Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Tokyo, Japan.
Hepatol Res. 2013 Oct;43(10):1052-63. doi: 10.1111/hepr.12060. Epub 2013 Feb 1.
Patient survival after living donor liver transplantation (LDLT) has improved, but improvement of the health-related quality of life (HRQOL) of LDLT recipients is also an important issue. The aim of this study was to assess the HRQOL of LDLT recipients from the preoperative period to 18 months following transplantation by prospectively evaluating Short Form-36 Version 2 (SF-36v2) scores.
Complete longitudinal SF-36v2 scores were collected from 35 consecutive LDLT recipients prior to surgery and at 3, 6, 12 and 18 months after transplantation.
HRQOL scores were severely impaired in all dimensions preoperatively. Although the scores improved significantly up to 18 months after transplantation, they remained lower than those of healthy controls in the majority of domains. Impaired scores preoperatively were significantly associated with severity of liver disease represented by a higher Model for End-Stage Liver Disease (MELD) score and Child-Turcotte-Pugh class C, and scores in such patients improved significantly after LDLT in every dimension at 12 months, indicating that the greater the impairment at the pretransplant stage, the greater the improvement in both physical and mental conditions. Preoperative lower HRQOL scores and higher MELD scores were independently associated with significant physical and mental score gains during the first year after LDLT.
The findings of the present study may facilitate the development of measures aimed at improving recipient's post-transplant life and establishing realistic expectations for LDLT recipients.
活体供肝肝移植(LDLT)后的患者生存率有所提高,但提高 LDLT 受者的健康相关生活质量(HRQOL)也是一个重要问题。本研究旨在通过前瞻性评估健康调查简表 36 项版本 2(SF-36v2)评分,从术前阶段评估 LDLT 受者在移植后 18 个月的 HRQOL。
连续纳入 35 例 LDLT 受者,在术前及移植后 3、6、12 和 18 个月时收集完整的 SF-36v2 评分。
术前所有维度的 HRQOL 评分均严重受损。尽管移植后 18 个月时评分显著提高,但在大多数领域仍低于健康对照组。术前受损评分与代表肝脏疾病严重程度的终末期肝病模型(MELD)评分和 Child-Turcotte-Pugh 分级 C 显著相关,此类患者在移植后 12 个月的所有维度上的评分均显著改善,表明移植前阶段受损越严重,在身心状况方面的改善就越大。术前较低的 HRQOL 评分和较高的 MELD 评分与 LDLT 后第一年的显著身心评分改善相关。
本研究的结果可能有助于制定旨在改善受者移植后生活质量和为 LDLT 受者建立现实期望的措施。