Zahn Alexandra, Seubert Lisa, Jünger Jana, Schellberg Dieter, Weiss Karl Heinz, Schemmer Peter, Stremmel Wolfgang, Sauer Peter, Gotthardt Daniel Nils
Department of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany.
Ann Transplant. 2013 Jun 26;18:327-35. doi: 10.12659/AOT.883962.
Health-related quality of life (HRQOL) following orthotopic liver transplantation (OLT) has become increasingly important. Therefore, we aimed to identify factors affecting HRQOL after OLT.
This cross-sectional, single-centre study surveyed 281 OLT patients. Survey tools included the Short Form (SF-36) Health Survey, the Patient Health Questionnaire 9 (PHQ9), and a self-designed employment questionnaire. Patient medical records were reviewed.
Participants included 187 men (mean age at OLT: 50 [± 11; 13-69] years). Primary indications for OLT were viral hepatitis (28%), alcoholic liver disease (35%), cholestatic liver disease (11%), and others (26%). Follow-up ranged from 2 to 136 months. Clinical factors associated with improved HRQOL were age ≤ 45 years at OLT and current MELD score <=≤ 13. Time after OLT and indication for transplantation affected SF-36 HRQOL. SF-36 physical component summary scales plateaued at 3-years post-OLT and then stabilized. For the SF-36 HRQOL, scores were the lowest in all domains for OLT recipients transplanted for chronic viral hepatitis and for unemployed patients, whereas sex and number of transplantations showed no significant differences. The PHQ9 results showed that depression was significantly more frequent among patients with current MELD score ≥ 13 or impaired liver function and those transplanted for chronic viral hepatitis or unemployed patients. Age and sex did not influence PHQ9 results.
Medical and psychosocial support is crucial for long-term HRQOL after OLT. Developing multidisciplinary interventions to address issues such as employment, age, MELD score, and liver function may improve long-term HRQOL in these patients.
原位肝移植（OLT）后的健康相关生活质量（HRQOL）变得越来越重要。因此，我们旨在确定影响OLT后HRQOL的因素。
这项横断面单中心研究对281例OLT患者进行了调查。调查工具包括简短健康调查问卷（SF-36）、患者健康问卷9（PHQ9）和一份自行设计的就业调查问卷。对患者的病历进行了回顾。
参与者包括187名男性（OLT时的平均年龄：50[±11；13 - 69]岁）。OLT的主要指征为病毒性肝炎（28%）、酒精性肝病（35%）、胆汁淤积性肝病（11%）和其他（26%）。随访时间为2至136个月。与HRQOL改善相关的临床因素为OLT时年龄≤45岁以及当前终末期肝病模型（MELD）评分≤13。OLT后的时间和移植指征影响SF-36 HRQOL。SF-36身体成分汇总量表在OLT后3年达到平稳，然后保持稳定。对于SF-36 HRQOL，在因慢性病毒性肝炎接受移植的OLT受者和失业患者中，所有领域的得分都是最低的，而性别和移植次数没有显著差异。PHQ9结果显示，当前MELD评分≥13或肝功能受损的患者以及因慢性病毒性肝炎接受移植的患者或失业患者中，抑郁明显更常见。年龄和性别不影响PHQ9结果。
医疗和心理社会支持对于OLT后的长期HRQOL至关重要。制定多学科干预措施以解决就业、年龄、MELD评分和肝功能等问题，可能会改善这些患者的长期HRQOL。
