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Health-related quality of life and psychological correlates in patients listed for liver transplantation.

ABSTRACT: PURPOSE: Given the increasing waiting time for liver transplantation, and the amount of possible stressors associated with it, assessment of psychological well-being and health-related quality of life (HRQoL) in these patients is warranted in order to optimize pretransplant care. PATIENTS AND METHODS: Patients with chronic liver disease (n = 32) awaiting transplantation completed a series of questionnaires measuring HRQoL, depression, anxiety, coping, and self-efficacy. Comparisons were made with other patients with liver disease with and without cirrhosis, and a healthy norm population. Relationships among these psychological variables were explored and subgroup analyses were performed to assess possible differences in coping strategies. RESULTS: Compared to other patients with liver disease without cirrhosis, liver transplant candidates had statistically significantly lower HRQoL scores on the subscales of physical functioning (P < 0.001) and general health (P < 0.001). Their HRQoL did not differ from patients with liver disease with cirrhosis. Overall, patients awaiting liver transplantation had significantly reduced HRQoL (P < 0.001) and increased depression scores (P < 0.001) compared to healthy controls. Levels of depression, anxiety, self-efficacy, and coping did not differ between liver transplant candidates and other patients with liver disease. Depression correlated significantly with HRQoL. Patients without depression made significantly more use of active coping strategies than patients with elevated depression levels. CONCLUSIONS: Patients awaiting liver transplantation are not experiencing worse physical and psychological HRQoL than other liver patients with cirrhosis of the liver. Therefore, there is currently no indication to increase the level of psychosocial care for liver transplant candidates.

SUBMITTER: Gutteling JJ

PROVIDER: S-EPMC2717547 | biostudies-other | 2007 Dec

REPOSITORIES: biostudies-other

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Project description:BackgroundHealth-related quality of life (HRQOL) is an important outcome measure in patients with end-stage renal disease. HRQOL is assumed to improve with kidney transplantation and also with nocturnal hemodialysis compared to conventional hemodialysis. However, there is no evidence regarding HRQOL to support the optimal treatment choice for patients on nocturnal hemodialysis who hesitate opting for transplantation. We therefore compared HRQOL between patients who were treated with kidney transplantation or nocturnal hemodialysis for one year.MethodsWe assessed HQROL using the Kidney Disease Quality of Life-Short Form questionnaire in a cross-sectional sample of patients who were treated with kidney transplantation (n = 41) or nocturnal hemodialysis (n = 31) for one year. All patients on nocturnal hemodialysis were transplantation candidates. Using linear regression, we compared HRQOL between kidney transplantation and nocturnal hemodialysis, and adjusted for age, sex, dialysis duration, cardiovascular disease, and presence of residual urine production.ResultsAt one year follow-up, mean age of the study population was 54 ±13 years, and median dialysis duration was 3.2 (IQR 2.1-5.0) years. Kidney transplantation was associated with significantly higher HRQOL on the domain "effects" compared to nocturnal hemodialysis (adjusted difference 12.0 points, 95% CI 3.9; 20.1). There were potentially clinically relevant differences between kidney transplantation and nocturnal hemodialysis on the domains "burden" (adjusted difference 11.1 points, 95% CI -2.6; 24.8), "social support" (adjusted difference 6.2, 95% CI -6.6; 19.1), and the physical composite score (adjusted difference 3.0, 95% CI -2.0; 8.1), but these were not significant.ConclusionsAfter kidney transplantation, HRQOL is especially higher on the domain "effects of kidney disease" compared to nocturnal hemodialysis. This can be useful when counseling patients on nocturnal hemodialysis who may opt for transplantation.

Project description:Patients with chronic liver disease often suffer from unspecific symptoms and report severe impairment in the quality of life. The underlying mechanisms are multifactorial and include disease-specific but also liver related causes. The current analysis evaluated the association of hepatocellular apoptosis in non-viral chronic liver disease and health-related quality of life (HRQL). Furthermore we examined factors, which influence patient's physical and mental well-being.A total of 150 patients with non-infectious chronic liver disease were included between January 2014 and June 2015. The German version of the Chronic Liver Disease Questionnaire (CLDQ-D), a liver disease specific instrument to assess HRQL, was employed. Hepatocellular apoptosis was determined by measuring Cytokeratin 18 (CK18, M30 Apoptosense ELISA).Female gender (5.24 vs. 5.54, p = 0.04), diabetes mellitus type II (4.75 vs. 5.46, p<0.001) and daily drug intake (5.24 vs. 6.01, p = 0.003) were associated with a significant impairment in HRQL. HRQL was not significantly different between the examined liver diseases. Levels of CK18 were the highest in patients with NASH compared to all other disease entities (p<0.001). Interestingly, CK18 exhibited significant correlations with obesity (p<0.001) and hyperlipidemia (p<0.001). In patients with cirrhosis levels of CK18 correlated with the MELD score (r = 0.18, p = 0.03) and were significantly higher compared to patients without existing cirrhosis (265.5 U/l vs. 186.9U/l, p = 0.047). Additionally, CK18 showed a significant correlation with the presence and the degree of hepatic fibrosis (p = 0.003) and inflammation (p<0.001) in liver histology. Finally, there was a small negative association between CLDQ and CK18 (r = -0.16, p = 0.048).Different parameters are influencing HRQL and CK18 levels in chronic non-viral liver disease and the amount of hepatocellular apoptosis correlates with the impairment in HRQL in chronic non-viral liver diseases. These findings support the role of liver-protective therapies for the improvement of the quality of life in chronic liver disease.

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Health-related quality of life and psychological correlates in patients listed for liver transplantation.

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