Health-related quality of life after different types of solid organ transplantation

Objective To describe functional health and health-related quality of life (QOL) before and after transplantation; to compare and contrast outcomes am ong liver, heart, lung, and kidney transplant patients, and compare these o utcomes with selected norms; and to explore whether physiologic performance , demographics, and other clinical variables are predictors of posttranspla ntation overall subjective QOL. Summary Background Data There is increasing demand for outcomes analysis, i ncluding health-related QOL, after medical and surgical interventions. Beca use of the high cost, interest in transplantation outcomes is particularly intense. With technical surgical experience and improved immunosuppression, survival after solid organ transplantation has matured to acceptable level s. More sensitive measures of outcomes are necessary to evaluate further de velopments in clinical transplantation, including data on objective functio nal outcome and subjective QOL. Methods The Karnofsky Performance Status was assessed objectively for patie nts before transplantation and up to 4 years after transplantation, and sco res were compared by repeated measures analysis of variance. Subjective eva luation of QOL over time was obtained using the Short Form-36 (SF-36) and t he Psychosocial Adjustment to Illness Scale (PAIS). These data were analyze d using multivariate and univariate analysis of variance. A summary model o f health-related QOL was tested by path analysis. Results Tools were administered to 100 liver, 94 heart, 112 kidney, and 65 lung transplant patients. Mean age at transplantation was 48 years; 36% of recipients were female. The Karnofsky Performance Status before transplanta tion was 37+/-1 for lung, 38+/-2 for heart, 53+/-3 for liver, and 75+/-1 fo r kidney recipients. After transplantation, the scores improved to 67+/-1 a t 3 months, 77+/-1 at 6 months, 82+/-1 at 12 months, 86+/-1 at 24 months, 8 4+/-2 at 36 months, and 83+/-3 at 48 months. When patients were stratified by initial performance score as disabled or able, both groups merged in ter ms of performance by 6 months after liver and heart transplantation; kidney transplant patients maintained their stratification 2 years after transpla ntation; The SF-36 physical and mental component scales improved after tran splantation. The PAIS score improved globally. Path analysis demonstrated a direct effect on the posttransplant Karnofsky score by time after transpla ntation and diabetes, with trends evident for education and preoperative se rum creatinine level. Although neither time after transplantation nor diabe tes was directly predictive of a composite QOL score that incorporated all 15 subjective domains, recent Karnofsky score and education level were dire ctly predictive of the QOL composite score. Conclusions Different types of transplant patients have a different health- related QOL before transplantation. Performance improved after transplantat ion for all four types of transplants, but the trajectories were not the sa me. Subjective QOL measured by the SF-36 and the PAIS also improved after t ransplantation. Path analysis shows the important predictors of health-rela ted QOL. These data provide clearly defined and widely useful QOL outcome b enchmarks for different types of solid organ transplants.