Cadaveric liver organ allocation is based on the model for end-stage liver disease (MELD) score. Those with low MELD scores (≤ 15) are considered to be low priority for liver transplantation. However, individuals with low MELD scores may experience an array of symptoms and health problems associated with chronic liver disease and therefore are at risk for low health related quality of life (HRQoL). No known published studies are available that have examined HRQoL specifically in the low MELD population. The aims of this pilot study were to 1) describe the HRQoL of the low MELD population and 2) identify clinical and demographic characteristics that were associated with HRQoL.
Methods: A single-center cross-sectional descriptive design was used to examine HRQoL in the cadaveric liver transplant candidate with MELD scores </= 15. For this pilot study, a convenience sample of fifty subjects was recruited from a large Midwestern metropolitan pre-liver transplant clinic. Variables to measure were selected based on the Wilson and Cleary Conceptual Model of HRQoL. Subjects completed written questionnaires examining quality of life, social support, depressive symptoms, health perception, biological function and liver disease symptoms. Clinical providers assessed physical functioning (Karnofsky Score).
Results: Descriptive, correlational and regression analysis were completed. The mean MELD score was 11.5, which suggests that overall; subjects had a low 3 month mortality rate. Subjects rated their HRQoL moderately high with a mean score of 20 (range 0-30). The MELD score was not associated with overall HRQoL. Depressive symptoms (CES-D) (B=-0.592, p=0.000) and perceived social support (B=0.202, p=0.012) independently predicted HRQoL. The regression model explained 78% of the variance in HRQoL (adjusted R2=0.787, F (8, 41) =23.58, p=0.000).
Conclusions: This population has limited likelihood for transplantation in the current prioritization system. The most significant predictors of HRQoL were depressive symptoms and level of social support. Although further longitudinal research is needed with a larger sample size, these findings have implications for health care providers. Health care providers can screen for depressive symptoms more proactively. Social support was also predictive and while, the health care team cannot modify it, support groups and resources can provide additional assistance and help to this population.
To cite this abstract in AMA style:Duke R. Health-Related Quality of Life in the Pre-Transplant Candidate Low MELD for End-Stage Liver Disease (MELD) Score: A Pilot Study [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/health-related-quality-of-life-in-the-pre-transplant-candidate-low-meld-for-end-stage-liver-disease-meld-score-a-pilot-study/. Accessed September 24, 2017.
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