Researchers in Japan report that health-related quality of life (HRQOL) for donors following living donor liver transplantation (LDLT) was better than the general Japanese population (the norm). This study -- one of the largest to date -- found that donors who developed two or more medical problems (co-morbidities) after donation had significantly decreased long-term HRQOL. Full findings are published in the November issue of Liver Transplantation, a journal of the American Association for the Study of Liver Diseases (AASLD).
The shortage of viable donor organs continues to be a critical issue for the transplant community. Livers, in particular, are in short supply, with the Organ Procurement and Transplantation Network (OPTN) reporting that in the U.S. more than 16,000 patients are currently on the waiting list. To ease the shortage of deceased donor organs, transplant specialists are turning to LDLT -- a widely accepted alternative approach, especially in Japan, where one study shows that close to 6,000 of these procedures were performed by December 2008.
"With LDLTs being performed at increasing rates, it is important to understand the long-term outcomes for living donors," explains lead study author Dr. Yasutsugu Takada with the Ehime University Graduate School of Medicine in Japan. "Our study is the largest to investigate living liver donors' quality of life and to determine potential risk factors following transplantation."
The team contacted 997 living donors who provided a piece of liver for transplantation, which were performed at Kyoto University Hospital between 1990 and 2004. Researchers mailed the 36-item short-form health survey to all donors and 578 (58%) responded. The survey responses are summarized by: the physical component summary, mental component summary, and role/social components by component. A norm-based scoring system was used to report survey results.
Findings indicate that norm-based HRQOL scores for the 367 left- and 211 right-lobe donors were better than the Japanese norm across all time periods. The median post-transplant follow-up period was nearly 7 years. Further analysis determined that decreased HRQOL scores, specifically lower mental health and social functioning, were significantly associated with age of donor, persistence of symptoms, emergence of additional diseases, or other consequences (additional hospital visits, continued work absence) following donation.
Dr. Takada concludes, "Kyoto University Hospital is one of the high volume transplant centers in Asia, as such, we are keenly aware of the necessity and responsibility to report donor long-term QOL. Our findings suggest that careful follow-up and counseling are necessary for donors at risk for poor quality of life."
In a related editorial, Drs. Leona Kim-Schluger and Sander Florman from The Mount Sinai Medical Center in New York highlight that the importance of the Takada et al study is the sheer size of the living donor cohort and the long-term follow-up of donors to evaluate HRQOL. They write, "We must strive to study and comprehend the motivations leading to donation, the financial and economic impact of donation, and learn to alleviate the fears pre and post donation, with the one goal of safely getting the living donors through the donor process medically, surgically, and psychologically."
- Leona Kim-Schluger, Sander Florman. Quality of life after living donor liver transplantation: What we have learned and how we can do better. Liver Transplantation, 2012; 18 (11): 1272 DOI: 10.1002/lt.23528
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