Yang Linda S, Shan Leonard L, Saxena Akshat, Morris David L
Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.
Liver Int. 2014 Oct;34(9):1298-313. doi: 10.1111/liv.12553. Epub 2014 Apr 23.
BACKGROUND & AIMS: Liver transplantation is the only curative intervention for terminal liver disease. Accurate long-term quality of life (QOL) data are required in the context of improved surgical outcomes and increasing post-transplant survival. This study reviews the long-term QOL after primary liver transplantation in adult patients surviving 5 or more years after surgery.
A literature search was conducted on PubMed for all studies matching the eligibility criteria between January 2000 and October 2013. Bibliographies of included studies were also reviewed. Two authors independently performed screening of titles and abstracts. Consensus for studies included for review was achieved by discussion between authors based on predetermined eligibility criteria. Quality appraisal and data tabulation were performed using predetermined forms. Results were synthesized by narrative review.
Twenty-three studies (5402 patients) were included. QOL following liver transplantation remains superior to preoperative status up to 20 years post-operatively. More post-operative complications predicted worse QOL scores especially in physical domains. Benefits in functional domains persist long-term with independence in self-care and mobility. Employment rates recover in the short-term but decline after 5 years, and differ significantly between various aetiologies of liver disease. Overall QOL improves to a similar level as the general population, but physical function remains worse. Participation in post-operative physical activity is associated with superior QOL outcomes in liver transplant recipients compared to the general population. QOL improvements are similar compared to lung, kidney and heart transplantation. Heterogeneity between studies precluded quantitative analysis.
Liver transplantation confers specific long-term QOL and functional benefits when compared to preoperative status. This information can assist in providing a more complete estimate of the overall health of liver transplant recipients and the effectiveness of surgery. Guidelines for future studies are provided.
肝移植是终末期肝病唯一的治愈性干预措施。在手术效果改善及移植后生存率提高的背景下，需要准确的长期生活质量（QOL）数据。本研究回顾了成年患者初次肝移植术后存活5年及以上的长期生活质量。
在PubMed上检索2000年1月至2013年10月期间所有符合纳入标准的研究。对纳入研究的参考文献也进行了回顾。两位作者独立进行标题和摘要筛选。作者之间根据预先确定的纳入标准进行讨论，就纳入综述的研究达成共识。使用预先确定的表格进行质量评估和数据制表。结果通过叙述性综述进行综合。
纳入23项研究（5402例患者）。肝移植后的生活质量在术后20年内仍优于术前状态。更多的术后并发症预示着生活质量评分更差，尤其是在身体领域。功能领域的益处长期存在，患者在自我护理和活动能力方面实现独立。就业率在短期内恢复，但5年后下降，且不同肝病病因之间存在显著差异。总体生活质量提高到与普通人群相似的水平，但身体功能仍然较差。与普通人群相比，肝移植受者参与术后体育活动与更好的生活质量结果相关。与肺、肾和心脏移植相比，生活质量改善情况相似。研究之间的异质性妨碍了定量分析。
与术前状态相比，肝移植具有特定的长期生活质量和功能益处。这些信息有助于更全面地评估肝移植受者的整体健康状况和手术效果。提供了未来研究的指南。
