Comparison of quality of life between two clinical conditions with immunosuppressive therapy: liver transplantation and multiple sclerosis

Coping Strategies in Liver Transplant Recipients and Caregivers According to Patient Posttraumatic Growth

The purpose of this study was to analyze the differences in coping strategies employed by liver transplant recipients and their family members according to patient posttraumatic growth. Two matched groups of 214 liver transplant recipients and 214 family members were selected. The Posttraumatic Growth Inventory and Brief COPE were used. The most relevant results were: (1) Interactive effects in active coping, support (instrumental and emotional) and acceptance strategies, which were all used more by patients with higher growth levels, while their family members showed no differences in use of these strategies by patient growth level. Furthermore, while a low level of patient growth did not mark differences between them and their caregivers, a high level did, patients employing more active coping and support (instrumental and emotional), (2) In both groups a high level of patient growth was associated with more use of positive reframing and denial than a low one, and (3) Self-blame was employed by patients more than by their caregivers. It was concluded that a high level of posttraumatic growth in liver transplant recipients is associated with more use of healthy coping strategies, basically active coping, instrumental support, and emotional support.

Quality of life after liver transplantation: State of the art

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.

Impact of different immunosuppressive regimens on the health-related quality of life following orthotopic liver transplantation

BACKGROUND

The influence of immunosuppression on the recipients' quality of life (QoL) is of major importance after OLT and has not yet been evaluated.

METHODS

The impact of different immunosuppression regimens after OLT was evaluated in 275 patients using the Short Form 36 (SF-36) survey. The following immunosuppressive strategies were compared: (a) CNI, (b) mTOR inhibitors, and (c) mTOR combined with CNI. All regimens were prescribed alone (mono) or in combination (+) with prednisolone and/or mycophenolate mofetil (MMF).

RESULTS

Highest scores were evident in patients in the mTOR+ group. There were significantly higher values for general health perceptions (GH, p = 0.049), vitality (VIT, p = 0.020), and physical component summary (PCS, p = 0.041) when compared to CNImono and for GH (p = 0.042) and VIT (p = 0.043), when compared to mTORmono. Early conversion to mTOR inhibitors (<two months after OLT) was associated with higher values for 7 of 10 scales, when compared to a late conversion (>two months after OLT), with a statistically significant improvement for the dimension role-emotional (RE, p = 0.027).

DISCUSSION

mTOR inhibitor-based regimens appear to have beneficial effects on QoL after OLT, especially after an early conversion.

Influence of acute cellular rejection and depressive symptomatology on liver transplant recipients' quality of life

BACKGROUND

The objective of this study was to analyze the influence of two variables (acute cellular rejection and depressive symptomatology) on liver transplant recipients' quality of life.

METHODS

Using a 2 × 2 factorial design, two groups were selected: 44 patients who had acute cellular rejection and 44 patients without this medical complication. After an average of 6 years since the transplant, patients were assessed with the Hospital Anxiety and Depression Scale and the SF-36 Health Survey. Analysis of variance, t test for unpaired samples, and Cohen's d effect size index were applied.

RESULTS

The presence of clinical depressive symptomatology negatively affected all dimensions of quality of life (P < .001; large effect sizes); and interactive effects between factors acute cellular rejection and depressive symptomatology were found in the dimensions role-physical (P = .049) and bodily pain (P = .017). Transplant recipients with clinical depressive symptomatology scored lower on both dimensions (role-physical, P = .110, d = 0.52, medium effect size; bodily pain, P = .001, d = 1.25, large effect size) if they had an acute cellular rejection. In contrast, if they did not exceed the clinical threshold for depressive symptomatology, there were no differences in these dimensions (role-physical, P = .239, d = -0.33, small effect size; bodily pain, P = .555, d = 0.16, null effect size) between transplant recipients with and without acute cellular rejection.

CONCLUSIONS

Clinical depressive symptomatology is associated with poorer quality of life in liver transplant recipients; and the long-term differences in the dimensions role-physical and bodily pain between liver transplant recipients with and without acute cellular rejection depend on patients' mental health.

Comparison of the affective symptomatology between liver transplant recipients and patients with multiple sclerosis considering their functional impairment

OBJECTIVES

We aimed to compare the affective symptomatology in two medical conditions under immunotherapy (cadaveric liver transplantation [G1] and multiple sclerosis [G2]), considering their functional impairment, and to assess the clinical significance of the results regarding a representative age-adjusted sample of the general Spanish population (G3).

METHODS

Using a cross-sectional design, 164 patients (82 per clinical group) were selected, matched for gender, and homogenized regarding age and functional impairment according to the Physical functioning subscale from the SF-36 Health Survey. The criterion variables were the Mental health and Role-emotional SF-36 subscales and the Hospital Anxiety and Depression Scale. An analysis of covariance was conducted, controlling for age and the Physical functioning score as covariates. Cohen's d was reported as an effect size index and to analyze the clinical significance regarding a representative age-adjusted sample of the general Spanish population (n = 7881).

RESULTS

No statistically significant differences were found between conditions in any affective dimension (P > .05; ds₁₋₂ from 0.08 to 0.30) or in the percentage of clinical cases regarding the anxious (P = .628) or depressive spectrum (P = .716). The neurological patients showed clinically significant impairment in both SF-36 subscales (ds₂₋₃ = 0.55 and 0.52, respectively), but transplant recipients only differed from the general population in Role-emotional (d₁₋₃ = 0.81).

CONCLUSIONS

Despite having controlled for functional impairment, important deterioration in daily functioning was still found in liver recipients due to emotional problems, and no relevant differences were observed even when compared with a neurodegenerative condition such as multiple sclerosis.

Evolution of quality of life in renal transplant recipients and patients with multiple sclerosis: a follow-up study

OBJECTIVE

We aimed to compare the evolution of quality of life in 2 medical conditions under immunotherapy (cadaveric renal transplantation [G1] and multiple sclerosis [G2]), and to assess the clinical significance of the results compared with a representative age-adjusted sample of the general Spanish population (G3).

METHODS

Using a mixed design (2 × 2), the SF-36 Health Survey was administered to 60 patients with one of these clinical conditions (30 in each group; the patient group factor), matched for gender, and homogenized regarding age and working status. All renal patients had undergone transplantation 6 months before the first assessment, and all neurological patients presented a relapsing-remitting course and a mild-moderate disability level. Both patient groups were assessed a second time 6 months later (the phase factor). A mixed analysis of covariance was computed controlling for age as a covariate. Cohen's d was reported as an effect size index and to analyze the clinical significance regarding a representative age-adjusted sample of the general Spanish population (n = 5821).

RESULTS

Statistically significant differences were found between patient groups in vitality, bodily pain, social functioning, and mental health (P < .01), in which worse levels were displayed by patients with multiple sclerosis in both phases (Cohen's ds1-2 from 0.61 to 1.40). Likewise, an interactive effect was observed in physical functioning [F(1,57) = 12.93; P = .001], such that the performance of daily physical activities improved in renal recipients after 6 months, but it decreased in neurological patients. Patients with multiple sclerosis showed higher, clinically significant impairment in all SF-36 dimensions in both phases compared with renal recipients (Cohen's ds2-3 from -0.50 to -1.61), who presented clinically significant impairment in general health, role-physical, and role-emotional (Cohen's ds1-3 from -0.73 to -1.28).

CONCLUSIONS

Renal transplant recipients need specialized health care 1 year after transplantation because they still display relevant impairment in daily functioning compared with the general population.