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Maxwell M, Alvarado M, Khungar V. Approach to sexual dysfunction in patients with chronic liver disease. Clin Liver Dis (Hoboken) 2024; 23:e0190. [PMID: 38872775 PMCID: PMC11168852 DOI: 10.1097/cld.0000000000000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/20/2024] [Indexed: 06/15/2024] Open
Affiliation(s)
- Mariko Maxwell
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Meagan Alvarado
- Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Vandana Khungar
- Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
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Abstract
OBJECTIVES Patients with cirrhosis experience a worsened quality of life; this may be quantified by the use of health-related QoL (HRQoL) constructs, such as the chronic liver disease questionnaire (CLDQ) and EuroQoL Group-visual analog scale (EQ-VAS). In this multicenter prospective study, we aimed to evaluate HRQoL as a predictor of unplanned hospital admission/early mortality, identify HRQoL domains most affected in cirrhosis, and identify predictors of low HRQoL in patients with cirrhosis. METHODS Multivariable logistic regression was used to determine independent association of HRQoL with primary outcome and identify predictors of low HRQoL. HRQoL was also compared with population norms. RESULTS In this cohort of 402 patients with cirrhosis, mean model for end-stage liver disease was 12.5 (4.9). More than 50% of the cohort had low HRQoL, considerably lower than population norms. HRQoL (measured by either CLDQ or EQ-VAS) was independently associated with the primary outcome of short-term unplanned hospitalization/mortality. Every 1-point increase in the CLDQ and every 10-point increase in the EQ-VAS reduced the risk of reaching this outcome by 30% and 13%, respectively. Patients with cirrhosis had lower HRQoL scores than population norms across all domains of the CLDQ. Younger age, female sex, current smoker, lower serum albumin, frailty, and ascites were independently associated with low CLDQ. DISCUSSION Patients with cirrhosis experience poor HRQoL. HRQoL is independently associated with increased mortality/unplanned hospitalizations in patients with cirrhosis and could be an easy-to-use prognostic screen that patients could complete in the waiting room before their appointment.
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Gülen H, Karaca A. Evaluation of the Educational Needs of Organ Donors After Transplantation Surgery. Transplant Proc 2020; 52:78-83. [PMID: 31901323 DOI: 10.1016/j.transproceed.2019.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study involved individuals (donors) who underwent transplant surgery and evaluated their educational requirements for meeting self-care needs in the postdischarge period. MATERIALS AND METHODS This descriptive study consisted of 73 donors who underwent surgery for organ donation in the Şişli Florence Nightingale Training and Research Hospital in Istanbul and who were intended to be discharged after the organ donation. Data were collected using the Donor Information Form and the Post-Organ Donation Educational Needs Survey, which were prepared by researchers based on literature. RESULTS The mean age of the participants was 38.86 ± 0.78 years. Of them, 54.8% were male, and 38.4% were high school graduates. All the donors (n = 73) received discharge education, and all the education was given by physicians and nurses. But, most donors (63%) stated that the discharge education was not adequate in meeting their needs. Participants received the lowest mean score (2.41 ± 1.27) on the item of "I feel calm and peaceful." The donors' mean total score on the survey was 137.81 ± 25.96 (minimum 76; maximum 170). CONCLUSION The donors' educational needs for postdischarge self-care were high. It is necessary to determine the educational needs of donors to plan the discharge education for self-care management in home care.
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Affiliation(s)
- Hande Gülen
- Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Anita Karaca
- Biruni University, Faculty of Health Sciences, Nursing Department, İstanbul, Turkey.
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A Retrospective Evaluation of 728 Kidney Donors Who Applied for Organ Donation. Transplant Proc 2019; 51:1054-1057. [PMID: 31101170 DOI: 10.1016/j.transproceed.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/28/2019] [Accepted: 02/16/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to determine the sociodemographic characteristics of people who applied to be kidney donors at an organ transplantation center. MATERIAL AND METHODS A total of 728 participants in the kidney donor program were included in the study between 2015 and 2018 at Istanbul Yeniyüzyıl University Gaziosmanpaşa Hospital. The sociodemographic data of the participants were retrospectively analyzed through computer records, and data were analyzed. RESULTS Two hundred thirty-nine men and 489 women were included into the study. Six hundred ten were live donors, and 118 were cadaveric donors. Of the donors included in the study, 24.9% were illiterate, 52.1% were primary school graduates, 17.3% were high school graduates, and 5.7% were university graduates. Of the living donors, 156 (25.5%) were spouses, 91 (14.9%) were mothers, 72 (11.9%) were siblings, 65 (10.5%) were fathers, 64 (10.7%) were children, 46 were (7.5%) were other relatives, and 116 (19.0%) were nonrelatives. CONCLUSIONS In recent years, the number of live kidney transplantations has increased. Therefore, it is necessary to protect their well-being by using evidence-based donor evaluation and treatment strategies to prevent and treat negative consequences of donations.
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McLean KA, Drake TM, Sgrò A, Camilleri-Brennan J, Knight SR, Ots R, Adair A, Wigmore SJ, Harrison EM. The effect of liver transplantation on patient-centred outcomes: a propensity-score matched analysis. Transpl Int 2019; 32:808-819. [PMID: 30793373 DOI: 10.1111/tri.13416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/19/2018] [Accepted: 02/18/2019] [Indexed: 12/21/2022]
Abstract
It is unclear whether liver transplantation confers an increase in health-related quality of life (HR-QoL) across all dimensions of health. This study aimed to estimate the effect of liver transplantation on HR-QoL. Pre- and post-transplantation patients attending an outpatient clinic were invited to complete the condition-specific 'Short form of liver disease QOL' questionnaire. Mixed-effect linear regression and propensity-score matching (PSM) on pretransplantation characteristics were used to estimate the difference in overall HR-QoL associated with transplantation. Of 454/609 (74.5%) eligible patients who were included in the analysis, 102 (22.5%) patients fall under pretransplantation category, and 352 (77.5%) were under post-transplantation category. Overall HR-QoL post-transplantation significantly increased in patients without hepatocellular carcinoma (HCC) (β = 16.84, 95% CI: 13.33 to 20.35, P < 0.001), but not with HCC (β = 1.25, 95% CI: -5.09 to 7.60, P = 0.704). Donation after circulatory death (DCD) organ recipients had a significantly lower HR-QoL (β = -4.61, 95% CI: -8.95 to -0.24, P = 0.043). Following PSM, transplantation was associated with a significant increase in overall HR-QoL (average treatment effect: 6.3, 95% CI: 2.1-10.9). There is a significant improvement in HR-QoL attributable to transplantation in this cohort. Post-transplantation HR-QoL was affected by several factors, including HCC status and DCD transplantation, which has important implications for counselling prior to liver transplantation.
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Affiliation(s)
- Kenneth A McLean
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Thomas M Drake
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alessandro Sgrò
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Julian Camilleri-Brennan
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Riinu Ots
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Anya Adair
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Stephen J Wigmore
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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Casanovas T, Herdman M, Chandía A, Peña MC, Fabregat J, Vilallonga JS. Identifying Improved and Non-improved Aspects of Health-related Quality of Life After Liver Transplantation Based on the Assessment of the Specific Questionnaire Liver Disease Quality of Life. Transplant Proc 2016; 48:132-7. [PMID: 26915858 DOI: 10.1016/j.transproceed.2015.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/10/2015] [Accepted: 11/18/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The specific questionnaire Liver Disease Quality of Life (LDQOL) is a valid tool for measuring quality of life (QOL) and has been used to show that liver transplantation (LT), which is an effective treatment for end-stage liver disease, may improve QOL. OBJECTIVES This study aims to identify aspects of QOL that improve after LT and those that do not. PATIENTS AND METHODS Patients accepted for LT were invited to answer the LDQOL at baseline and after transplantation at 6 and 12 months. LDQOL contains the 36-item Short Form Health Survey (SF-36) and 12 specific dimensions. Responsiveness was assessed using the paired Student t test. RESULTS The study included a cohort of 156 patients, 73% males, of an average age of 53 (26-67) years, with the following common indications: tumor (35%), hepatitis C (23%), and alcohol-related (21%) liver disease. Mean scores showed a statistically significant (P < .05) improvement after 1 year in 6 of 8 SF-36 dimensions, in the physical component summary score, and in 7 of 12 disease-specific dimensions. The two dimensions that showed no improvement in the SF-36 dimensions were "social functioning" and "vitality," whereas the specific dimensions to not improve were "sleep problems," "social interaction," "activities of daily living," and "concerns about the future." CONCLUSION Findings suggest that perceived QOL after LT improves but could be further enhanced with the use of specific programs for amending sleep disorders and physical aspects.
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Affiliation(s)
- T Casanovas
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
| | - M Herdman
- Insight Consulting and Research, Mataró, Spain
| | - A Chandía
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - M C Peña
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - J Fabregat
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
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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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Aguiar MIFD, Braga VAB, Almeida PCD, Garcia JHP, Lima CAD. Gravidade da doença hepática e qualidade de vida no transplante de fígado. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Resumo Objetivo Analisar a influência da gravidade da doença hepática na qualidade de vida dos pacientes antes e depois do transplante de fígado. Métodos Estudo descritivo com 150 receptores de transplante hepático, maiores de 18 anos. A gravidade foi avaliada pelo Child e MELD e aplicado o Liver Disease Quality of Life. Foi utilizado teste t ou Mann-Whitney para comparação das médias dos domínios e ANOVA ou Kruskal-Wallis para comparação entre grupos. Resultados Antes do transplante, os pacientes com Child C obtiveram menores escores de qualidade de vida do que os com Child A. Pacientes com MELD menor ou igual a 15 tiveram aumento significativo das médias em 10 domínios, enquanto os pacientes com MELD superior a 15 tiveram aumento nos 12 domínios. Conclusão Houve influência negativa da gravidade pelo CTP na qualidade de vida antes do transplante. O MELD não interferiu significativamente nos resultados pós-transplante, mesmo com elevação das médias.
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Ferreira FAP, de Almeida-Neto C, Teixeira MCD, Strauss E. Health-related quality of life among blood donors with hepatitis B and hepatitis C: longitudinal study before and after diagnosis. Rev Bras Hematol Hemoter 2015; 37:381-7. [PMID: 26670400 PMCID: PMC4678909 DOI: 10.1016/j.bjhh.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/15/2015] [Accepted: 08/24/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction There is evidence that patients suffering from chronic hepatic diseases, including chronic hepatitis B and chronic hepatitis C, have a reduced health-related quality of life. The aim of this study was to evaluate the impact of the notification of test results for hepatitis B and hepatitis C on the quality of life of blood donors. Methods Over a 29-month period, this study assessed the quality of life of 105 blood donors with positive serological screening tests for hepatitis B and hepatitis C and donors who presented false-positive test results. The Medical Outcome Study 36-Item Short Form Health Survey Questionnaire was applied at three time points: (1) when an additional blood sample was collected for confirmatory tests; (2) when donors were notified about their serological status; and (3) when donors, positive for hepatitis B and hepatitis C, started clinical follow-up. Quality of life scores for the confirmed hepatitis B and hepatitis C groups were compared to the false-positive control group. Results The domains bodily pain, general health perception, social function, and mental health and the physical component improved significantly in donors with hepatitis C from Time Point 1 to Time Point 3. Health-related quality of life scores of donors diagnosed with hepatitis B and hepatitis C were significantly lower in six and four of the eight domains, respectively, compared to the false-positive control group. Conclusion A decreased quality of life was detected before and after diagnosis in blood donors with hepatitis B and hepatitis C. Contrary to hepatitis B positive donors, the possibility of medical care may have improved the quality of life among hepatitis C positive donors.
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Affiliation(s)
| | | | | | - Edna Strauss
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Ladner DP, Dew MA, Forney S, Gillespie BW, Brown RS, Merion RM, Freise CE, Hayashi PH, Hong JC, Ashworth A, Berg CL, Burton JR, Shaked A, Butt Z. Long-term quality of life after liver donation in the adult to adult living donor liver transplantation cohort study (A2ALL). J Hepatol 2015; 62:346-53. [PMID: 25195558 PMCID: PMC4300258 DOI: 10.1016/j.jhep.2014.08.043] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/21/2014] [Accepted: 08/29/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS There are few long-term studies of the health-related quality of life (HRQOL) in living liver donors. This study aimed to characterize donor HRQOL in the Adult to Adult Living Donor Liver Transplantation Study (A2ALL) up to 11 years post-donation. METHODS Between 2004 and 2013, HRQOL was assessed at evaluation, at 3 months, and yearly post-donation in prevalent liver donors using the short-form survey (SF-36), which provides a physical (PCS) and a mental component summary (MCS). RESULTS Of the 458 donors enrolled in A2ALL, 374 (82%) had SF-36 data. Mean age at evaluation was 38 (range 18-63), 47% were male, 93% white, and 43% had a bachelor's degree or higher. MCS and PCS means were above the US population at all time points. However, at every time point there were some donors who reported poor scores (>1/2 standard deviation below the age and sex adjusted mean) (PCS: 5.3-26.8%, MCS 10.0-25.0%). Predictors of poor PCS and MCS scores included recipient's death within the two years prior to the survey and education less than a bachelor's degree; poor PCS scores were also predicted by time since donation, Hispanic ethnicity, and at the 3-month post-donation time point. CONCLUSIONS In summary, most living donors maintain above average HRQOL up to 11 years prospectively, supporting the notion that living donation does not negatively affect HRQOL. However, targeted support for donors at risk for poor HRQOL may improve overall HRQOL outcomes for living liver donors.
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Affiliation(s)
- Daniela P. Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, Chicago, IL, United States
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology and Biostatistics, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA, United States
| | - Sarah Forney
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States
| | - Brenda W. Gillespie
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Robert S. Brown
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Robert M. Merion
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Chris E. Freise
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Paul H. Hayashi
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Johnny C. Hong
- Department of Surgery, Medical College of Wisconsin, WI, United States
| | - April Ashworth
- Virginia Commonwealth University, Richmond, VA, United States
| | - Carl L. Berg
- Duke University Health System, Durham, North Carolina, United States
| | - James R. Burton
- Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Abraham Shaked
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Zeeshan Butt
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, Chicago, IL, United States, Department of Medical Social Sciences, Northwestern University Feinberg School of ssMedicine, Chicago, IL, United States, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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García-Rodríguez MT, Piñón-Villar MDC, López-Calviño B, Otero-Ferreiro A, Suárez-López F, Gómez-Gutiérrez M, Pita-Fernández S. Assessment of nutritional status and health-related quality of life before and after liver transplantation. BMC Gastroenterol 2015; 15:6. [PMID: 25608608 PMCID: PMC4310167 DOI: 10.1186/s12876-015-0232-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/13/2015] [Indexed: 02/06/2023] Open
Abstract
Background Patients with chronic liver disease frequently suffer from malnutrition, together with a decline in their health-related quality of life. This study was carried out with the aim of evaluating the nutritional status, complications of medical and surgical care, anxiety, health-related quality of life and dependence level on basic and instrumental activities of daily living in pre- and post-liver transplant patients. Methods/Design A prospective observational study with follow-up of patients on the waiting list for liver transplants who subsequently received a transplant at the University Hospital Complex in A Coruña during the period 2012–2014 (n = 110). All the patients will be followed-up for a maximum of 6 months. For survivors, assessments will be re-evaluated at one, three and six months post- transplant. Informed consent of the patient and ethical review board approval was obtained (Code: 2010/081 and 2010/082). The following variables will be studied: socio-demographic data, reason for the transplant, comorbidity (Charlson Score), analytical parameters, time on transplant waiting list and post-transplant complications. A trained nurse will evaluate the following for each patient: nutritional indices, anthropometric variables and handgrip strength. Validated questionnaires will be used to determine the patients’ nutritional status (Subjective Global Assessment), anxiety (STAI questionnaire), Health-Related Quality of Life (LDQoL 1.0 questionnaire), dependence (Barthel Index and Lawton-Brody Scale), nursing diagnoses (NANDA) and post-transplant quality indicators. Multiple linear/logistic regression models will be used to identify variables associated with the events of interest. Changes in nutritional status, quality of life and dependence over time will be analysed with linear mixed-effects regression models. Actuarial survival analysis using Kaplan-Meier curves, Cox regression and competitive risk will be performed Concordance between the different scores that assess nutritional status and interobserver agreement regarding nursing diagnoses will be studied using the statistical Kappa index and Bland Altman method. Discussion The risk of malnutrition can be considered as a possible prognostic factor in transplant outcomes, associated with anxiety, health-related quality of life and dependence. For this reason we consider interesting to perform a prospective follow-up study of patients who require a transplant to survive, studying their nutritional status and health-related quality of life. Electronic supplementary material The online version of this article (doi:10.1186/s12876-015-0232-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- María Teresa García-Rodríguez
- Digestive Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Xerencia de Xestión Integrada de A Coruña, SERGAS, Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain.
| | - María Del Carmen Piñón-Villar
- Digestive Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Xerencia de Xestión Integrada de A Coruña, SERGAS, Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain.
| | - Beatriz López-Calviño
- Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, 15006, A Coruña, Spain.
| | - Alejandra Otero-Ferreiro
- Digestive Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Xerencia de Xestión Integrada de A Coruña, SERGAS, Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain.
| | - Francisco Suárez-López
- Digestive Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Xerencia de Xestión Integrada de A Coruña, SERGAS, Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain.
| | - Manuel Gómez-Gutiérrez
- Transplant Coordination, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), SERGAS, Universidade da Coruña, 15006, A Coruña, Spain.
| | - Salvador Pita-Fernández
- Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, 15006, A Coruña, Spain.
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Orr JG, Homer T, Ternent L, Newton J, McNeil CJ, Hudson M, Jones DEJ. Health related quality of life in people with advanced chronic liver disease. J Hepatol 2014; 61:1158-65. [PMID: 25010259 DOI: 10.1016/j.jhep.2014.06.034] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/19/2014] [Accepted: 06/30/2014] [Indexed: 02/06/2023]
Abstract
Cirrhosis has a long natural history with considerable symptomatic impacts, particularly in advancing disease. Measuring health related quality of life (HRQOL) in liver disease provides detail about the nature and extent of its effects on individuals. Understanding the drivers of impaired HRQOL can help identify targets for improvement through new treatments or health systems service delivery. Evaluation of novel therapies which target symptomatic improvement, should be done with suitable outcome measures, including HRQOL assessment. In this article, we provide an overview of HRQOL in advanced liver disease for the clinician. A clear description of the important HRQOL tools is given alongside a discussion of the factors, which are known to contribute to impaired HRQOL in advanced liver disease.
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Affiliation(s)
- James G Orr
- Institute of Cellular Medicine, Newcastle University, UK
| | - Tara Homer
- Institute of Health and Society, Newcastle University, UK
| | - Laura Ternent
- Institute of Health and Society, Newcastle University, UK
| | - Julia Newton
- Institute of Cellular Medicine, Newcastle University, UK
| | - Calum J McNeil
- Institute of Cellular Medicine, Newcastle University, UK
| | - Mark Hudson
- Institute of Cellular Medicine, Newcastle University, UK
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Altered quality of life in the early stages of chronic hepatitis C is due to the virus itself. Clin Res Hepatol Gastroenterol 2014; 38:40-5. [PMID: 24239318 PMCID: PMC5061030 DOI: 10.1016/j.clinre.2013.08.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/22/2013] [Accepted: 08/27/2013] [Indexed: 02/04/2023]
Abstract
UNLABELLED Health-related quality of life (HRQOL) is impaired in chronic viral hepatitis and a direct role of the virus, although suggested, has not been demonstrated. Our aim was to evaluate HRQOL at blood donation before knowledge of the diagnosis of both hepatitis C virus (HCV) and hepatitis B virus (HBV) so as to elucidate this matter. METHODS Prospectively, 67 sequential patients, 35 with HCV and 32 with HBV, and 67 matched controls were administered the generic Short Form-36 (SF-36) questionnaire. After knowledge of diagnosis, the SF-36 was repeated and a disease-specific questionnaire (Liver Disease Quality of Life, LDQOL-1.0) was also administered. The Wilcoxon test and Mann-Whitney U were used for between-group comparisons. RESULTS Before knowledge of diagnosis, patients with HCV had worse HRQOL than controls, with statistically significant changes in 7/8 domains of the SF-36, and also in its physical and mental components. In the HBV group, only 2/8 domains and the physical component were significantly different from controls. After diagnosis, similar changes persisted in the HCV group, whereas two more domains were compromised in the HBV group. Comparisons between the HCV and HBV groups did not show significant differences. CONCLUSION The finding of greater HRQOL impairment in the HCV group before diagnosis confirms the theory that the presence of HCV in the early stage of the disease is associated with worse quality of life.
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Abstract
Quality of life is a construct that reflects the positive and negative aspects of one's life, and is expanded upon by health-related quality of life (HRQL), which specifically address the impact of health on patients' well-being. Cirrhosis is the culmination of various pathways that leads into development of advanced hepatic fibrosis with its complications. This paper addresses the impact of cirrhosis on individuals HRQL. In addition, we will define what disease specific and general HRQL instruments aim to measure. We discuss the liver disease specific scales [Chronic Liver Disease Questionnaire (CLDQ), Liver Disease Quality of Life 1.0 (LDQOL)] and the most commonly used generic health profile [Short Form 36 Profile (SF-36)]. Furthermore, we examine recent literature which describes how to measure and what is known about quality of life of patients with cirrhosis. This information gives insight to health care providers concerning the impact of disease on patients if treatments are not only to improve health but also function and unexpected treatment outcomes.
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Quality of life, risk assessment, and safety research in liver transplantation: new frontiers in health services and outcomes research. Curr Opin Organ Transplant 2013; 17:241-7. [PMID: 22476225 DOI: 10.1097/mot.0b013e32835365c6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW In this review, we briefly summarize three fruitful, emerging areas in liver transplantation research, quality of life; risk assessment; and patient safety. Our goal is to highlight recent findings in these areas, with a call for increased integration of social scientists and transplant clinicians to address how best to shape policy and improve outcomes. RECENT FINDINGS After liver transplantation, recipients generally experience clinically significant, sustained improvement in their physical, social and emotional well being. However, a sizeable minority of patients do experience excess morbidity that may benefit from ongoing surveillance and/or intervention. There is growing body of research that describes risks associated with liver transplantation, which can be useful aids to better inform decision making by patients, clinicians, payers, and policy makers. In contrast, there has been a relative lack of empirical data on transplant patient safety vulnerabilities, placing the field of surgery in stark contrast to other high-risk industries, wherein such assessments inform continuous process improvement. SUMMARY Health services and outcomes research has grown in importance in the liver transplantation literature, but several important questions remain unanswered that merit programmatic, interdisciplinary research.
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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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17
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Ordin YS, Dicle A, Wellard S. Quality of life in recipients before and after liver transplantation in Turkey. Prog Transplant 2011. [PMID: 21977888 DOI: 10.7182/prtr.21.3.pl837214k0276260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Liver transplantation has become the treatment of choice for patients with end-stage liver disease. Most studies show a positive effect on quality of life after liver transplantation, but most studies are based on data from Western countries and little is known about quality of life in liver transplant recipients in Turkey or other developing countries. OBJECTIVE To investigate liver transplant recipients' quality of life and factors affecting it, before and 3 months after transplantation in western Turkey. DESIGN Descriptive and comparative, with data collected prospectively. SETTING Two medical centers in Western Turkey. PATIENTS Sixty-five adult recipients of a liver transplant between May 15 and December 31,2007. INSTRUMENTS Quality of life was measured by using the Nottingham Health Profile Turkish version, and sociodemographic and clinical data were collected from patients' records. RESULTS Scores on all subscales of the Nottingham Health Profile differed significantly from before to after liver transplantation. The differences between the mean scores for quality of life before and after transplantation varied significantly with the patients' sex and disease severity.
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Affiliation(s)
- Yaprak S Ordin
- Surgical Nursing Department, School of Nursing, Dokuz Eylul University, Inciralti, Turkey.
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Ordin YS, Dicle A, Wellard S. Quality of Life in Recipients before and after Liver Transplantation in Turkey. Prog Transplant 2011; 21:260-7. [DOI: 10.1177/152692481102100312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yaprak S. Ordin
- Dokuz Eylul University, Inciralti, Turkey (YSO, AD), University of Ballarat, Ballarat, Australia (SW)
| | - Aklime Dicle
- Dokuz Eylul University, Inciralti, Turkey (YSO, AD), University of Ballarat, Ballarat, Australia (SW)
| | - Sally Wellard
- Dokuz Eylul University, Inciralti, Turkey (YSO, AD), University of Ballarat, Ballarat, Australia (SW)
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Saab S, Ng V, Landaverde C, Lee SJ, Comulada WS, Arevalo J, Durazo F, Han SH, Younossi Z, Busuttil RW. Development of a disease-specific questionnaire to measure health-related quality of life in liver transplant recipients. Liver Transpl 2011; 17:567-79. [PMID: 21506245 DOI: 10.1002/lt.22267] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Currently, no disease-targeted instrument is available for measuring health-related quality of life (HRQOL) in liver transplant recipients. We developed and tested a post-liver transplant quality of life (pLTQ) instrument. Item selection for the pLTQ instrument was based on responses from liver transplant recipients, 12 liver experts, and a literature search. Impact scores were generated, and a factor analysis was conducted to organize the items into domains. Questions were constructed for each item, and redundant questions were removed. The pLTQ instrument was initially administered to 196 liver transplant patients and then was again administered to 77 patients 6 to 9 months later with a generic HRQOL survey [Medical Outcomes Study Short Form 36 (SF-36)]. Analysis of variance was used to compare the scores of patients at different times since transplantation and with various indications for transplantation. After redundancies were eliminated, the pLTQ instrument included 32 items in 8 domains: Emotional Function, Worry, Medications, Physical Function, Healthcare, Graft Rejection Concern, Financial, and Pain. We found stable pLTQ instrument and SF-36 instrument scores over time. Data 6 to 9 months after the initial assessment indicated stable quality of life outcomes. The pLTQ instrument is applicable to a variety of liver transplant recipients. The questionnaire was tested with a cross-sectional and longitudinal approach.
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Affiliation(s)
- Sammy Saab
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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Parikh ND, Ladner D, Abecassis M, Butt Z. Quality of life for donors after living donor liver transplantation: a review of the literature. Liver Transpl 2010; 16:1352-8. [PMID: 21117194 PMCID: PMC3058676 DOI: 10.1002/lt.22181] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Living donor liver transplantation (LDLT) decreases the shortage of liver grafts for patients in need of a liver transplant, but it involves 2 patients: a recipient and a living donor. Despite the magnitude of the procedure for LDLT donors, only a few studies have investigated the effect of LDLT on the quality of life (QOL) of donors. We performed a systematic search of the MEDLINE database to identify peer-reviewed articles assessing QOL in adults after LDLT donation. Nineteen studies describing 768 unique donors met our inclusion criteria for this review. The median number of donors enrolled in each study was 30 (range = 10-143), and the median follow-up period was 10.4 months (range = 3-51.3 months). Before donation, donor QOL was significantly better than that in control adult populations across all measured QOL domains. Within the first 3 months after donation, the physical domains of QOL were significantly worse than the predonation levels, but they returned to baseline levels within 6 months for the majority of patients (80%-93%). Mental domains of QOL remained unchanged throughout the donation process. Common donor concerns after LDLT included bloating, loss of muscle tone, poor body image, and fatigue. In conclusion, according to our review of the existing literature, most LDLT donors return to their baseline QOL within 6 months. However, there is a lack of long-term data on donor QOL after LDLT, and few standardized assessments include measures of common patient concerns. Additional studies are necessary to develop a comprehensive risk profile for LDLT that includes a rigorous assessment of donor QOL.
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Affiliation(s)
- Neehar D. Parikh
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, Chicago IL,Division of Gastroenterology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago IL
| | - Daniela Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, Chicago IL,Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago IL,Institute for Healthcare Studies, Northwestern Feinberg School of Medicine, Chicago IL
| | - Michael Abecassis
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, Chicago IL
| | - Zeeshan Butt
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, Chicago IL,Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago IL,Institute for Healthcare Studies, Northwestern Feinberg School of Medicine, Chicago IL
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Carey EJ, Steidley DE, Aqel BA, Byrne TJ, Mekeel KL, Rakela J, Vargas HE, Douglas DD. Six-minute walk distance predicts mortality in liver transplant candidates. Liver Transpl 2010; 16:1373-8. [PMID: 21117246 DOI: 10.1002/lt.22167] [Citation(s) in RCA: 211] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The 6-minute walk distance (6MWD) is a simple test measuring global physical function. It is commonly used to predict mortality in patients with cardiac and pulmonary diseases, but it is also useful in assessing the functional status of patients with a variety of other medical conditions. We sought to determine (1) the characteristics of the 6MWD in patients listed for liver transplantation (LT), (2) the existence of a relationship between the 6MWD and the quality of life, and (3) the relationship between the 6MWD and survival in LT candidates. The 6MWD was prospectively measured in all patients listed for LT. The 6MWD was determined when the listed Model for End-Stage Liver Disease (MELD) score was ≥ 15. Patients were followed until LT, death, removal from the wait list, or the end of the study period. Quality of life was assessed with the Short Form 36 (SF-36). In 121 patients, the mean 6MWD was 369 ± 122 m; it was not related to age, height, weight, body mass index, albumin level, or etiology of liver disease and showed a moderate correlation with the physical component score (PCS) on the SF-36 (r = 0.4) and a moderate inverse correlation with the native MELD score (r = -0.61). In an unadjusted analysis, a high native MELD score, a low 6MWD, and a low PCS were associated with mortality, with only the 6MWD retaining significance after adjustment for covariates. Each 100-m increase in the 6MWD was significantly associated with increased survival (hazard ratio = 0.48, P = 0.0001), with 6MWD < 250 m being associated with an increased risk of death (P = 0.0001). In conclusion, the 6MWD is significantly reduced in patients awaiting LT and is inversely correlated with the native MELD score. A pretransplant 6MWD < 250 m is a risk for death on the wait list.
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Affiliation(s)
- Elizabeth J Carey
- Divisions of Hepatology and Gastroenterology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
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Long-term patient outcome and quality of life after liver transplantation: analysis of 20-year survivors. Ann Surg 2010; 252:652-61. [PMID: 20881772 DOI: 10.1097/sla.0b013e3181f5f23a] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate patient survival and allograft function and health-related quality of life (HRQOL) 20 years after orthotopic liver transplantation (LT). SUMMARY OF BACKGROUND DATA Although LT is the established treatment of choice for acute and chronic liver failure, allograft function and recipient HRQOL 20 years after LT remain undefined. METHODS We performed a prospective, cross-sectional study of LT recipients surviving 20 years or more. Clinical data were reviewed to identify factors associated with 20-year survival. Survivors were directly contacted and offered a survey to assess HRQOL (SF-36; Liver Disease Quality of Life), social support, and cognition (Neuropsychological Impairment Scale). Logistic regression analysis was performed to identify clinical factors influencing HRQOL 20 years after LT. RESULTS Between February 1, 1984 and December 31, 1988, a total of 293 patients (179 adults, 114 children) received 348 LTs. Of the 293 patients, 168 (56%) survived for 20 years or more. Actuarial 20-year survival was 52% (patient) and 42% (graft). Factors associated with 20-year survival included recipient age <18 (P = 0.01), nonurgent LT (P = 0.01), no retransplantation (0.02), female gender (0.03), absence of biliary complications (P = 0.04), and short total ischemia time (P = 0.05). Rejection episodes were seen in a greater proportion of 20-year survivors than in nonsurvivors (35% vs. 27%; P = 0.3). Of the 168 survivors, 87 were contacted, and 68 (78%) completed the HRQOL surveys. Compared with the general population, survivors had lower physical scores (P < 0.01) but comparable mental scores on the SF-36. Overall HRQOL was significantly better in 20-year survivors than in patients with chronic liver disease, congestive heart failure, or diabetes. Clinical factors associated with improved post-LT HRQOL were younger age at LT, allograft longevity, and strong social support. More than 90% of pediatric survivors completed high school. After LT, 34% of pediatric recipients married, and 79% remained married at 20 years' follow-up. CONCLUSIONS More than 50% of LT recipients survive 20 years, achieve important socioeconomic milestones, and report quality of life superior to patients with liver disease or other chronic conditions. LT is a durable surgery that restores both long-term physiologic and psychologic well-being in patients with end-stage liver disease.
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Tanikella R, Kawut SM, Brown RS, Krowka MJ, Reinen J, Dinasarapu CR, Trotter JF, Roberts KE, Mohd MA, Arnett DK, Fallon MB. Health-related quality of life and survival in liver transplant candidates. Liver Transpl 2010; 16:238-45. [PMID: 20104497 PMCID: PMC2903545 DOI: 10.1002/lt.21984] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Health-related quality of life (HRQOL) is an important measure of the effects of chronic liver disease in affected patients that helps guide interventions to improve well-being. However, the relationship between HRQOL and survival in liver transplant candidates remains unclear. We examined whether the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the Short Form 36 (SF-36) Health Survey were associated with survival in liver transplant candidates. We administered the SF-36 questionnaire (version 2.0) to patients in the Pulmonary Vascular Complications of Liver Disease study, a multicenter prospective cohort of patients evaluated for liver transplantation in 7 academic centers in the United States between 2003 and 2006. Cox proportional hazards models were used with death as the primary outcome and adjustment for liver transplantation as a time-varying covariate. The mean age of the 252 participants was 54 +/- 10 years, 64% were male, and 94% were white. During the 422 person years of follow-up, 147 patients (58%) were listed, 75 patients (30%) underwent transplantation, 49 patients (19%) died, and 3 patients were lost to follow-up. Lower baseline PCS scores were associated with an increased mortality rate despite adjustments for age, gender, Model for End-Stage Liver Disease score, and liver transplantation (P for the trend = 0.0001). The MCS score was not associated with mortality (P for the trend = 0.53). In conclusion, PCS significantly predicts survival in liver transplant candidates, and interventions directed toward improving the physical status may be helpful in improving outcomes in liver transplant candidates.
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Affiliation(s)
- Rajasekhar Tanikella
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Steven M. Kawut
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Robert S. Brown
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | | | - Jenna Reinen
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | | | - James F. Trotter
- Department of Medicine, Baylor University Medical Center at Dallas, Dallas, TX
| | - Kari E. Roberts
- Department of Medicine, Tufts–New England Medical Center, Boston, MA
| | - Mustafa A. Mohd
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Donna K. Arnett
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Michael B. Fallon
- Department of Internal Medicine, University of Texas Medical School at Houston, University of Texas Health Science Center at Houston, Houston, TX
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