Long‐term improvement in health‐related quality of life after orthotopic liver transplantation

Traditionally, the liver transplantation outcomes of interest to both clinicians and researchers have been survival rates and postoperative complications. For patients, however, the decision to have a liver transplant is often made in an effort to improve their quality of life and to reduce their risk of mortality and morbidity. Measurement of health-related quality of life (HRQL) has become a large area of research in the past few decades across the full spectrum of patient groups. In addition to scientific interest in HRQL, clinicians have increasingly become interested in how liver transplantation may affect not only patients’ quantity of life but also their quality of life. Some research has investigated the quality of life of liver transplant patients, focusing largely on comparisons between quality-of-life domains of patients before transplantation and shortly after transplantation. The investigated posttransplantation period is typically within a year and less frequently within the first few years after the transplant. In one such study, orthotopic liver transplantation (OLT) was associated with significant improvement in a number of HRQL domains. In fact, this rapid improvement in HRQL was associated with better resource utilization. Additionally, in a recent meta-analysis, Bravata and colleagues reported data on HRQL of liver transplant recipients. They concluded that there generally were improvements in patients’ general health, physical health, daily activity functioning, and sexual functioning after transplantation. There was less consistent evidence of improvement in psychological health, however, including social isolation and social functioning. These findings are consistent with studies of recipients of other organ transplants (for example, lung, kidney, and heart transplants), which have found that the posttransplantation quality of life of organ recipients is better than their pretransplantation quality of life, particularly in physical health domains. Desai et al.’s study in this issue of Liver Transplantation provides valuable cross-sectional information on the quality of life of patients at least 10 years (and up to 30 years) after they underwent liver transplantation. Their patient population consists of 57 residents in the United Kingdom who received a liver transplant between 1968 and 1994 and completed a mail survey asking about their quality of life. Additionally, a wide range of clinical and demographic data was retrospectively collected. This study is one of the first to provide quality-of-life data over a decade after patients received organ transplantation. Not only is little known about the long-term physical and psychological benefits of liver transplants, but it is uncommon to have long-term data on any population group because it is time-consuming and cost-prohibitive to follow up with patient groups over many years. One of the greatest strengths of this study by Desai et al. is that they used both a generic (global) HRQL measure and a disease-specific HRQL measure. The generic instrument, the SF-36, which is a widely used 8-domain HRQL instrument, allows for comparisons in quality of life to be made across patient groups, including long-term HRQL outcomes of other organ transplant patients. The Ferrans and Powers Questionnaire, on the other hand, was designed to assess the HRQL of liver transplant recipients and therefore pro-