MEASURING OUTCOME AFTER LIVER-TRANSPLANTATION - A CRITICAL-REVIEW

As the number of liver transplantations performed around the world and the survival rates increase, attention is turning to the broad impact this procedure has on patients' quality of life (QOL), including thei r physical and psychosocial functioning and their perceived sense of w ellbeing. There exists a small body of literature that examines the gl obal effects of liver transplantation on QOL. The purpose of this arti cle is to discuss the general framework used to assess QOL and to crit ically review the studies that have broadly examined QOL outcomes afte r liver transplantation. The reviewed studies used measures that led t o broad assessment of the various domains of QOL. Although the instrum ents used to measure QOL in these studies are largely validated, there is significant heterogeneity in this literature in terms of the instr uments used, leading to difficulties in making generalizable conclusio ns among the studies. Although limited by internal validity problems, the available data suggest improvement in QOL by liver transplantation . Additionally, a large recent study that used the Liver Transplant Da tabase Quality of Life Questionnaire also reported a subset of patient s in whom QOL seemed to worsen after liver transplantation. Knowledge of the factors related to QOL outcome after liver transplantation is i mportant because it might allow development of new interventions that may have an impact on future allocation decisions. Copyright (C) 1998 by the American Association for the Study of Liver Diseases.