Iranian Journal of Medical Sciences

Document Type : Original Article(s)

Authors

1 Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Industrial Engineering, Iran University of Science and Technology, Tehran, Iran

3 Shiraz Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran

10.30476/ijms.2021.88302.1895

Abstract

Background: The health-related quality of life (HRQOL) in the before liver transplantation (LT) stage has not been studied as much as that after the LT stage. We aimed to assess HRQOL and its determinants before the LT stage.
Methods: As a cross-sectional study, HRQOL of all adult patients (n=632) referred to the LT center of Shiraz, Iran in 2018-2019 were assessed. Demographic, socioeconomic, medical, and paraclinical data were requested. Physical (PCS) and mental (MCS) aspects of HRQOL were assessed using the SF36 questionnaire. Univariable, multivariable (linear regression), and confirmatory factor analysis were performed utilizing SPSS 20 and Mplus 6.1 software. P<0.05 was considered to be significant.
Results: The mean age of the patients was 47.6±12.3 years, while 414 (65.6%) were men, and the mean, score of the model for end-stage liver disease (MELD) was 18.36±5.58. The mean score of QOL, PCS, and MCS was 50.01±21.73, 46.23±23.23, and 53.78±23.91 (out of 100), respectively. Vitality had the most association with HRQOL, while role limitations had the lowest. The multivariable analysis revealed that unemployment (P<0.001), anemia (P=0.005), weight loss (P=0.005), diabetes mellitus (DM) (P=0.009), low MELD score (P=0.027), and drug use (P=0.03) were the significant determinants of HRQOL, respectively.
Conclusion: The present study showed that HRQOL in the LT candidates was at the intermediate level, while their PCS and MCS are at the low and moderate levels, respectively. Furthermore, physical performance, job status, anemia, weight loss, MELD score, DM, and drug use should be considered as the significant determinants of HRQOL in the LT candidates.

Keywords

  1. Viswanath L, Nathan GG. Assessment of health related quality of life among liver transplant recipients. International Journal of Nursing Education. 2017;9:52-7. doi: 10.5958/0974-9357.2017.00010.1
  2. Yang LS, Shan LL, Saxena A, Morris DL. Liver transplantation: a systematic review of long-term quality of life. Liver Int. 2014;34:1298-313. doi: 10.1111/liv.12553. PubMed PMID: 24703371.
  3. Bagheri Lankarani K, Honarvar B, Seif MA, Anushiravani A, Nikeghbalian S, Motazedian N, et al. Outcome of Liver Transplant Patients With Intraoperative-Detected Portal Vein Thrombosis: A Retrospective Cohort Study in Shiraz, Iran. Exp Clin Transplant. 2021;19:324-30. doi: 10.6002/ect.2018.0295. PubMed PMID: 30995894.
  4. Malek-Hosseini SA, Jafarian A, Nikeghbalian S, Poustchi H, Lankarani KB, Nasiri Toosi M, et al. Liver Transplantation Status in Iran: A Multi-center Report on the Main Transplant Indicators and Survival Rates. Arch Iran Med. 2018;21:275-82. PubMed PMID: 30041524.
  5. Kim WR, Lake JR, Smith JM, Schladt DP, Skeans MA, Harper AM, et al. OPTN/SRTR 2016 Annual Data Report: Liver. Am J Transplant. 2018;18:172-253. doi: 10.1111/ajt.14559. PubMed PMID: 29292603.
  6. Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67:123-33. doi: 10.1002/hep.29466. PubMed PMID: 28802062; PubMed Central PMCID: PMCPMC5767767.
  7. Saab S, Han SH, Martin P. Liver transplantation. Selection, listing criteria, and preoperative management. Clin Liver Dis. 2000;4:513-32. doi: 10.1016/s1089-3261(05)70124-0. PubMed PMID: 11232159.
  8. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73-84. doi: 10.1002/hep.28431. PubMed PMID: 26707365.
  9. Keshani P, Bagheri Lankarani K, Honarvar B, Raeisi Shahraki H. Regression of nonalcoholic fatty liver disease detected by sonography: Results of a four years prospective adult population-based study. Hepatitis Monthly. 2019;19:1-8. doi: 10.5812/hepatmon.95646.
  10. Fisher RA. Living donor liver transplantation: eliminating the wait for death in end-stage liver disease? Nat Rev Gastroenterol Hepatol. 2017;14:373-82. doi: 10.1038/nrgastro.2017.2. PubMed PMID: 28196987.
  11. Saberifiroozi M, Serati AR, Malekhosseini SA, Salahi H, Bahador A, Lankarani KB, et al. Analysis of patients listed for liver transplantation in Shiraz, Iran. Indian J Gastroenterol. 2006;25:11-3. PubMed PMID: 16567887.
  12. Pai R, Karvellas CJ. Is palliative care appropriate in the liver transplant candidate? Clin Liver Dis (Hoboken). 2015;6:24-6. doi: 10.1002/cld.482. PubMed PMID: 31040980; PubMed Central PMCID: PMCPMC6490641.
  13. Swanson A, Geller J, DeMartini K, Fernandez A, Fehon D. Active Coping and Perceived Social Support Mediate the Relationship Between Physical Health and Resilience in Liver Transplant Candidates. J Clin Psychol Med Settings. 2018;25:485-96. doi: 10.1007/s10880-018-9559-6. PubMed PMID: 29546621.
  14. Febrero B, Ramirez P, Martinez-Alarcon L, Abete C, Galera M, Rios A, et al. Quality of Life and Group Psychological Intervention in Patients With Cirrhosis on Liver Transplant Waiting List. Transplant Proc. 2018;50:2626-9. doi: 10.1016/j.transproceed.2018.04.013. PubMed PMID: 30401363.
  15. Rosenberger EM, Dew MA, DiMartini AF, DeVito Dabbs AJ, Yusen RD. Psychosocial issues facing lung transplant candidates, recipients and family caregivers. Thorac Surg Clin. 2012;22:517-29. doi: 10.1016/j.thorsurg.2012.08.001. PubMed PMID: 23084615; PubMed Central PMCID: PMCPMC3516399.
  16. Alt Y, Grimm A, Schlegel L, Grambihler A, Kittner JM, Wiltink J, et al. The Impact of Liver Cell Injury on Health-Related Quality of Life in Patients with Chronic Liver Disease. PLoS One. 2016;11:e0151200. doi: 10.1371/journal.pone.0151200. PubMed PMID: 26990427; PubMed Central PMCID: PMCPMC4798400.
  17. Jay CL, Butt Z, Ladner DP, Skaro AI, Abecassis MM. A review of quality of life instruments used in liver transplantation. J Hepatol. 2009;51:949-59. doi: 10.1016/j.jhep.2009.07.010. PubMed PMID: 19775771; PubMed Central PMCID: PMCPMC2761971.
  18. Kanwal F, Gralnek IM, Hays RD, Zeringue A, Durazo F, Han SB, et al. Health-related quality of life predicts mortality in patients with advanced chronic liver disease. Clin Gastroenterol Hepatol. 2009;7:793-9. doi: 10.1016/j.cgh.2009.03.013. PubMed PMID: 19306949.
  19. Josefsson A, Fu M, Bjornsson E, Castedal M, Kalaitzakis E. Impact of cardiac dysfunction on health-related quality of life in cirrhotic liver transplant candidates. Eur J Gastroenterol Hepatol. 2015;27:393-8. doi: 10.1097/MEG.0000000000000292. PubMed PMID: 25874511.
  20. Kalaitzakis E, Josefsson A, Castedal M, Henfridsson P, Bengtsson M, Hugosson I, et al. Factors related to fatigue in patients with cirrhosis before and after liver transplantation. Clin Gastroenterol Hepatol. 2012;10:174-81. doi: 10.1016/j.cgh.2011.07.029. PubMed PMID: 21839709.
  21. Arguedas MR, DeLawrence TG, McGuire BM. Influence of hepatic encephalopathy on health-related quality of life in patients with cirrhosis. Dig Dis Sci. 2003;48:1622-6. doi: 10.1023/a:1024784327783. PubMed PMID: 12924658.
  22. Sanyal A, Younossi ZM, Bass NM, Mullen KD, Poordad F, Brown RS, et al. Randomised clinical trial: rifaximin improves health-related quality of life in cirrhotic patients with hepatic encephalopathy - a double-blind placebo-controlled study. Aliment Pharmacol Ther. 2011;34:853-61. doi: 10.1111/j.1365-2036.2011.04808.x. PubMed PMID: 21848797.
  23. Motamed N, Ayatollahi AR, Zare N, Sadeghi-Hassanabadi A. Validity and reliability of the Persian translation of the SF-36 version 2 questionnaire. East Mediterr Health J. 2005;11:349-57. PubMed PMID: 16602453.
  24. Zaydfudim V, Feurer ID, Moore DE, Wisawatapnimit P, Wright JK, Wright Pinson C. The negative effect of pretransplant overweight and obesity on the rate of improvement in physical quality of life after liver transplantation. Surgery. 2009;146:174-80. doi: 10.1016/j.surg.2009.04.027. PubMed PMID: 19628071.
  25. Mahmoudi H, Jafari P, Alizadeh-Naini M, Gholami S, Malek-Hosseini SA, Ghaffaripour S. Validity and reliability of Persian version of Chronic Liver Disease Questionnaire (CLDQ). Qual Life Res. 2012;21:1479-85. doi: 10.1007/s11136-011-0059-5. PubMed PMID: 22081217.
  26. Aberg F, Rissanen AM, Sintonen H, Roine RP, Hockerstedt K, Isoniemi H. Health-related quality of life and employment status of liver transplant patients. Liver Transpl. 2009;15:64-72. doi: 10.1002/lt.21651. PubMed PMID: 19109833.
  27. Aberg F. From prolonging life to prolonging working life: Tackling unemployment among liver-transplant recipients. World J Gastroenterol. 2016;22:3701-11. doi: 10.3748/wjg.v22.i14.3701. PubMed PMID: 27076755; PubMed Central PMCID: PMCPMC4814733.
  28. Ortiz F, Aronen P, Koskinen PK, Malmstrom RK, Finne P, Honkanen EO, et al. Health-related quality of life after kidney transplantation: who benefits the most? Transpl Int. 2014;27:1143-51. doi: 10.1111/tri.12394. PubMed PMID: 24977951.
  29. Nour N, Heck CS, Ross H. Factors related to participation in paid work after organ transplantation: perceptions of kidney transplant recipients. J Occup Rehabil. 2015;25:38-51. doi: 10.1007/s10926-014-9519-4. PubMed PMID: 24871373.
  30. Pockros PJ, Shiffman ML, Schiff ER, Sulkowski MS, Younossi Z, Dieterich DT, et al. Epoetin alfa improves quality of life in anemic HCV-infected patients receiving combination therapy. Hepatology. 2004;40:1450-8. doi: 10.1002/hep.20482. PubMed PMID: 15565613.
  31. Samsa G, Edelman D, Rothman ML, Williams GR, Lipscomb J, Matchar D. Determining clinically important differences in health status measures: a general approach with illustration to the Health Utilities Index Mark II. Pharmacoeconomics. 1999;15:141-55. doi: 10.2165/00019053-199915020-00003. PubMed PMID: 10351188.
  32. Kotarska K, Raszeja-Wyszomirska J, Wunsch E, Chmurowicz T, Kempinska-Podhorodecka A, Wojcicki M, et al. Relationship between pretransplantation liver status and health-related quality of life after grafting: a single-center prospective study. Transplant Proc. 2014;46:2770-3. doi: 10.1016/j.transproceed.2014.09.005. PubMed PMID: 25380914.
  33. Rogal SS, Winger D, Bielefeldt K, Szigethy E. Pain and opioid use in chronic liver disease. Dig Dis Sci. 2013;58:2976-85. doi: 10.1007/s10620-013-2638-5. PubMed PMID: 23512406; PubMed Central PMCID: PMCPMC3751995.
  34. Koch M, Banys P. Liver transplantation and opioid dependence. JAMA. 2001;285:1056-8. doi: 10.1001/jama.285.8.1056. PubMed PMID: 11209177.
  35. Bownik H, Saab S. Health-related quality of life after liver transplantation for adult recipients. Liver Transpl. 2009;15:S42-9. doi: 10.1002/lt.21911. PubMed PMID: 19876941.
  36. Saab S, Ibrahim AB, Shpaner A, Younossi ZM, Lee C, Durazo F, et al. MELD fails to measure quality of life in liver transplant candidates. Liver Transpl. 2005;11:218-23. doi: 10.1002/lt.20345. PubMed PMID: 15666392.
  37. Shamsaeefar A, Nikeghbalian S, Kazemi K, Gholami S, Sayadi M, Azadian F, et al. Quality of life among liver transplantation recipients before and after surgery: A single-center longitudinal study. Indian Journal of Transplantation. 2020;14:48-52. doi: 10.4103/ijot.ijot_42_19.
  38. Mabrouk M, Esmat G, Yosry A, El-Serafy M, Doss W, Zayed N, et al. Health-related quality of life in Egyptian patients after liver transplantation. Ann Hepatol. 2012;11:882-90. PubMed PMID: 23109452.