An Analysis of Health-Related Quality of Life in Liver Transplantion for Hepatocellular Carcinoma
Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN.
Meeting: 2015 American Transplant Congress
Abstract number: D184
Keywords: Allocation
Session Information
Session Name: Poster Session D: Liver Transplantation for Hepatocellular Carcinoma
Session Type: Poster Session
Date: Tuesday, May 5, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Background:
There is a disproportionate waiting time and an unclear survival benefit between hepatocellular carcinoma (HCC) versus non-HCC liver transplant recipients. However, there is paucity of data on mental health-related quality of life (HRQOL) in HCC versus non-HCC patients. HRQOL is an important outcome metric worth considering in the debate regarding exception point allocation in HCC patients.
Methods:
HRQOL was measured before and after liver transplant using the physical (PCS) and mental component summary (MCS) scales of the Short Form 36 Health Survey. Data were analyzed using multivariable linear mixed effects models.
Results:
The sample included 1,521 HRQOL data points in 502 adult transplant recipients (67% male, 29% HCC) between 2002-2014. Follow-up time averaged 25 months. PCS scores improved significantly after transplantation (table 1) After adjusting for the etiology of liver disease, re-transplant prior to HRQOL assessment, laboratory MELD at transplant, MELD era, and follow up time, HCC had a statistically negative effect on PCS, but didn't reach clinical significance. Receiving exception points for HCC was independently associated with significantly better PCS scores, and the rate of improvement in scores didn't differ between patients who were or were not awarded HCC exception points. MCS remained stable within the general population norm, and wasn't associated with HCC or whether exception points were awarded.
| PCS Beta | PCS p-value | MCS Beta | MCS p-value | |
|---|---|---|---|---|
| Exception points awarded for HCC (ref: no) | 5.69 | 0.001 | -0.51 | 0.748 |
| Laboratory MELD at time of transplant | -0.045 | 0.486 | -0.54 | 0.399 |
| MELD era 2005-present (ref: 2002-2004) | 1.82 | 0.092 | 0.89 | 0.415 |
| Re-transplant prior to HRQOL (ref: no) | -8.28 | 0.021 | 1.85 | 0.607 |
| Etiology of Liver disease (ref: no) | ||||
| HCC | -3.01 | 0.031 | -0.79 | 0.572 |
| NASH | 1.85 | 0.209 | 0.51 | 0.731 |
| HCV | -2.21 | 0.035 | -1.33 | 0.209 |
| ETOH | -0.91 | 0.400 | -2.03 | 0.063 |
| Cryptogenic | -0.811 | 0.633 | 0.81 | 0.635 |
| Metabolic | -0.27 | 0.873 | 1.14 | 0.513 |
| Autoimmune | 1.26 | 0.385 | 2.46 | 0.940 |
| Follow up time at HRQOL (months) | 0.12 | <0.001 | 0.02 | 0.133 |
| Interaction term (time from transplant by exception point awarded) | -0.013 | 0.680 | 0.02 | 0.488 |
| Covariance parameter | 48.89 | <0.001 | 50.48 | <0.001 |
Liver transplant recipients with HCC who received exception points had better HRQOL compared to other patients within the cohort. Thus, by awarding exception points, patients with HCC are offered improved quality of life.
To cite this abstract in AMA style:
Kensinger C, O'Dell H, LaNeve D, Simmons L, Feurer I, Moore D. An Analysis of Health-Related Quality of Life in Liver Transplantion for Hepatocellular Carcinoma [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/an-analysis-of-health-related-quality-of-life-in-liver-transplantion-for-hepatocellular-carcinoma/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress