Quality of life following liver transplantation and its impact factors

Abstract

Objective To study the quality of life and its impact factors in liver transplant recipients. Methods A total of 202 patients in the First Affiliated Hospital and the Third Affiliated Hospital of Sun Yat-sen University who had undergone liver transplantation for more than 2 weeks were voluntarily enrolled in this retrospective study by Convenience Sampling and the questionnaire surveys including general information questionaire, Medical outcomes study of 36-item short-form health survey (SF-36), self-rating depression scale (SDS), self-rating anxiety scale(SAS) and social support rating scale were performed in each patient. This study was approved by local ethical committee and that the informed consent of all participating subjects was obtained. The participants were divided into 5 groups according to their postoperative period. There were 42 patients in the group of less than or equal to 6 months after transplantation and 40 patients respectively in the group of 6 to 12 months, 13 to 24 months, 25 to 36 months and more than 3 years after transplantation. The scores of 8 sub-scales in SF-36, physical function(PF), role limitation due to physical problem(RP), blood pain (BP), general health(GH), vitality(VT), social function(SF), role limitation due to emotional problem(RE), mental health(MH), and physical component summary(PCS), mental component summary(MCS) scores were calculated and the differences among 5 groups were tested by Kruskal-Wallis test. The PCS and MCS scores were the dependent variables and the scores of objective support, subjective support, social supports and uses (sub-scales of Social Support Rating Scale), depression, anxiety, age, gender, marital status, education, postoperative period, family income, primary disease, medical payment were included as independent varibles into subsequent multiple linear regression analysis to identify factors influencing the quality of the recipients’ life. Results Except RP and GH scores, there were significant differences of scores in other six scales and PCS, MCS scores among 5 groups (P<0.05). Compared to patients in the group of less than or equal to 6 months, the scores of PCS and MCS were significantly higher among the patients in the group of 13 to 24 months after transplantation and more than 3 years after transplantation (Z=3.103, 2.233 and Z=2.859, 2.551, all in P<0.05). Multivariate analysis showed that subjective support and postoperative time were the influencing factors of patients’ physical health(t=3.518, 2.771, 2.402, all in P<0.05). Higher scores of subjective support of patients in the group of 13 to 24 months after transplantation and more than 3 years after transplantation had higher physical health scores. Postoperative time, depression and anxiety were the main influencing factors for patients’ mental health. Patients in the group of 13 to 24 months after transplantation and more than 3 years after transplantation had higher mental health scores (t=2.385, 2.479, all in P<0.05). Patients with mild, moderate depression, moderate and severe anxiety had lower mental health scores (t=-2.141, -2.517, -2.071, all in P<0.05). Conclusions The quality of life in patients who received liver transplantation for more than 1 year but less than 2 years and more than 3 years are better than those within 1 year. The subjective support and postoperative time are the factors influencing physical health, while the postoperative time, depression and anxiety are the main factors influencing mental health. Key words: Liver transplantation; Life quality; Depression; Anxiety; Social support; Medical outcomes study 36-item short form health survey; Self-rating depression scales; Self-rating axiety scales