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INTRODUCTION

The Centers for Disease Control and Prevention (CDC) defines quality of life (QOL) as “an overall sense of wellbeing, including aspects of happiness and satisfaction with life as a whole.”

BACKGROUND

Liver transplantation has moved from an experimental treatment to standard management for end-stage liver disease. Prolongation in survival is accepted, but evaluation of long-term effects on the patient’s quality of life and its enhancement is the new objective.

QUALITY OF LIFE

  • Comprehensive measurement of posttransplantation health-related quality of life (HRQL) are important for several reasons:

    • Patients are more concerned about QOL than longevity.

    • Liver transplant recipients may have debilitating fatigue, bone pain, loss of self-esteem, depression, and complications of immunosuppression that are poorly evaluated through traditional clinical outcomes.

    • Provide valuable information to the health professionals to focus their treatment and procedures toward the most affected areas of recipients’ lives.

    • Provide key components of an evaluation of both effectiveness and cost-effectiveness, which are of particular importance given the cost and scarcity of the resources involved in liver transplantation (LT).

  • Measuring of QOL helps to address the overall health status of liver transplant recipients.

METHOD FOR MEASURING QUALITY OF LIFE

  • Generic instruments (Table 37-1)

  • Targeted instruments focused on disease or treatment (Table 37-2)

  • Pretransplant predictors of QOL (Table 37-3)

  • Employment: interval without work prior to LT and pre-LT diagnosis correlated with the likelihood of employment after LT.

  • Sexual functioning: in most cases there isn’t a perceptible improvement; perceptions of sexual health are likely to be psychological rather than endocrine, since endocrine function typically recovers after LT.

  • Effect of immunosuppressant medications (Table 37-4)

    • Increased risk of infections

    • Metabolic complications such as hypertension, diabetes mellitus (DM), hyperlipidemia, obesity, and gout

      • Cardiovascular disease and renal failure are the leading nonhepatic causes of morbidity and mortality late after LT

    • De novo cancers, including posttransplant lymphoproliferative disorder

    • Psychological effects associated with steroid therapy aren’t common

Strategies to improve QOL in post-LT patients

  • Monitoring of renal function

  • Bone mineral density screenings should be done

  • Immunization

    • Annual influenza vaccination

    • Avoid live virus vaccines

    • Reimmunization is indicated for the pneumococcal vaccine (every 3 to 5 years)

  • Behavioral intervention

    • Psychoeducational counseling

      • Frequent handwashing

      • Avoid unnecessary sun exposure

      • During periods of maximal immunosuppression, avoid crowds

      • Avoid the consumption of water from lakes and rivers, unpasteurized milk products, and raw and undercooked eggs and meats

      • Avoid high-risk pets, which include rodents, reptiles, and birds

      • Reduction of travel-related risks

      • Sustained cessation of smoking

      • Preconception counseling about contraception and the risks and outcomes of pregnancy

      • Exercise and dietary counseling

TABLE 37-1Generic Instruments for the Evaluation of QOL (Review Pathology)

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