Impact Of Symptoms Experience And Quality Of Life In Liver Transplant Recipients

Objective: This study aimed to describe symptom experience and quality of life (OOL) in liver transplant recipients; to identify the factors that predict their quality of life; to test the relati- -onship between symptoms experience of liver transplant recipi -ents and their health-related quality of life.Methods: This study is a cross-sectional, descriptive design. A structured questionnaire was used to gather data: The Self-report Symptom Check-List for liver transplant recipient developed by researchers through a literature review was used to gather self-reported data on presence or absence of symptoms, intensity of present symptoms; The social support questionnaire was used to gather data about availability and amount of social support of liver transplant recipients; and QOL variables (domains) was collected by Medical Outcomes Study Short Form-36 (MOS SF-36). The demographic data was collected from liver transplant recipients and clinical records. Database records of 148 liver transplant recipients who are currently alive and received liver transplantation between 1999 to 2006 were approached for participation in this study and asked to complete the structured questionnaire. The data of 141 recipients were obtained from September 25, 2006 to November 30, 2006. The response rate was 95.27%.Data were analyzed using Statistical Package for the Social Sciences (SPSS 13.0) for Windows software application program. Statistical methods such as t-test, Kruskal Wallis H, One-way ANOVA, Mann-whitney U, Stepwise multiple regression and Spearman rank correlation were used to assess the questionnaires.Results:1. Compare with a reference general population, the liver transplant recipients showed a significantly worse HRQoL score on all domains of the SF-36 scales (P＜0.05). As the surviving time extending, however, the QOL can be improved gradually.2. Examining the relationships between demographic variables and QOL showed: age,sex,level of education,family income were significantly associated to QOL (P＜0.05). The higher education level,more work hours and family income linked with better QOL. Marital status,occupation,medical payment status were not associated with QOL (P＞0.05). Moreover, patients with or without hepatic cancer and their Child-Pugh classification were not associated with QOL.3. Examining the relationships between variables and symptom experience showed: All demographic variables except Level of education were not associated with symptom experience. Lower education level reported poorer symptom experience (P＜0.05). Patients with benign End—stage liver disease and patients with Child-Pugh classification C reported more symptoms (P＜0.05).4. The result of the stepwise multiple regression analysis in prediction QOL showed: overall symptom experience score,long-time surviving after transplantation operation,social support score and family monthly income were significant predictors of QOL, and explained 36.3% and 40% of the total variance in physical-related QOL and psychological-related QOL respectively. The overall symptom experience score was the most significant predictor, which separately accounted for 16.3% and 26.6% of variance of physical -related QOL and psychological-related QOL respectively.6. Social support factors were associated to QOL and symptom experience. The objective support,the subjective support and the total social support score were positively related to mental health related QOL (P＜0.05) (r=0.22～0.40). The objective support,the subjective support and the total social support score were negatively related to the symptom experience (P＜0.05) (r=-0.193～0.319).7. liver transplant recipients experienced many symptoms (mean 15.75±.6.03, range 2-30of 31). The most frequently occurring symptoms were: fatigue and drowsy (85.8%),sleeplessness (80.1%),mood swings (75.2%),excessive appetite(73%),depression(69.5%),poor vision (66%),dizzy and headache (63.1%),increased weight(62.4%),abdominal distension(58.9%),diarrhea (56.7%). 17 symptoms out of 31 were most strongly associated with poorer HRQL in more than half of the SF-36 subscales. Of the 10 top prevalence symptoms, 7 had a significant relationship to more than 1 of the HRQL subscales: fatigue and drowsy (r=-0.272～0.566),sleeplessness ( r=-0.178～-0.355),mood swings (r=-0.261～-0.500),depression (r=-0.220～-0.529),dizzy and headache (r=-0.217～-0.324),abdominal distension (r=-0.191～-0.341),diarrhea (r=-0.225)。Conclusion:1. Compared with a general population, liver transplant recipients demonstrated a significantly reduced HRQoL. But evidence showed the longer the patients alive the better QOL obtained.2. The variables such as sex,age,level of education,family income were associated with QOL. Male,older,higher level of education and more family income were associated with better QOL. 3. Patients with higher education level had better symptom experience. And those with Child-Pugh classification C and patient with benign End—stage liver disease experienced more symptoms.4. overall symptom experience score,long-time surviving after transplantation operation,social support score and family monthly income were significant predictors of QOL. The overall symptom experience score was the most significant predictor.5. Liver transplant recipients experienced many symptoms. Poorer symptoms experiences were strongly associated with worse HRQL. fatigue and drowsy,sleeplessness,mood swings,depression,dizzy and headache,abdominal distension,diarrhea are urgent symptoms need intervention.The symptoms experience is very important factor which is significantly associated with health-related quality of life in liver transplant recipients. In such patients, targeting specific symptoms may improve health-related quality of life.