Health Related Quality of Life Assessment in Egyptian Recipients after Living Donor Liver Transplantation

Abstract

This study was conducted to evaluate Quality of life after LDLT in Egyptian recipients using short form 36 (SF – 36) score and to assess the impact of post transplant medical and psychiatric complications on quality of life. To fulfill the aim of our study 35 patients who underwent LDLT in Ain Shams Center For Organ Transplantation (ASCOT) were included. All included patients were transplanted for HCV related disease. At the beginning all included recipients were subjected to: (1) Designed Sheet: including full history taking and thorough clinical examination with special stress on past medical and psychiatric illness, (2) Determination of severity of illness using the MELD score and Child-Pugh score, (3) Investigations including complete blood count, liver function tests and abdominal Doppler ultrasound before and after liver transplantation and immunosuppression trough level (FK/ cyclosporine) after liver transplantation, (4) recipients were assessed by SF-36 and Beck Depression Inventory questionnaires during the pretransplant period and following transplantation by one month, six months and one year later. The age of patients ranged from 18 - 60 years with a mean age of (49.27±8.16) years. Regarding sex distribution 32 (91.43%) were males and 3 (8.57%) were females. HCV related end stage liver disease is the most important cause of liver transplantation in Egypt due to high HCV infection prevalence (26%). In the present work (65.71%) of the studied patients had HCV related end stage liver disease (ESLD), followed by hepatocellular carcinoma (HCC) on top of liver cirrhosis (HCV) in nine patients (25.71%) and end stage liver disease (ESLD) accompanied with portal vein thrombosis in three patients (8.57% ). Regarding the medical characteristics of the studied patients, (60.00%) had MELD score less than 18 and (57.14%) were Child C. Regarding encephalopathy, (34.29%) of the studied patients had encephalopathy episodes. Nineteen patients (54.29%) had ascites and thirteen patients (37.14%) suffered from SBP. Assessment of HRQOL before and after liver transplantation revealed that there were highly statistically significant improvements in all dimensions of HRQOL after liver transplantation. The highest score before liver transplantation was for mental health (51.60±21.49), while after one month and six months it was for role limitation due to emotional health (76.67±43.02 & 93.33±25.37) respectively. Also the Beck Depression Inventory scores showed a statistically significant improvement after liver transplantation in comparison with pre transplantation scores. Regarding the Correlation between health-related quality of life and psychological outcomes after liver transplantation, Both the physical component summary (PCS) and mental component summary (MCS) scores of the SF-36 were significantly correlated with the scores of Beck Depression Inventory (P> 0.001). Regarding the relations between age and HRQOL, there were statistically significant negative correlations between all dimensions of quality of life and age (i.e. as patient's age increases, HRQOL scores decrease) before liver transplantation except for role limitation due to emotional health and mental health. However, there were no statistically significant correlations between all dimensions of quality of life and age after liver transplantation except for role limitation due to emotional health. Regarding the Relations between initial hepatopathy and HRQOL scores before liver transplantation, there was a statistically significant difference between those who had HCC and those who didn't before liver transplantation regarding mental health, social functioning, emotional role and vitality. However, there were no statistically significant differences between those who had HCC and those who didn't six months after liver transplantation. Regarding the relations between gender and HRQOL scores, there was no statistically significant difference between males and females regarding all dimensions of quality of life before or after liver transplantation. Regarding the relations between working status and HRQOL scores, there were no statistically significant relations between dimensions of quality of life and working status before liver transplantation. However, there was a statistically significant relation between mental health only and working status six months post liver transplantation. Regarding the Relations between educational level and HRQOL scores, there were statistically significant relations between physical functioning, social functioning, and general health dimensions of quality of life and educational level before liver transplantation. However, there were no statistically significant relations between dimensions of quality of life and educational level six months post liver transplantation. Regarding the Relations between disease severity assessed by MELD score and HRQOL scores, there were statistically significant relations between role limitation due to physical health, vitality dimensions of quality of life and disease severity before liver transplantation. However, there were no statistically significant relations between all dimensions of quality of life and disease severity six months post liver transplantation. Regarding the relations between Child score and HRQOL scores, there was no statistically significant relation between dimensions of quality of life and Child score before or after liver transplantation. Assessment of HRQOL one year after liver transplantation revealed that there was a statistically significant improvement in all dimensions of HRQOL one year after liver transplantation except in the mental health, role emotional and social function domains.