Evaluation of the effects of liver transplantation on the physical and psychological status of children with pediatric liver transplant quality of life index

BACKGROUND/AIMS: Increased number of patients with excellent survival rates in pediatric liver transplantation has led health care providers to develop the concept of health-related quality of life (HRQoL) which enables assessment of medical and physical complications as well as psychosocial status and serves to help with the adjustment to transplantation. The aim of this study is to evaluate the factors that may affect the QoL in pediatric liver transplant recipients (LTR), to accurately measure the QoL and to determine the possible interventions to improve it. METHODS: Pediatric LTR (n=59) between 8-18 years of age, who were seen in outpatient clinic of Istanbul University Istanbul Medical Faculty Department of Pediatric Gastroenterology, Hepatology and Nutrition for routine follow-up, between April 2019 and July 2019, who had undergone liver transplantation at same faculty at least one year prior, as well as their parents (n=59) were evaluated with PeLTQL (Pediatric Liver Transplant Quality of Life Index) with separate child and parent forms. Sociodemographic characteristics, body measurement data, pre-transplant problems, early post-transplant medical and surgical complications, immunosuppressive therapy, long-term follow-up problems and hospitalization data were analyzed. Parent and patient forms were evaluated in terms of PeLTQL subscales [Future Health (FH), Coping&Adjustment (CA), Social-Emotional (SE)] and total scores. The factors affecting the PeLTQL scale scores were investigated. RESULTS: Of the 59 cases included in our study, 39% (n=23) were girls and 61% (n=36) were boys. Retransplantation recipients (n=2) were excluded from the study. Of 57 patients and parent pairs; the mean age of transplantation was 4.9±3.7 years. Patient and parent scores on PeLTQL were examined and significant positive correlation was found between FH (r:0.63; p<0.01), CA (r:0.536; p<0.01), SE (r:0.522; p<0.01) and total scores (r:0,663; p<0.01) in parent-patient pairs. In the evaluation of PeLTQL child form; there was a negative correlation between the number of children and SE scores (r =-0.298, p =0.022). Sex and pre-transplant hepatopulmonary syndrome (HPS) were found to be statistically significant factors on FH subscale scores; girls and those with pre-transplant HPS had higher FH scores [for both (p=0.005)]. CA subscale scores were statistically affected by donor type and post-transplant vascular complication; it was found that those who had living related donor had higher scores than cadaveric transplantation (p=0.023) but those with post-transplant vascular complications had lower scores (p=0.04). Pre-transplant HPS, pre-transplant hepatic encephalopathy (HE), and donor type were statistically significant factors affecting total scores; those transplanted from living related donor (p=0.043) and those with pre-transplant HPS had higher scores (p=0.01) but those with pre-transplant HE had lower scores (p=0.03). There was no statistically significant effect of the other factors investigated (p>0.05). CONCLUSION: As a result; sex had a statistically significant effect on FH scores, post-transplant vascular complications on CA scores, the number of children in the family on SE scores, pre-transplant HE history on total scores; pre-transplant HPS on both FH and total scores, donor type on both UB and total scores. Positive correlation between PeLTQL parent and patient form total scores and all subscale scores was associated with strong family ties in our society, upbringing from self-centeredness and individualistic approach.