Psychosocial conditions of children after liver transplant: Post-traumatic stress, depression, and anxiety.

AIM: This study aimed to determine psychosocial conditions, post-traumatic stress, depression, and anxiety of children who underwent a liver transplant. METHOD: This is a relational descriptive study, which was conducted between March 2019 and December 2020 in the Inonu University Liver Transplantation Institute Pediatric Liver Transplant Clinic. The "Child Information Form," "Child Post-Traumatic Stress Reaction Index," "State-Trait Anxiety Inventory for Children-Trait Form," and "Children's Depression Inventory" were used to collect data. The study was conducted with 71 children who had a previous liver transplant. RESULTS: Of the participating children, 56.3% were girls, 63.4% continued their primary school education after the transplant, 32.5% were diagnosed with cirrhosis, 39.4% received the transplant in 2017, 32.4% received it from the mother, and 25.4% received it from a cadaveric donor. Although it had been at least 3 years since the transplant, 47.9% exhibited moderate and 43.7% severe post-traumatic stress responses. There was a significant negative relationship between the age of children with a liver transplant and trait anxiety and post-traumatic stress responses (path coefficients ß = -0.268, p = 0.002; ß = -0.166, p = 0.023, respectively). There was a significant positive relationship between anxiety and post-traumatic stress responses of the children after the transplant and there was a statistically significant relationship between the path coefficients (ß = 0.750; p < 0.001). CONCLUSION: Children who underwent a liver transplant had post-traumatic stress disorder, depression, and trait anxiety.

Sleep Quality and Related Factors Among Liver Transplant Recipients in Korea: A Cross-Sectional Study.

BACKGROUND: Poor sleep quality is common after liver transplantation, which lowers health-related quality of life. However, the detection and management of sleeping difficulties in liver transplant recipients have been limited. PURPOSE: This study was designed to assess sleep quality in liver transplant recipients in Korea and associated factors, including symptom experience, depression, and family support, using the theory of unpleasant symptoms as a theoretical framework. METHODS: This cross-sectional study of 149 liver transplant recipients in a Korean tertiary hospital was conducted in 2019. Data were obtained using several structured self-report questionnaires, including the Pittsburgh Sleep Quality Index, Modified Transplant Symptom Occurrence and Symptom Distress Scale, Center for Epidemiologic Studies Depression Scale-Revised, and Family Support Scale. Multiple linear regression was used to determine the factors associated with sleep quality. RESULTS: The prevalence of sleep disturbance was 55% in the sample. Low sleep quality was associated with being female and with having a higher symptom experience, higher depressive symptoms, and lower family support. In the multiple linear regression analysis, depression and symptom experience was shown to significantly affect sleep quality. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The liver transplant recipients in this study reported poor sleep quality. The factors associated with the sleep quality included depression and symptom experience. To enhance sleep quality, interventions designed to reduce depression and symptoms related to liver transplantation should be provided. The results of this study may be used to develop nursing strategies to improve sleep quality in liver transplant recipients.

Mediating Role of Hope Between Social Support and Self-Management Among Chinese Liver Transplant Recipients: A Multi-Center Cross-Sectional Study.

This study aimed to investigate the common status of self-management in liver transplant recipients and to explore the mediating role of hope in the relationship between social support and self-management. Two hundred and ten liver transplant recipients from two tertiary hospitals were included. Questionnaires were used for general demographic information, the Perceived Social Support Scale, the Herth Hope Index, and the Self-Management Questionnaire for Liver Transplantation Recipients. Lifestyle management of liver transplant recipients was good, while the communication with physicians, cognitive symptom management, and exercise dimensions were less than satisfactory. Minimal assurance of family and education levels were significantly associated with self-management. Social support was positively correlated with self-management and hope (r = .31, p < .01; r = .40, p < .01). Hope was positively correlated with self-management (r = .39, p < .01). Additionally, the effect of social support on self-management was partially mediated (ß = .17, p < .01) by hope. The proportion of mediation of hope was 40.09%. Therefore, well-designed interventions that boost both social support and hope may help improve self-management behavior in liver transplant recipients.

Psychosocial Characteristics of Patients Evaluated for Kidney, Liver, or Heart Transplantation.

OBJECTIVE: Psychosocial parameters play a pivotal role in organ recipient evaluation before wait-listing for transplantation because of their impact on organ and patient outcome. Patients in need of heart (HTx), liver (LTx), or kidney transplantation (KTx) face distinct physical and psychological challenges. This study compares the psychosocial characteristics and preferences for additional therapy for patients undergoing assessment for these three types of organ transplantation to optimize patient-tailored psychological, social, and other supportive interventions. METHODS: We conducted a cross-sectional, observational study with 1110 potential transplantation candidates (LTx, n = 544; KTx, n = 330; HTx, n = 236), psychosocial status was determined for depressive symptoms (Patient Health Questionnaire Depression Scale), anxiety symptoms (seven-item Generalized Anxiety Disorder Screener), health-related quality of life (36-Item Short Form Health Survey), perceived social support (Perceived Social Support Questionnaire), sense of coherence (SoC; short form of the Sense of Coherence Scale), self-efficacy (General Self-Efficacy Short Scale), and body image (German Body Image Questionnaire-20). Preferences for additional supportive therapy were assessed dichotomously. Data were analyzed using multivariate analysis of covariance and χ2 tests. RESULTS: Patient groups differed significantly regarding depression ( F (2,1107) = 35.283, p < .001, partial η2 = 0.01), anxiety ( F (2,1107) = 15.027, p < .001, partial η2 = 0.03), health-related quality of life (physical: F (2,1107) = 96.772, p < .001, partial η2 = 0.15; mental: F (2,1107) = 11.442, p < .001, partial η2 = 0.02), perceived social support ( F (2,1107) = 20.813, p < .001, partial η2 = 0.04), SoC ( F (2,1107) = 12.920, p < .001, partial η2 = 0.02), self-efficacy ( F (2,1107) = 17.308, p < .001, partial η2 = 0.03), and body image (rejecting body evaluation: F (2,1107) = 5.006, p = .007, partial η2 = 0.01; vital body dynamics: F (2,1107) = 40.216, p < .001, partial η2 = 0.07). Patients evaluated for HTx showed the highest psychosocial impairment and the highest inclination regarding additional supportive therapy. CONCLUSIONS: Patients evaluated for HTx, LTx, and KTx have distinct psychosocial characteristics and treatment preferences. HTx patients display the highest psychosocial impairment. We suggest psychocardiological treatment structures for optimal outcome.

Mental health of recipients after cadaveric liver transplantation: A perspective from positive psychology.

AIMS AND OBJECTIVES: The aim of this study was to explore the mental health of transplant recipients, especially psychological integration and the donor-recipient relationship. BACKGROUND: Psychological integration and the donor-recipient relationship are unique psychological perception of recipients with transplantation, which have important effects on their mental health and recovery. However, few studies have focused on the feelings and attitudes of cadaveric liver transplant recipients. DESIGN: A qualitative descriptive design was used. METHODS: Individual semi-structured interviews were conducted face-to-face with 30 recipients after liver transplantation. Qualitative content analysis was used and data saturation was achieved. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) were used. RESULTS: Three themes and eight subthemes were identified. (1) Psychological integration-acknowledging the transplanted liver was a part of their own body and attaching great importance to the liver; (2) Attitudes towards the donor-gratitude to the donor, being inspired by the dedication of the donor and mourning the donor's misfortune; and (3) Living in the moment-health behaviours of self-care, emotional regulation and positive attitude about life. CONCLUSION: The psychological integration of recipients of cadaveric liver transplants is smooth, and the attitudes towards the donor are positive. From the perspective of positive psychology, we observed the important role of post-traumatic growth of the recipient and positive emotions in promoting the recipient's health behaviours for self-care, emotion regulation and attitudes towards life. RELEVANCE FOR CLINICAL PRACTICE: Medical staff should help recipients to deal with these issues about the organ and its donor constructively and guide them to focus on postoperative inner growth and positive emotion.

Impact of psychosocial factors on medication level variability index and outcomes in pediatric liver transplant recipients.

BACKGROUND: Caregivers play an important role in maintaining a functioning graft after pediatric liver transplantation. Therefore, the psychosocial factors of both patients and caregivers can have a critical impact on transplant outcomes. Appropriate assessment and recognition of these factors pre-transplantation may allow transplant teams to better define the needs of pediatric organ recipients and develop specific countermeasures, which may then contribute toward improving transplant outcomes. METHODS: We studied 136 pediatric LT recipients followed at Texas Children's Hospital. Licensed social workers conducted comprehensive pre-transplant assessments on each patient, consisting of 22 psychosocial variables that were thought to impact adherence, which were reviewed during our study period. Non-adherence was determined using the MLVI for up to 4 years after transplantation. Biopsy-confirmed rejection episodes were assessed in the first 3 years after liver transplantation. RESULTS: Factors significantly associated with non-adherence (defined as MLVI >2) included parental age and parental education level at assessment, type of insurance, and household income. The number of ACR episodes trended higher in patients with non-adherence, and these patients had a higher number of moderate to severe rejection episodes but this trend was not statistically significant. CONCLUSIONS: Psychosocial characteristics such as parental age, education level, insurance, and household income may contribute significantly to suboptimal adherence to medications after transplantation. Identification of these psychosocial factors and early intervention is essential to the success and equitable care of our pediatric LT recipients.

MENTAL DISORDERS AND LIVER TRANSPLANTATION: A 2-YEAR COHORT STUDY.

BACKGROUND: Psychosocial assessment is a key component in evaluation for liver transplantation and may affect survival rates and outcomes. OBJECTIVE: The primary aim of this study was to investigate the impact of previous mental disorders and impulsivity on the 2-year surviving rate after liver transplantation. METHODS: We performed a prospective cohort study assessing end-stage liver disease individuals with and without psychiatric comorbidities for 2 years post-transplant. Psychiatric diagnosis was carried out through Mini-Plus 5.0.0 and impulsivity by using Barratt Impulsiveness Scale in the pre-transplant phase. We followed patient's status for 2 years after transplantation. The main outcome was death. We used a logistic regression to evaluate the association of psychiatric comorbidities with death and performed a survival analysis with Kaplan-Meier and Cox regression models. RESULTS: Between June 2010 and July 2014, 93 out of 191 transplant candidates received transplants. From the 93 transplant patients, 21 had psychiatric comorbidities and 72 had not. 25 patients died during the study. The presence of psychiatric comorbidities (P=0.353) and high impulsivity (P=0.272) were not associated to 2-year post transplant death. CONCLUSION: This study found no evidence that the presence of mental disorders and impulsivity worsened prognosis in post-liver transplantation.

A compreensão das expectativas dos pacientes candidatos ao transplante hepático / Understanding the expectations of patients who are candidates for liver transplantation / Comprender las expectativas de los pacientes candidatos a un trasplante de hígado

As doenças hepáticas crônicas trazem alterações metabólicas no organismo que alteram a qualidade de vida do indivíduo. A depender da gravidade clínica, o transplante hepático surge como uma proposta terapêutica que necessita de inclusão no Sistema Nacional de Transplantes e avaliação multiprofissional. O objetivo deste trabalho é identificar as expectativas que os pacientes candidatos ao transplante hepático expressam sobre esta terapêutica. Trata-se de um estudo descritivo, de abordagem qualitativa, que utilizou o método da pesquisa documental nos Formulários de Avaliação Psicológica Pré Transplante do serviço de psicologia de um hospital universitário em Fortaleza, Ceará. Foram analisados 202 Formulários pelo método de análise de conteúdo de Bardin que se dividiram em três categorias: 1. Diminuição dos sintomas a recuperação à saúde; 2. Esperança frente ao desconhecido; 3. Reconstrução da identidade. A pesquisa permitiu identificar as principais expectativas dos pacientes relacionados ao transplante hepático, delineando os aspectos que são sustentadores para que os sujeitos deem continuidade ao tratamento, a saber: rede social de apoio, possibilidade de melhora clínica e aumento da sobrevida, sentimentos de esperança e desejo de qualidade de vida. O desejo de cura está relacionado à recuperação da cirurgia e não apenas ao desaparecimento da doença hepática. (AU)

Chronic liver diseases bring metabolic changes in the body that affect the individual's quality of life. Depending on the clinical severity, liver transplantation emerges as a therapeutic proposal that requires inclusion in the National Transplant System and multidisciplinary evaluation. The aim of this study was to identify the expectations that patients who are candidates for liver transplantation express about this therapy. This is a descriptive, qualitative study that used the documentary research method in the Pre-Transplant Psychological Assessment Forms of the psychology service at a university hospital in the city of Fortaleza, Ceará. 202 Forms were analyzed using Bardin's content analysis method, which were divided into three categories: 1. Reduction of symptoms and recovery to health; 2. Hope in the face of the unknown; 3. Reconstruction of identity. The research identified the main expectations of patients related to liver transplantation, outlining the aspects that support subjects in continuing treatment, namely: social support network, the possibility of clinical improvement and increased survival, feelings of hope, and desire for quality of life. The desire for a cure is related to recovery from surgery and not just to the disappearance of liver disease. (AU)

Las enfermidades hepáticas crónicas traen alteraciones metabólicas en el organismo que alteran la calidad de vida. Dependiendo de la gravidad, el trasplante de hígado surge como una propuesta terapéutica que necesita de inclusión en el Sistema Nacional de Trasplante. El objetivo de este trabajo es identificar las expectativas que los pacientes candidatos al trasplante expresan sobre esta terapia. Se trata de un estudio descriptivo, que se utilizó del método de la búsqueda documental en los Formulários de Evaluación Psicológica Pré Trasplante de un Servicio de Psicología de un Hospital Universitário de la ciudad de Fortaleza (Ceará). Se analizaron 202 Formulários por el método de análisis de contenidos de Bardin que se dividieron en tres categorias: Dismi-nución de los síntomas y la recuperación de la salud; Esperanza frente a lo desconocido; Reconstrucción de la identidad. La búsqueda permitió identificar las expectativas de los pacientes relacionados al trasplante de hígado. Desta-cando los aspectos que son fundamentales para que los sujetos continúen al tratamiento, tenemos: rede social de apoyo, posibilidad de mejora clínica y aumento de supervivencia, sentimientos de esperanza y deseo de calidad de vida. El deseo de cura está relacionado a la recuperación de la cirurgia y desaparición de la enfermedad hepática. (AU)

Evaluation of Psychosocial Outcomes of Living Liver Donors in Liver Transplantation.

BACKGROUND: The purpose of this study was to evaluate the risk factors affecting psychosocial outcomes of living liver donors after liver transplantations. METHODS: This was a descriptive, cross-sectional study. The sample consisted of living liver donors followed by 2 liver transplantation centers in 2 private hospitals in 2 different provinces, between August 2017 and October 2019. All the living liver donors were contacted without a time frame after donation and all the participants were evaluated once. The Beck Depression Scale, SF-36, General Self- Efficacy Scale, and Perceived Available Support Scale were used to collect data. The t-test, Kruskal-Wallis test, Mann-Whitney U-test, and Pearson correlation analysis were used for data analysis. RESULTS: The mean age of the patients was 34.31 ± 8.22 years. There was a positive, weak correlation between age and physical func- tion. Gender, marital status, financial status, and education levels significantly affected physical components, social function, vitality, depression, and self-efficacy scores. High depression levels negatively affected the physical component, self-efficacy, and social sup- port scores of the living liver donors. High self-efficacy positively affected social support. CONCLUSION: The study revealed that gender, marital status, employment status, and education levels were associated with psychosocial outcomes. The financial status was the main factor affecting each psychosocial variable. Financial status needs to be assessed in detail before and after the operation.

Anonymous living liver donor perspectives on the role of family in their donation experience.

Anonymous living organ donation is an understudied but rapidly expanding sector in organ transplantation, in which donors choose to donate anonymously to a recipient in need. The family members and close support network of living donors often play a crucial role in the donation process, and their influence likely has a large impact on the decision to donate as well as the donor's physical and psychosocial state. However, there is limited data examining the impact donor families have on the anonymous donor, and in turn, the impact donation has on donors' families. To assess this, we analyzed a semi-structured qualitative interview on living donor experiences with 26 anonymous living liver donors for common themes concerning donor families. Responses surrounding donor families were grouped into three major categories: (1) family reactions to donation, ranging from (a) pride/support, (b) fear/worry, and (c) jealousy/anger; (2) the impact of donation on donor-family relationships, including (a) positive impacts, (b) negative impacts, (c) a positive ripple effect; (3) gaps in institutional support for donor families. This study provides unique information on anonymous living liver donor perceptions related to their families and will help improve existing programs to accommodate donor family needs and cater to donor relationships.

Growth through adversity: posttraumatic growth in anonymous living liver donors.

PURPOSE: Post-traumatic growth (PTG) is positive change that occurs after struggling with challenging life crises. Research on PTG has typically been limited to oncology populations, first-responders, and individuals in warzones. We report the experience of PTG amongst a sample of 26 anonymous live liver donors. METHODS: Anonymous donors were those with no biological connection or prior relationship with recipients. Twenty-six participants participated in a semi-structured qualitative interview examining their experience with, and outcomes of donation. Interview transcripts were analyzed for themes about PTG using the constant comparison method. RESULTS: While some donors indicated that donation had little lasting impact on their life, most cited significant personal and interpersonal changes resulting from the experience. The most common positive changes included deepened bonds with others, appreciation for personal strength, clearer life direction, legacy-building, and a connection to the transplant community. CONCLUSION: Despite the short-term physical trauma of living donor surgery, the act of anonymous donation appeared to be a catalyst for positive long-term psychological growth. These findings help to bolster the ethical argument in favour of anonymous donation.IMPLICATIONS FOR REHABILITATIONThere is a shortage of organ donors for recipients in need, and anonymous living liver donors can successfully reduce wait times and mortality rates for those on wait lists.There are some questions about the ethics of anonymous donation due to possible negative physical and psychological effects of donation surgery on donors.In a qualitative study, this study shows that donors ascribe significant meaning to, and derive many psychological benefits from, their donation experience.These findings provide insights about how to best support anonymous donors through and after their donation experience.

Subjective Cognition Reported by Caregivers Is Correlated With Objective Cognition in Liver Transplant Recipients.

Objective cognitive assessments, a gold standard diagnostic tool for cognitive impairment, may not be feasible in busy liver transplantation (LT) practice because they are often time consuming. This study determined whether subjective cognition, patients' self-ratings and/or caregivers' ratings of patients' cognition, reflects objective cognition in LT recipients. A convenience sample of 60 adult LT recipients and their caregivers, recruited at a single transplant center, participated in this cross-sectional descriptive study. Subjective cognition (ie, recipient self-rated and caregiver rated) was measured using the Everyday Cognition (ECog; global and 6 domain scores). Objective global and domain-specific cognition of recipients was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test parts A and B, Digit Span Backward, and Rey-Osterrieth Complex Figure. Agreement between LT recipients' ECog scores and those of their caregivers was fair to moderate (intraclass correlation coefficient = 0.48 for global score, 0.35-0.56 for domain scores). Significant, albeit rather weak, correlations were found between subjective and objective scores. Recipients' ECog visuospatial abilities scores were correlated with Rey-Osterrieth Complex Figure scores (rs  = -0.39; P = 0.007), whereas caregivers' ECog global, attention, visuospatial abilities, and organization scores were, respectively, correlated with the scores of RBANS global (rs  = -0.33; P = 0.04) and attention (rs  = -0.46; P = 0.005), Rey-Osterrieth Complex Figure (Copy; rs  = -0.34; P = 0.03), and Trail Making Test part A (rs  = 0.31; P = 0.049). The findings suggest that caregivers may estimate LT recipients' cognition better than recipients themselves. Caregivers may provide supplemental information that could be useful for clinicians when considering the cognitive functioning of LT recipients.

Early Survivorship After Liver Transplantation: A Qualitative Study Identifying Challenges in Recovery From the Patient and Caregiver Perspective.

Survivorship after liver transplantation (LT) is a novel concept providing a holistic view of the arduous recovery experienced after transplantation. We explored components of early survivorship including physical, emotional, and psychological challenges to identify intervention targets for improving the recovery process of LT recipients and caregivers. A total of 20 in-person interviews were conducted among adults 3 to 6 months after LT. Trained qualitative research experts conducted interviews, coded, and analyzed transcripts to identify relevant themes and representative quotes. Early survivorship comprises overcoming (1) physical challenges, with the most challenging experiences involving mobility, driving, dietary modifications, and medication adherence, and (2) emotional and psychological challenges, including new health concerns, financial worries, body image/identity struggles, social isolation, dependency issues, and concerns about never returning to normal. Etiology of liver disease informed survivorship experiences including some patients with hepatocellular carcinoma expressing decisional regret or uncertainty in light of their post-LT experiences. Important topics were identified that framed LT recovery including setting expectations about waitlist experiences, hospital recovery, and ongoing medication requirements. Early survivorship after LT within the first 6 months involves a wide array of physical, emotional, and psychological challenges. Patients and caregivers identified what they wish they had known prior to LT and strategies for recovery, which can inform targeted LT survivorship interventions.

Fear of COVID 19 and social effects in liver transplant patients.

BACKGROUND: This study was descriptively conducted to evaluate the fear of COVID 19 and its social effects on patients who had liver transplant. METHODS: The study was conducted between September 2020 and April 2021 in a liver transplant institute affiliated with a university hospital. The sample of the study was 135 patients. Personal Information Form, Fear of Covid 19 Scale, and Questionnaire of Social Impact of COVID 19 Pandemic were used to collect data. RESULTS: It was determined that the Fear of Covid 19 Scale mean score of the patients was 21.25 ± 6.99. As the fear of COVID 19 increases in patients who had liver transplant, it was determined that their desire to be in crowded environments, to prefer public transportation, to go to the doctor for examination and their focusing on various objectives were decreasing. Also, fear of COVID 19 increased the difficulty in sleep, storage of food and cleaning materials, washing hands frequently, using masks and gloves when going out, health concerns, doubts about disease symptoms, orientation towards healthy eating, worries about the future and questioning the meaning of life. CONCLUSION: The results show that it is important for transplant centers to be able to provide guidance and psychological counseling services to liver transplant patients, who are significantly affected by COVID 19, through telemedicine or various technological opportunities.

The real experience of patients after liver transplantation in intensive care unit.

ABSTRACT: We aimed to explore the real experience of patients after liver transplantation in the intensive care unit (ICU).Objective sampling method was used to select patients transferred to the ICU in 10 hospitals in Zhuhai from May 2018 to August 2020. Patients need liver transplantation due to advanced liver cancer and decompensated cirrhosis. The eligibility criteria of patients mainly included liver transplant patients who were clear-minded and willing to participate in the study and had stayed in ICU. Phenomenological research methods and in-depth interviews were used in this qualitative study.The results showed that the true experience of patients after liver transplantation during ICU stay was summarized into four themes. The strengths of our qualitative research are that we can find the trend from a phenomenon through interviews and other methods to provide a directional foundation for future quantitative research. Its limitations are that it requires a lot of manpower and time, and its objectivity and universality are limited.Hospitalization experience in the ICU may lead to many negative experiences for liver transplant patients. Nurses should fully understand and pay attention to the psychological changes in patients. Nurses should take effective targeted measures to reduce or eliminate patients' fear of ICU stay and promote rehabilitation.

Psychosocial situation, adherence, and utilization of video consultation in young adult long-term pediatric liver transplant recipients during COVID-19 pandemic.

BACKGROUND: Young adults who underwent liver transplantation in childhood (YALTs) are highly vulnerable to non-adherent behavior and psychosocial problems. During the COVID-19 pandemic, special efforts may be necessary to maintain contact with these patients and offer support. This can be achieved through the use of telemedicine. The study's objective was to assess adherence and the psychosocial situation of YALTs during the COVID-19 pandemic in Germany and to evaluate the utilization of video consultations. METHODS: In May 2020, a questionnaire was sent to YALTs treated at the Hamburg University Transplant Center, accompanied by the offer of video appointments with the attending physician. The questionnaire included the Generalized Anxiety Disorder Scale 7, the Patient Health Questionnaire 2, and questions compiled by the authors. RESULTS: Of 98 YALTs, 12% used the video consultation, while 65% had an in-person appointment. The 56 patients who completed the questionnaire did not report reduced medication adherence during the pandemic, but 40% missed follow-up visits with their primary care physician or check-up laboratory tests. About 70% of YALTs were afraid to visit their physician and the transplant center, and 34% were afraid of a SARS-CoV-2 infection. Mental health and well-being were unimpaired. CONCLUSIONS: During the COVID-19 pandemic, YALTs in our study did not show an increased need for psychosocial support, but a majority were afraid to attend medical appointments, and 40% reported lower appointment adherence. Acceptance of video consultations was lower than expected. The reasons for this need to be further investigated in order to optimize care.

Quality of life 5 years following liver transplantation.

BACKGROUND: Data on quality of life (QOL) among liver transplant recipients from India is scarce. We conducted a prospective assessment of QOL and incidence of complications 5 years following liver transplantation (LT). METHODS: Demographic data of 130 patients (M:F = 98:32, mean age 38.4 ± 14.9 years) who had completed at least 5 years after LT were collected and the incidence of new onset metabolic complications and renal dysfunction was analyzed. Liver transplant database (LTD QOL) questionnaire was given to 100 patients and scoring was done on five QOL domains. This was compared to a historical cohort from the liver transplant database of three transplant centres from North America, who had completed the same questionnaire before and 1 year after LT. RESULTS: The incidence of new onset dyslipidemia, diabetes mellitus, renal dysfunction, hypertension and overweight/obesity was 43%, 26.7%, 25%, 16.4% and 15.4%, respectively. Although ethanol-related cirrhosis was the etiology for transplant in 38%, recidivism was not evident in any recipient in this cohort even after 5 years. Significant improvement in QOL was observed in all five domains, namely measures of disease (p=0.001), psychological status (p=0.001), personal function (p=0.001), social and role function (p=0.001) and general health perception (p=0.001) in our patients 5 years after transplant compared to historical data. CONCLUSION: Although metabolic disease is common after LT, there is significant improvement in long-term QOL. Recidivism appeared to be rare in our study population.