In a 12-Year Study, Sustainability of Quality of Life Benefits After Liver Transplantation Varies With Pretransplantation Diagnosis

Abstract

As life-extending benefits of liver transplantation (LTX) are realized, the focus of improving outcomes after LTX transitioned from merely extending quantity of life to improving quality of life (QOL). Numerous cross-sectional studies have shown that QOL improves within 1 year after LTX; however, the long-term prospective pattern of QOL is not known. We assessed the sustainability of early QOL benefits after LTX. Patients who underwent LTX (n = 381) were followed for 12 years. We collected clinical information, survival data, and data on 5 QOL domains: physical distress (PHY), psychological distress (PSY), social/role function (SRF), personal function (PF), and general health perception (GHP). Mixed model analysis was used to determine whether initial gains in QOL were sustained long term. Outcomes were analyzed according to the primary liver diagnosis. After 12 years, liver recipients had marked declines in PHY (P < .001), SRF (P = .006), and GHP (P < .001) scores, whereas improvements in PSY (P = .09) and PF (P = .09) were sustained. Women had worse outcomes in PHY and PF than men. Patients with autoimmune disease had decreased QOL PHY, SRF, PF, and GHP domains. Patients with alcoholic liver disease and hepatitis C initially had lower QOL in all domains, with the greatest decreases in PHY (P < .001) and PF (P = .03). Although QOL improves within 1 year after patients receive liver transplants, not all groups of patients achieve or sustain the same level of QOL for 12 years. QOL decreases with time in most areas. Efforts should be made to improve QOL and function in the initial recovery period in liver transplant recipients.