Health-related quality of life in liver transplant recipients

Purpose of review: The success of liver transplantation has traditionally been measured by survival rates. With 1-year survival rates approaching 90%, other measures must be used to permit us to understand the impact of liver transplantation on outcome. Assessment of health-related quality of life in those awaiting transplantation and liver transplant recipients will permit us to hear the voice and perspective of the patient and help us predict future health status, mortality, and resource utilization. The purpose of this review is to summarize the current status of measurement of health-related quality of life and our current understanding of its application to pediatric and adult liver transplant candidates. Recent findings: Before transplantation, health-related quality of life is poor in all domains. One half of adult patients are willing to accept a 50% risk of death in exchange for perfect health. Health-related quality of life in pediatric liver transplant recipients is lower than in healthy children but similar to that in children with chronic illness. Summary: Health-related quality of life improves after transplantation, but the factors that influence it in this setting are unclear. Research in this area will help in decision making, help identify interventions that improve the health of recipients after liver transplantation, and permit us to better inform patients, families, providers, and payers about clinical and functional tradeoffs.