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Mode of allocation and social demographic factors correlate with impaired quality of life after liver transplantation.

Heits N, Meer G, Bernsmeier A, Guenther R, Malchow B, Kuechler T, Becker T, Braun F - Health Qual Life Outcomes (2015)

Bottom Line: There is still disagreement on the effects of social-demographic factors and changes in the allocation system on HRQoL.HCC as a primary disease did not affect HRQoL.Improvement of HRQoL after LTx may require clinical management of pain, psychotherapy and financial support.

View Article: PubMed Central - PubMed

Affiliation: Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany. nils.heits@uksh-kiel.de.

ABSTRACT

Background: Health-related Quality of life (HRQoL) is a major goal of clinical management after liver transplantation (LTx). There is still disagreement on the effects of social-demographic factors and changes in the allocation system on HRQoL. The aim of this study was to evaluate the impact of social-demographic factors, mode of organ-allocation, waiting time and hepatocellular carcinoma (HCC) on HRQoL after LTx.

Methods: HRQoL was assessed using the EORTC-QLQ-C30 questionnaire, which was sent to 238 recipients. Investigated parameters included age, sex, distance to transplant center, follow-up at hospital, size of hometown, highest education, marital status, having children, background liver disease, waiting time, mode of allocation, HCC, hospitalization after LTx and diagnosis of malignancy after LTx. All evaluated parameters were entered into multivariate linear regression analysis.

Results: Completed questionnaire were returned by 73% of the recipients. After LTx, the HRQoL-function scales increased over time. Age, marital status, highest education, completed professional training, working status, job position, duration of waiting time to LTx, distance to transplant center, place offollow, HU-statuts, mode of organ allocation and duration of hospitalization were associated with significantly worse function- and significantly lower symptom scales. HCC as a primary disease did not affect HRQoL.

Conclusions: Low HRQoL correlated significantly with MELD-based organ allocation, more than 28-day hospitalization, divorced status, lower education- and non-working status, higher distance to transplant center, follow up at transplant center, HU-status, shorter waiting time to LTx and younger age. Improvement of HRQoL after LTx may require clinical management of pain, psychotherapy and financial support.

No MeSH data available.


Related in: MedlinePlus

Correlation of symptom scores to highest education (*p < 0.05)
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Fig2: Correlation of symptom scores to highest education (*p < 0.05)

Mentions: We also assessed the role of family and social network by examining the effects of marital status on HRQoL. HRQoL-scores for divorced patients were significantly worst in physical functioning (p = 0.004). Surprisingly, single patients, widowed patients, patients living alone and having children had no effect on HRQoL. Further analysis showed significantly worse HRQoL-scores for patients with a lower education and graduation. Patients with a job had significantly better HRQoL-scores. Patients with no graduation had significantly worst HRQoL-scores for cognitive functioning (p = 0.03) and constipation (p = 0.022). Patients with secondary school certificate had significantly worst functioning scores for global health status (p = 0007). Patients with technical college degree (insomnia: p = 0.002), secondary modern school certificate (financial difficulties: p = 0.032) and university-entrance diploma (insomnia: p = 0.009) showed significantly better symptom scores for insomnia and financial difficulties (Fig.Β 2). An unexpected significant worse symptom score for diarrhea was measured in patients with technical college degree (p = 0.012). Patients with no education had significantly worst symptom-scores for diarrhea (p = 0.047) and financial difficulties (p = 0.042). Workers had worse symptom-scores in nausea and vomiting (p = 0.005). Being employed was correlated with better HRQoL-scores. Working patients had significantly better scores in physical functioning (p = <0.001), role functioning (p = 0.01), global health status (p = 0.02), fatigue (p = 0.002), dyspnoe (p = 0.008) and insomnia (p = 0.032) (Fig.Β 3). To test the influence of a high distance, that patients had to travel for their follow up examinations, we compared HRQoL-scores for patients with long and short distance to the transplant center. Living in a distance >155Β km was associated with significantly worst HRQoL-scores for role functioning (p = 0.023), emotional functioning (p = 0.035), fatigue (p = 0.014) and dyspnoe (p = 0.046) (Fig.Β 4). Follow-up at transplant center had worst HRQoL-scores for emotional functioning (p = 0.012), cognitive functioning (p = 0.009), fatigue (p = 0.022) and insomnia (p = 0.038). Size of hometown had no effect on HRQoL. All significant HRQoL-scores are shown in TableΒ 2.Fig. 2


Mode of allocation and social demographic factors correlate with impaired quality of life after liver transplantation.

Heits N, Meer G, Bernsmeier A, Guenther R, Malchow B, Kuechler T, Becker T, Braun F - Health Qual Life Outcomes (2015)

Correlation of symptom scores to highest education (*p < 0.05)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4588670&req=5

Fig2: Correlation of symptom scores to highest education (*p < 0.05)
Mentions: We also assessed the role of family and social network by examining the effects of marital status on HRQoL. HRQoL-scores for divorced patients were significantly worst in physical functioning (p = 0.004). Surprisingly, single patients, widowed patients, patients living alone and having children had no effect on HRQoL. Further analysis showed significantly worse HRQoL-scores for patients with a lower education and graduation. Patients with a job had significantly better HRQoL-scores. Patients with no graduation had significantly worst HRQoL-scores for cognitive functioning (p = 0.03) and constipation (p = 0.022). Patients with secondary school certificate had significantly worst functioning scores for global health status (p = 0007). Patients with technical college degree (insomnia: p = 0.002), secondary modern school certificate (financial difficulties: p = 0.032) and university-entrance diploma (insomnia: p = 0.009) showed significantly better symptom scores for insomnia and financial difficulties (Fig.Β 2). An unexpected significant worse symptom score for diarrhea was measured in patients with technical college degree (p = 0.012). Patients with no education had significantly worst symptom-scores for diarrhea (p = 0.047) and financial difficulties (p = 0.042). Workers had worse symptom-scores in nausea and vomiting (p = 0.005). Being employed was correlated with better HRQoL-scores. Working patients had significantly better scores in physical functioning (p = <0.001), role functioning (p = 0.01), global health status (p = 0.02), fatigue (p = 0.002), dyspnoe (p = 0.008) and insomnia (p = 0.032) (Fig.Β 3). To test the influence of a high distance, that patients had to travel for their follow up examinations, we compared HRQoL-scores for patients with long and short distance to the transplant center. Living in a distance >155Β km was associated with significantly worst HRQoL-scores for role functioning (p = 0.023), emotional functioning (p = 0.035), fatigue (p = 0.014) and dyspnoe (p = 0.046) (Fig.Β 4). Follow-up at transplant center had worst HRQoL-scores for emotional functioning (p = 0.012), cognitive functioning (p = 0.009), fatigue (p = 0.022) and insomnia (p = 0.038). Size of hometown had no effect on HRQoL. All significant HRQoL-scores are shown in TableΒ 2.Fig. 2

Bottom Line: There is still disagreement on the effects of social-demographic factors and changes in the allocation system on HRQoL.HCC as a primary disease did not affect HRQoL.Improvement of HRQoL after LTx may require clinical management of pain, psychotherapy and financial support.

View Article: PubMed Central - PubMed

Affiliation: Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany. nils.heits@uksh-kiel.de.

ABSTRACT

Background: Health-related Quality of life (HRQoL) is a major goal of clinical management after liver transplantation (LTx). There is still disagreement on the effects of social-demographic factors and changes in the allocation system on HRQoL. The aim of this study was to evaluate the impact of social-demographic factors, mode of organ-allocation, waiting time and hepatocellular carcinoma (HCC) on HRQoL after LTx.

Methods: HRQoL was assessed using the EORTC-QLQ-C30 questionnaire, which was sent to 238 recipients. Investigated parameters included age, sex, distance to transplant center, follow-up at hospital, size of hometown, highest education, marital status, having children, background liver disease, waiting time, mode of allocation, HCC, hospitalization after LTx and diagnosis of malignancy after LTx. All evaluated parameters were entered into multivariate linear regression analysis.

Results: Completed questionnaire were returned by 73% of the recipients. After LTx, the HRQoL-function scales increased over time. Age, marital status, highest education, completed professional training, working status, job position, duration of waiting time to LTx, distance to transplant center, place offollow, HU-statuts, mode of organ allocation and duration of hospitalization were associated with significantly worse function- and significantly lower symptom scales. HCC as a primary disease did not affect HRQoL.

Conclusions: Low HRQoL correlated significantly with MELD-based organ allocation, more than 28-day hospitalization, divorced status, lower education- and non-working status, higher distance to transplant center, follow up at transplant center, HU-status, shorter waiting time to LTx and younger age. Improvement of HRQoL after LTx may require clinical management of pain, psychotherapy and financial support.

No MeSH data available.


Related in: MedlinePlus