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Reuters Health Information (2011-05-03): After liver transplant as babies, young adults have good QOL


After liver transplant as babies, young adults have good QOL

Last Updated: 2011-05-03 19:30:28 -0400 (Reuters Health)

PHILADELPHIA (Reuters Health) - Two decades after undergoing liver transplantation as infants, young adults have good health-related quality of life (HRQOL), a new study suggests.

Yesterday at the American Transplant Congress, Dr. Saeed Mohammad reported on 35 patients who received liver transplants between 1988 and 1992, at a median age of roughly one year.

When those same patients responded to a survey at a mean age of 23, 62% had attended college, 69% lived with their parents, and 80% of those over 23 were employed. Those education and employment statistics are equivalent to what's reported for their peers in the general population, Dr. Mohammed said.

The liver recipients' mean total score on the PedsQL 4.0 Generic Core Scale was 76, which was not significantly different from the score of 78 found in 1,171 controls.

Overall, based on that scale and on their Short Form (SF)-36 scores, these young adults have a HRQOL that's comparable to their healthy peers, except in the physical domain (53. 25 vs. 53.50, p=0.03).

But the lower physical domain scores "don't reflect how they're managing in life," senior investigator Dr. Estella M. Alonso said in an interview. Instead, they reflect the fact that patients need to "check yes" on more of those "have you ever been diagnosed with..." questions, she said.

In fact, liver recipients and controls had comparable scores for domains of vitality, bodily pain, mental health, social function, and emotional and physical roles. The transplant patients, however, had better scores than reported standards for age-matched patients with chronic diseases.

Dr. Alonso and Dr. Mohammed, both from Northwestern University in Chicago, told Reuters Health that the transplant group had a lower-than-average score on the Health Utility Index, but not by much. The best possible score is 1.0, the norm is 0.8, and the pediatric transplant survivors' average score was 0.75 (p<0.0001). That score is equivalent to scores for cancer survivors and higher than for people who have liver transplants as adults, Dr. Alonso said.

The two researchers said an earlier study by their group, done with younger liver transplant survivors, had shown lower school function and social function scores in patients compared to controls. The new findings in this older group suggest that most of those issues may resolve with time, Dr. Alonso said.

In the same session on pediatric liver transplantation at which Dr. Mohammad gave his talk, other presenters highlighted the importance of ensuring that teenagers make a smooth transition from pediatric to adult care. Dr. Alonso said the difficulty of that process is reflected in the fact that her team could only locate two thirds of the survivors from the original cohort.

Altogether, 181 children had been transplanted between 1988 and 1992 at the University of Chicago, where Dr. Alonso was working at the time. Social security records confirmed that 95 were still alive. (Most deaths had occurred relatively early after transplant, according to the researchers.) Of those 95 survivors, 36 had been lost to follow-up.

"We called the doctors the patients' records had been sent to, the doctors who the patients told us would be taking care of them, and often those doctors didn't have any information on them," Dr. Alonso said. "They hadn't seen or heard from them in years."

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