The effect of recurrence of HCV infection of life after liver transplantation

Impact of hepatitis C virus infection on health-related quality of life before and after liver transplantation: a multidisciplinary point of view

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.

Health-related quality of life after liver transplantation for adult recipients

1. Pretransplantation health-related quality of life scores are affected by the etiology of liver cirrhosis, with hepatocellular and cholestatic etiologies having higher health-related quality of life scores than alcohol or viral hepatitis etiologies. 2. Posttransplantation health-related quality of life scores are not affected by the etiology of the original liver cirrhosis, but transplant recipient scores continue to remain significantly lower than those of healthy patient controls. 3. During the first 6 months after liver transplantation, the majority of physical and mental components of health-related quality of life scores improve, but these increases are not sustained in the long term. 4. At 1 year after liver transplantation, emotional and mental health-related quality of life scores begin to decrease. 5. During postoperative years 1 to 5, episodes of acute cellular rejection and patient age over 60 years decrease physical function and overall general health-related quality of life scores. 6. Beyond 5 years after orthotopic liver transplantation, age over 60, osteoporosis, and episodes of chronic rejection decrease health-related quality of life scores through decreases in the physical function and bodily pain domains. 7. Hepatitis C as an indication for liver transplantation is an independent factor in decreasing posttransplantation health-related quality of life scores. 8. Further studies are necessary that include a complete evaluation of the effects of gender, socioeconomic status, education, and ethnicity in order to better understand factors influencing post-liver transplantation health-related quality of life scores. 9. The development of a health-related quality of life assessment tool specific to transplantation could help us to more accurately assess factors (such as immunosuppression) that alter posttransplantation health-related quality of life.

Factors influencing change in health-related quality of life after liver transplantation

OBJECTIVE

To assess health-related quality of life (HRQoL) in patients following liver transplantation and the factors associated with HRQoL variation.

METHODS AND MATERIALS

Sociodemographic and clinical data were collected for 60 consecutive patients activated for liver transplantation in a single hospital. Patients were classified according to the severity of the cirrhosis (Child-Pugh class) and disease etiology (alcoholic cirrhosis, viral cirrhosis, cholestatic diseases, and hepatocarcinoma). HRQoL was assessed by three different questionnaires: the Health Survey Short Form 36 (SF-36), the Hospital Anxiety and Depression Scale (HAD), and a specific-symptom questionnaire. Questionnaires were completed during the pre-operative period and six months after transplantation.

RESULTS

In the pre-operative period, patients with Child A had higher mean levels of HRQoL than did those in other groups. At six months following transplantation, there were no significant differences among the groups, largely because gains obtained by patients with Child B and C were much greater than those attained by patients with Child A. Across the four etiological groups, there were significant differences in all domains of the three questionnaires, except SF-36-bodily pain and HAD-anxiety, prior to transplantation, because patients with hepatocarcinoma had much better HRQoL. After transplantation, there were no differences because patients with viral and alcohol-induced cirrhosis achieved greater gains with respect to the neoplastic group. During the pre-operative period, the scores for all areas of the SF-36 and for all groups were below the general population normalized score of 50 (except for patients with Child class A and those affected with hepatocarcinoma). Six-months post-transplantation, the scores on most of the domains remained below 50, except for certain mental areas in which higher scores were attained.

CONCLUSIONS

Health-related quality of life is influenced by the severity and etiology of cirrhosis-patients with Child class C and those with alcoholic or viral cirrhosis have the poorest quality of life. There were no differences observed among the groups after the transplantation, as the patients with the lowest HRQoLs prior to surgery demonstrated greater gains in HRQoL associated with liver transplantation.