet was another relevant predictor. Regarding mental score, female patients were 1.78 times more likely to show impaired mental score in comparison with males. Sedentary activity and adherence to Mediterranean diet were further noteworthy predictors. CONCLUSIONS Females and subjects with sedentary lifestyle or work inactive seem to show the worst quality of life and both physical activity and Mediterranean diet might be helpful to improve it.
Collapse
Affiliation(s)
- Stefano Gitto
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Lucia Golfieri
- Internal Medicine Unit for the Treatment of Severe Organ Failure, Dipartimento Medico chirurgico delle malattie digestive, epatiche ed endocrino‐metabolicheIRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di Sant’OrsolaBolognaItaly
| | - Nicolò Mannelli
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Maria Rosa Tamè
- Gastroenterology Division, Dipartimento Medico chirurgico delle malattie digestive, epatiche ed endocrino‐metabolicheIRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di Sant’OrsolaBolognaItaly
| | - Ivo Lopez
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Roberta Ceccato
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Stanislao Montanari
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Margherita Falcini
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Giovanni Vitale
- Internal Medicine Unit for the Treatment of Severe Organ Failure, Dipartimento Medico chirurgico delle malattie digestive, epatiche ed endocrino‐metabolicheIRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di Sant’OrsolaBolognaItaly
| | - Nicola De Maria
- Department of GastroenterologyAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Danilo Lo Presti
- Internal Medicine Unit for the Treatment of Severe Organ Failure, Dipartimento Medico chirurgico delle malattie digestive, epatiche ed endocrino‐metabolicheIRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di Sant’OrsolaBolognaItaly
| | - Luca Marzi
- Division of GastroenterologyBolzano Regional HospitalBolzanoItaly
| | - Andrea Mega
- Division of GastroenterologyBolzano Regional HospitalBolzanoItaly
| | - Giovanna Valente
- Liver Unit for Transplant Management – SATTE, Department of Medical SciencesAORN Sant’Anna e San SebastianoCasertaItaly
| | | | | | - Silvana Grandi
- Laboratory of Psychosomatics and Clinimetrics, Department of PsychologyUniversity of BolognaBolognaItaly
| | - Paolo Forte
- Gastroenterology UnitUniversity Hospital CareggiFlorenceItaly
| | - Matteo Cescon
- General Surgery and Transplant UnitIRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di Sant’OrsolaBolognaItaly
| | - Fabrizio Di Benedetto
- Hepato‐Pancreato‐Biliary Surgery and Liver Transplantation UnitUniversity of Modena and Reggio EmiliaModenaItaly
| | - Pietro Andreone
- Internal and Metabolic MedicineAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Giulio Arcangeli
- Occupational Health Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceItaly
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver TransplantationUniversity of Pisa Medical School HospitalPisaItaly
| | - Andrea Bonacchi
- Centro Studi e Ricerca SynthesisAssociazione sul sentiero APSFlorenceItaly
| | - Francesco Sofi
- Unit of Clinical Nutrition, Careggi University Hospital, Department of Experimental and Clinical MedicineUniversity of FlorenceFirenzeItaly
| | - Maria Cristina Morelli
- Internal Medicine Unit for the Treatment of Severe Organ Failure, Dipartimento Medico chirurgico delle malattie digestive, epatiche ed endocrino‐metabolicheIRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di Sant’OrsolaBolognaItaly
| | - Marco Petranelli
- Department of Experimental and Clinical MedicineUniversity of FlorenceFirenzeItaly
| | - Chloe Lau
- Department of PsychologyUniversity of Western OntarioLondonOntarioCanada
| | - Fabio Marra
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital CareggiUniversity of FlorenceFirenzeItaly
| | - Francesca Chiesi
- Department of Neuroscience, Psychology, Drug, and Child’s Health (NEUROFARBA), Section of PsychologyUniversity of FlorenceFirenzeItaly
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Onghena L, Berrevoet F, Vanlander A, Van Vlierberghe H, Verhelst X, Hoste E, Poppe C. Illness cognitions and health-related quality of life in liver transplant patients related to length of stay, comorbidities and complications. Qual Life Res 2022; 31:2493-2504. [DOI: 10.1007/s11136-022-03083-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
|
4
|
Becchetti C, Ferrarese A, Zeni N, Russo FP, Senzolo M, Gambato M, Bassi D, Cillo U, Burra P, Germani G. A prospective longitudinal assessment of de novo metabolic syndrome after liver transplantation. Clin Transplant 2021; 36:e14532. [PMID: 34757678 DOI: 10.1111/ctr.14532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/13/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND De novo metabolic syndrome (MS) is a frequent complication after liver transplantation (LT). The aim of this prospective study is to identify potential risk factors longitudinally associated to post-LT de novo MS. Patients without pre-LT MS who underwent LT between April 2013 and October 2017 were prospectively included. Metabolic variables were collected at LT and at 6, 12 and 24 months post-LT. RESULTS 63 patients fulfilled the inclusion criteria (76% male, mean age 53.6±9.5 years). The prevalence of de novo MS was 46%, 43% and 49% at 6, 12, and 24 months after LT respectively. Among other MS components, the prevalence of type 2 diabetes, hypertension and hypertriglyceridemia significantly increased after LT. Considering the baseline characteristics at the adjusted analysis, alcoholic liver disease (OR 4.17, 95%CI 1.20-14.51; p = 0.03) and hypertension pre-LT (OR 11.3, 95%CI 1.49-85.46; p = 0.02 were confirmed as independent risk factors of post-LT de novo MS. In the time varying analysis, only eGFR (OR 0.97, 95%IC 0.97-0.98; p<0.0001) was found associated with post-LT de novo MS. CONCLUSIONS De novo MS frequently occurs shortly after LT, affecting nearly half of patients at 24 months post-LT. Lifestyle modifications should be recommended starting early post-LT, particularly for patients with established risk factors. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Chiara Becchetti
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy.,Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Department of Biomedical Research, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Alberto Ferrarese
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
| | - Nicola Zeni
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
| | - Francesco Paolo Russo
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
| | - Marco Senzolo
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
| | - Martina Gambato
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
| | - Domenico Bassi
- Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
| | - Giacomo Germani
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
| |
Collapse
|
5
|
Guirguis RN, Nashaat EH, Yassin AE, Ibrahim WA, Saleh SA, Bahaa M, El-Meteini M, Fathy M, Dabbous HM, Montasser IF, Salah M, Mohamed GA. Impact of biliary complications on quality of life in live-donor liver transplant recipients. World J Hepatol 2021; 13:1405-1416. [PMID: 34786175 PMCID: PMC8568573 DOI: 10.4254/wjh.v13.i10.1405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/23/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite significant advancements in liver transplantation (LT) surgical procedures and perioperative care, post-LT biliary complications (BCs) remain a significant source of morbidity, mortality, and graft failure. In addition, data are conflicting regarding the health-related quality of life (HRQoL) of LT recipients. Thus, the success of LT should be considered in terms of both the survival and recovery of HRQoL.
AIM To assess the impact of BCs on the HRQoL of live-donor LT recipients (LDLT-Rs).
METHODS We retrospectively analysed data for 25 LDLT-Rs who developed BCs post-LT between January 2011 and December 2016 at our institution. The Short Form 12 version 2 (SF 12v2) health survey was used to assess their HRQoL. We also included 25 LDLT-Rs without any post-LT complications as a control group.
RESULTS The scores for HRQoL of LDLT-Rs who developed BCs were significantly higher than the norm-based scores in the domains of physical functioning (P = 0.003), role-physical (P < 0.001), bodily pain (P = 0.003), general health (P = 0.004), social functioning (P = 0.005), role-emotional (P < 0.001), and mental health (P < 0.001). No significant difference between the two groups regarding vitality was detected (P = 1.000). The LDLT-Rs with BCs had significantly lower scores than LDLT-Rs without BCs in all HRQoL domains (P < 0.001) and the mental (P < 0.001) and physical (P = 0.0002) component summary scores.
CONCLUSION The development of BCs in LDLT-Rs causes a lower range of improvement in HRQoL.
Collapse
Affiliation(s)
- Reginia Nabil Guirguis
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Ehab Hasan Nashaat
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Azza Emam Yassin
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Wesam Ahmed Ibrahim
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Shereen A Saleh
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Mohamed Bahaa
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Mahmoud El-Meteini
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Mohamed Fathy
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Hany Mansour Dabbous
- Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Iman Fawzy Montasser
- Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Manar Salah
- Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Ghada Abdelrahman Mohamed
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| |
Collapse
|
6
|
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
| |
Collapse
|
7
|
Ivanics T, Abreu P, De Martin E, Sapisochin G. Changing Trends in Liver Transplantation: Challenges and Solutions. Transplantation 2021; 105:743-756. [PMID: 32910093 DOI: 10.1097/tp.0000000000003454] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite improvements in postliver transplant outcomes through refinements in perioperative management and surgical techniques, several changing trends in liver transplantation have presented challenges. Mortality on the waitlist remains high. In the United States, Europe, and the United Kingdom, there is an increasing need for liver transplantation, primarily as a result of increased incidence of nonalcoholic steatohepatitis-related cirrhosis and cancer indications. Meanwhile, donor suitability has decreased, as donors are often older and have more comorbidities. Despite a mismatch between organ need and availability, many organs are discarded. Notwithstanding this, many solutions have been developed to overcome these challenges. Innovative techniques in allograft preservation, viability assessment, and reconditioning have allowed the use of suboptimal organs with adequate results. Refinements in surgical procedures, including live donor liver transplantations, have increased the organ pool and are decreasing the time and mortality on the waitlist. Despite many challenges, a similar number of solutions and prospects are on the horizon. This review seeks to explore the changing trends and challenges in liver transplantation and highlight possible solutions and future directions.
Collapse
Affiliation(s)
- Tommy Ivanics
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Phillipe Abreu
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Eleonora De Martin
- APHP, Hôpital Paul Brousse, Centre Hépato-Biliaire, INSERM 1193, Université Paris-Sud, DHU Hepatinov, Villejuif, France
| | - Gonzalo Sapisochin
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| |
Collapse
|
8
|
Girgenti R, Tropea A, Buttafarro MA, Ragusa R, Ammirata M. Quality of Life in Liver Transplant Recipients: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113809. [PMID: 32471157 PMCID: PMC7313086 DOI: 10.3390/ijerph17113809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study aims to investigate the quality of life and the therapeutic compliance of the patients who received a liver transplant, from a living or deceased donor, at IRCCS ISMETT in the last three years. Liver transplantation is an effective therapeutic strategy for patients with end-stage liver failure. The quality of life (QOL) of liver disease patients is placed under considerable stress due to the debilitating clinical conditions and related issues experienced in everyday life by these individuals. The concept of QOL is being increasingly used to define the individual perception of health, including physical, mental, and social wellbeing. The success of a liver transplant should therefore be intended not only in terms of survival, but also of recovery of a satisfying quality of life. For this reason, our liver transplant recipients are closely monitored and supported from a psychological standpoint. This is done to monitor their ability to adapt to and comply with their clinical condition and to verify their gradual resumption of their path of life Methods: We retrospectively analyzed data collected by the IRCCS ISMETT Clinical Psychology Service during routine psychological follow-up of liver transplant recipients. Data refer to 82 patients who received a liver transplant between January 2017 and September 2019 and describe their QOL and therapeutic adherence. The obtained results were compared with the main studies on this issue available in literature. RESULTS Ninety-four percent of liver transplant recipients reported high mean scores of quality of life and therapeutic adherence 28% of patients reported at least one persistent annoying symptom after transplantation, although in some cases this did not affect the overall QOL. The results also refer to patients with a pre-transplant diagnosis of alcohol-related cirrhosis, who confirm their complete abstinence from alcohol. CONCLUSIONS Our results confirm the efficacy of the liver transplantation to achieve of a good QOL. Furthermore, these patients seem to maintain high therapeutic adherence, thus ensuring a good outcome of the care received during the transplantation process.
Collapse
Affiliation(s)
- Rosario Girgenti
- Clinical Psychology Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy; (R.G.); (M.A.B.); (M.A.)
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy;
- Correspondence:
| | - Maria Antonina Buttafarro
- Clinical Psychology Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy; (R.G.); (M.A.B.); (M.A.)
| | - Rosalia Ragusa
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy;
- Health Technology Assessment Committee, University Hospital “G. Rodolico”, 95100 Catania, Italy
| | - Martina Ammirata
- Clinical Psychology Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy; (R.G.); (M.A.B.); (M.A.)
| |
Collapse
|
9
|
Physical Condition, Glycemia, Liver Function, and Quality of Life in Liver Transplant Recipients After a 12-Month Supervised Exercise Program. Transplant Proc 2019; 51:2952-2957. [PMID: 31607623 DOI: 10.1016/j.transproceed.2019.03.087] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/10/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Despite the excellent long-term outcomes in liver transplant (LT) recipients, several medical complications related to lifestyle still represent an issue. This study examined the effects of a 12-month supervised aerobic and strength training program on the aerobic capacity, muscle strength, metabolic profile, liver function, and quality of life of a cohort of LT recipients. METHODS LT recipients with stable liver function were assigned to interventional exercise (group A) or usual care (group B). Aerobic capacity, muscle strength, metabolic profile, liver and kidney function, and health-related quality of life were assessed at baseline and after 6 and 12 months. Group A attended supervised training sessions 3 times per week for 12 months. Group B received general recommendations about home-based exercise. RESULTS Forty patients from 6 Italian LT centers were randomized. Twenty-nine (72.5%, men-to-women ratio 23:6, mean age, 52 ± 8 years) LT recipients completed the study. Baseline characteristics were similar between groups except for body mass index and time from LT. No episode of acute rejection nor increase of transaminases occurred. Maximum workload and body mass index increased in both groups over time, but fasting glucose significantly decreased in group A (94.0 ± 15.0 mg/dL vs 90.0 ± 17.0 mg/dL; P = .037) and increased in controls (95.0 ± 24.0 mg/dL vs 102.0 ± 34.0 mg/dL, P = .04). Upper limb muscle strength increased only in supervised LT recipients. Vitality and general and mental health domains significantly improved after physical exercise. CONCLUSIONS Supervised combined training was safe and effective in increasing aerobic capacity, muscle strength, and quality of life and in improving glucose metabolism in stable LT recipients.
Collapse
|
10
|
Improvement of Physical Capacity and Quality of Life After Liver Transplantation: A Longitudinal Study. HEPATITIS MONTHLY 2019. [DOI: 10.5812/hepatmon.88018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
|
11
|
Krawczyk M, Koźma M, Szymańska A, Leszko K, Przedniczek M, Mucha K, Foroncewicz B, Pączek L, Moszczuk B, Milkiewicz P, Raszeja-Wyszomirska J. Effects of liver transplantation on health-related quality of life in patients with primary biliary cholangitis. Clin Transplant 2018; 32:e13434. [PMID: 30362634 DOI: 10.1111/ctr.13434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 10/15/2018] [Accepted: 10/19/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with primary biliary cholangitis (PBC) have decreased health-related quality of life (HRQoL). Here, we investigate HRQoL in two cohorts of transplanted patients with PBC and compare their results to healthy subjects. PATIENTS AND METHODS We used generic SF-36 and disease-specific PBC-40 questionnaires to evaluate HRQoL in 26 patients with PBC (23 females, age 59.4 ± 5.7 years) before and after liver transplantation (LT), and in 107 patients with PBC (99 females, age 62.8 ± 6.7 years) who were previously transplanted. The control group was comprised of 60 healthy controls (55 females, age 54.6 ± 8.8 years). RESULTS Health-related quality of life improved after LT in 85% of PBC patients. The SF-36 measure showed significant (all P < 0.05) improvements in the majority of domains after LT, and in the summary scores both physical and mental. We also documented significant improvements in pruritus and fatigue after LT (all P < 0.01). However, liver graft recipients had significantly worse physical functioning, physical role, and emotional role domains, and physical component score (all P < 0.001), as compared to healthy subjects. No differences in HRQoL were detected between patients evaluated after short and prolonged post-LT periods (P > 0.05). CONCLUSION Liver transplantation substantially improves most aspects of life quality in PBC patients. Nevertheless, their HRQoL remains worse in comparison to healthy individuals, mainly in physical aspects.
Collapse
Affiliation(s)
- Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany.,Laboratory of Metabolic Liver Diseases, Center for Preclinical Research, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Koźma
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Szymańska
- Department of Immunology, Transplantology and Internal Medicine, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Leszko
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Marta Przedniczek
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Mucha
- Department of Immunology, Transplantology and Internal Medicine, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.,Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Bartosz Foroncewicz
- Department of Immunology, Transplantology and Internal Medicine, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Pączek
- Department of Immunology, Transplantology and Internal Medicine, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.,Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Barbara Moszczuk
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Piotr Milkiewicz
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.,Translational Medicine Group, Pomeranian Medical University, Szczecin, Poland
| | - Joanna Raszeja-Wyszomirska
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
12
|
Golfieri L, Gitto S, Morelli MC, Pinna AD, Grandi S, Andreone P. Impact of hepatitis C virus infection on health-related quality of life before and after liver transplantation: a multidisciplinary point of view. Expert Rev Anti Infect Ther 2018; 15:759-765. [PMID: 28756716 DOI: 10.1080/14787210.2017.1362334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Hepatitis C negatively changes patient quality of life even in the absence of advanced liver disease. The specific patterns of quality of life of hepatitis C positive patients waiting for transplant or after surgery are not widely studied. Areas covered: A significant percentage of infected patients show cognitive impairment, fatigue, and/or a 'brain fog', that cannot be explained by the liver disease. Depression can be diagnosed in one third of hepatitis C positive patients. Conflicting data are available regarding the possible role of Model for End-Stage Liver Disease score as predictor of impaired quality of life. In the first period after liver transplant, quality of life tends to increase at the pre-transplant period but in the medium and long-term period, it declines. The recurrence of hepatitis C infection represents a strong predictor of morbidity and mortality and can significantly affect the global quality of life of patients. Expert commentary: Hepatologists, surgeons and psychologists should collaborate to support infected patients in all phases of transplant including the long-term period after surgery. Education and information should be implemented especially regarding the positive role of new direct antivirals.
Collapse
Affiliation(s)
- Lucia Golfieri
- a Dipartimento di Psicologia , Università di Bologna , Bologna , Italy
| | - Stefano Gitto
- b Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche , Università di Bologna , Bologna , Italy.,c Programma Dipartimentale Innovazione Terapeutica Epatopatie Croniche Virali (ITEC), Dipartimento Ospedaliero dell'Apparato Digerente , Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola , Bologna , Italy
| | - Maria Cristina Morelli
- d Medicina Interna per il trattamento delle gravi insufficienze d'organo , Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola , Bologna , Italy
| | - Antonio Daniele Pinna
- e Chirurgia Generale e Trapianti , Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola , Bologna , Italy
| | - Silvana Grandi
- a Dipartimento di Psicologia , Università di Bologna , Bologna , Italy
| | - Pietro Andreone
- b Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche , Università di Bologna , Bologna , Italy.,c Programma Dipartimentale Innovazione Terapeutica Epatopatie Croniche Virali (ITEC), Dipartimento Ospedaliero dell'Apparato Digerente , Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola , Bologna , Italy
| |
Collapse
|
13
|
Onghena L, Develtere W, Poppe C, Geerts A, Troisi R, Vanlander A, Berrevoet F, Rogiers X, Van Vlierberghe H, Verhelst X. Quality of life after liver transplantation: State of the art. World J Hepatol 2016; 8:749-756. [PMID: 27366301 PMCID: PMC4921796 DOI: 10.4254/wjh.v8.i18.749] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/04/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
Quality of life (QoL) after deceased donor liver transplantation is increasingly recognized as a major outcome parameter. We reviewed recent publications in this rapidly evolving field in order to summarize recent achievements in the field and to define opportunities and perspectives for research and improvement of patient care. QoL does improve after liver transplantation according to a typical pattern. During the first year, there is a significant improvement in QoL. After one year, the improvement does stabilise and tends to decline slightly. In addition to the physical condition, different psychological parameters (such as depression, anxiety, sexual function) and sociodemographic elements (professional state, sex, marital state) seem to impact QoL. Opportunities for further research are the use of dedicated questionnaires and identification of influencing factors for QoL.
Collapse
|
14
|
Denny B, Kienhuis M, Gavidia-Payne S. Explaining the quality of life of organ transplant patients by using crisis theory. Prog Transplant 2015; 25:324-31. [PMID: 26645927 DOI: 10.7182/pit2015904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT Ubiquitous findings regarding the quality of life (QOL) of transplant patients have yet to be explained from a theoretical perspective. OBJECTIVE To investigate transplant patients' QOL by using the conceptual framework of crisis theory. DESIGN Cross-sectional study to explore differences in transplant patients' experiences of stress, coping, and QOL. Regression analysis was used to test crisis theory in relation to QOL, stress, and coping. PARTICIPANTS A total of 226 participants representing transplant candidates, transplant recipients, and nontransplant individuals participated via survey-based data collection. RESULTS Results showed that transplant candidates experience lower QOL than transplant recipients and nontransplant individuals. No significant differences were detected regarding stress levels or coping styles. Stress made a significant contribution to patients' QOL. CONCLUSIONS Current findings suggest important QOL benefits of organ transplant. Using a theoretical model is an effective way to investigate the QOL of people experiencing chronic illness such as end-stage organ failure. Further investigation is required to reach a conclusive understanding of the complex interaction between transplant patients' QOL, stress, and coping.
Collapse
|
15
|
Mavis AM, Ertl A, Chapman S, Cassidy LD, Lerret SM. Vulnerability and Chronic Illness Management in Pediatric Kidney and Liver Transplant Recipients. Prog Transplant 2015; 25:139-46. [DOI: 10.7182/pit2015551] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Context— Solid-organ transplant is the treatment of choice for end-stage organ failure and requires a transition from management of a life-threatening condition to a chronic illness. Despite research focusing on quality of life after transplant, there is a gap addressing the role of managing a chronic illness focusing on vulnerability and impact on family. Objective— Identify patient and family patterns of adaptation among kidney and liver transplant recipients in regard to (1) vulnerability, (2) impact of illness on the family, (3) family functioning, and (4) quality of life (parent and child report). Design— Cross-sectional study enrolling children 5 to 18 years old and their parent at a single time point after kidney or liver transplant. Validated self-report tools were completed. Results— In all, 47 participants (24 kidney and 23 liver) were recruited. Mean age at transplant was 4.0 (kidney) and 2.1 (liver) years. Mean age at report was 12.1 (kidney) and 7.1 (liver) years. Child vulnerability correlated negatively with (1) family impact in the kidney ( P < .05) and liver ( P < .05) transplant groups, (2) PedsQL subscales including Parent Emotional ( P < .05), Parent Social ( P < .01), Parent Psychosocial ( P < .01), Parent Physical ( P < .05), Parent School ( P < .05), and Child Social ( P < .01) in the kidney transplant group, (3) PedsQL Parent Emotional subscale ( P < .01) in the liver transplant group, and (4) Functional status ( P < .01) in the liver transplant group. Conclusions— Child vulnerability provides insight into quality of life and the impact of illness on the family and family functioning.
Collapse
Affiliation(s)
- Alisha M. Mavis
- Medical College of Wisconsin (AMM, AE, LDC, SML), Children's Hospital of Wisconsin (SC), Milwaukee, Wisconsin
| | - Allison Ertl
- Medical College of Wisconsin (AMM, AE, LDC, SML), Children's Hospital of Wisconsin (SC), Milwaukee, Wisconsin
| | - Shelley Chapman
- Medical College of Wisconsin (AMM, AE, LDC, SML), Children's Hospital of Wisconsin (SC), Milwaukee, Wisconsin
| | - Laura D. Cassidy
- Medical College of Wisconsin (AMM, AE, LDC, SML), Children's Hospital of Wisconsin (SC), Milwaukee, Wisconsin
| | - Stacee M. Lerret
- Medical College of Wisconsin (AMM, AE, LDC, SML), Children's Hospital of Wisconsin (SC), Milwaukee, Wisconsin
| |
Collapse
|
16
|
Mullish BH, Kabir MS, Thursz MR, Dhar A. Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation. Aliment Pharmacol Ther 2014; 40:880-92. [PMID: 25175904 DOI: 10.1111/apt.12925] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 07/14/2014] [Accepted: 07/28/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The scale of depression in patients with chronic liver disease (CLD) and those who have received orthotopic liver transplantation (OLT) is poorly characterised. Clinicians are uncertain of how best to manage depression within these patients. AIMS To review the literature evaluating both the prevalence and impact of depression in patients with CLD and post-OLT, and to assess the safety and efficacy of antidepressant use within this context. METHODS A PubMed search using the phrases 'chronic liver disease', 'cirrhosis', 'liver transplantation', 'depression', 'antidepressant' and the names of specific causes of liver disease and individual antidepressants. RESULTS Over 30% of cirrhotic patients have depressive features, and they experience worse clinical outcomes than nondepressed cirrhotic patients. CLD patients with chronic hepatitis C are particularly prone to depression, partly related to the use of interferon therapy. OLT patients with depression have higher mortality rates than nondepressed patients; appropriate antidepressant use reverses this effect. Selective serotonin reuptake inhibitors (SSRIs) and selective noradrenaline reuptake inhibitors (SNRIs) are effective and generally safe in both CLD and OLT patients. CONCLUSIONS Depression is much more prevalent in CLD or OLT patients than is generally recognised, and it adversely affects clinical outcomes. The reasons for this relationship are complex and multifactorial. Antidepressants are effective in both CLD and post-OLT, although lower doses or a reduced dosing frequency may be required to minimise side effects, e.g. exacerbation of hepatic encephalopathy. Further research is needed to establish optimal management of depression in these patients, including the potential role of nonpharmacological treatments.
Collapse
Affiliation(s)
- B H Mullish
- Section of Hepatology, Faculty of Medicine, Imperial College London, St Mary's Hospital Campus, Paddington, London, UK
| | | | | | | |
Collapse
|