WTC Report 2014: Are the early quality of life benefits sustained long-term after liver transplantation? A 10-year longitudinal diagnosis stratified evaluation

By Vincent H Karam et al, Hôpital Paul Brousse, Villejuif, France.  Liver transplantation is associated with consistent improvements in quality of life in the first three years after transplantation, although the rate of improvement may be different depending on the underlying cause of liver disease. A study presented as a poster by Dr Vincent Karam and colleagues showed that the initial improvement in quality of life post-transplant was followed by a decline in most domains, the reasons for which are not clear.

As survival outcomes after liver transplantation continue to improve, focus is increasingly shifting towards improving not only the quantity but also the quality of life. Dr Karam and colleagues hypothesised that the impact of liver transplantation on quality of life and the rate of any improvement may vary between different pre-transplant diagnoses. To this end, 48 consecutive liver transplant patients were included in an analysis of the change in quality of life in five domains: measures of disease (MD), psychological distress (PS), personal function (PF), social function (SF), and general health perception (GHP). Patients included in the study completed the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) quality of life questionnaire prior to undergoing liver transplantation and at one, three, six, and 10 years after transplantation. Changes in quality of life scores over time were evaluated in four separate diagnostic groups: cirrhosis caused by hepatitis C virus (HCV, n=12), cirrhosis caused by alcoholic liver disease (ALD, n=14), hepatocellular carcinoma (HCC, n=14) and familial amyloid polyneuropathy (FAP, n=8). A group of age- and gender-matched healthy subjects were recruited from the general population as controls (GP, n=487).

At one year post-transplant, all diagnosis groups had experienced dramatic improvements in all five quality of life domains, with the only exception of MD and PF scores which had worsened in the FAP group and continued to worsen as the study progressed. Paradoxically, patients in the FAP group had the highest graft survival rate in the study. Patients in the ALD group reported the biggest improvement in quality of life with scores exceeding those for the general population in all domains at one year post-transplant. The MD and PF scores continued to improve until year three post-transplant; in contrast, a decline was seen in the PS domain after the first year which Dr Karam and colleagues attributed to fear of recurrence of the underlying liver disease. Beyond six years post-transplant, patients in the HCC and HCV groups reported improvements in most domains which approached the level in the general population, and quality of life in the ALD group remained at a comparatively high level despite the slight decline seen at year three. Dr Karam and colleagues concluded that although liver transplantation was associated with improved quality of life over time, further research is required to explain the variation in the rate of improvement in different diagnostic groups and to develop tailored interventions for improving physical and mental quality of life.