Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Egypt.
Ann Hepatol. 2012 Nov-Dec;11(6):882-90.
INTRODUCTION-AIM: Health-Related Quality of Life (HRQOL) has become an important focus of patient care and clinical outcomes research with the improvement in patient and graft survival after liver transplantation (LT). The current study was designed to evaluate the post-transplant HRQOL profiles using the Liver Disease Quality of Life 1.0 (LDQOL 1.0) Questionnaire and demonstrate the possible effect of peri-transplant clinical covariates on these profiles.
Participants included pre-transplant group (waiting-list patients n = 50) and post-transplant group (mean 5 ± 4 years after deceased or living donor LT n = 103) who were recruited from 3 specialized centers in Egypt. We applied the LDQOL 1.0 questionnaire; a 111-item containing the Short Form-36 version 2.0 (SF-36v2) as a generic component supplemented by 75 disease-specific items. The etiology of cirrhosis, co-morbidities, model for end-stage liver disease (MELD), Child-Pugh class and post-operative complications were analyzed.
All recipients had significant higher HRQOL scores than patients in waiting-list using both questionnaire components. Recipients with pre-LT MELD ≥ 15, Child-Pugh class C, history of hepatocellular carcinoma (HCC) demonstrated low HRQOL scores. Recipients without post-operative surgical complications had a statistically better HRQOL using the disease-specific, but not the SF-36v2 component. On the other hand, both components demonstrated non-significant lower scores in recipients with rejection episodes, cytomegalovirus (CMV) infection and hepatitis C recurrence had compared to those without medical complications.
Generally HRQOL improves dramatically after LT as assessed by LDQOL questionnaire. Moreover, combined questionnaires can provide accurate information about the possible impaired HRQOL post-LT due to pre-transplant disease severity and post-operative complications.
随着肝移植(LT)后患者和移植物存活率的提高,健康相关生活质量(HRQOL)已成为患者护理和临床结果研究的重要焦点。本研究旨在使用肝病生活质量 1.0(LDQOL 1.0)问卷评估移植后 HRQOL 谱,并证明移植前临床协变量对这些谱的可能影响。
参与者包括移植前组(等待名单患者 n=50)和移植后组(死亡或活体供体 LT 后平均 5±4 年 n=103),他们是从埃及的 3 个专门中心招募的。我们应用 LDQOL 1.0 问卷;一个包含 111 个项目的问卷,包含简短形式 36 版本 2.0(SF-36v2)作为通用组成部分,补充了 75 个疾病特异性项目。分析了肝硬化的病因、合并症、终末期肝病模型(MELD)、Child-Pugh 分级和术后并发症。
所有受者的 HRQOL 评分均显著高于等待名单中的患者,两个问卷组成部分均如此。LT 前 MELD≥15、Child-Pugh 分级 C、肝细胞癌(HCC)病史的受者 HRQOL 评分较低。无术后手术并发症的受者在使用疾病特异性问卷时 HRQOL 具有统计学意义,但在使用 SF-36v2 组件时则不然。另一方面,与无医疗并发症的受者相比,排斥反应发作、巨细胞病毒(CMV)感染和丙型肝炎复发的受者在两个组件中均显示出较低的分数。
LDQOL 问卷评估表明,LT 后 HRQOL 显著改善。此外,联合问卷可以提供有关 LT 后因移植前疾病严重程度和术后并发症导致可能受损的 HRQOL 的准确信息。