Conflicts of Interest None of the authors has a conflict of interest to declare.
Reduction in functional ability is significant postliver transplantation compared with matched liver disease and community dwelling controls
Version of Record online: 8 MAR 2011
© 2011 The Authors. Transplant International © 2011 European Society for Organ Transplantation
Volume 24, Issue 6, pages 588–595, June 2011
How to Cite
Elliott, C., Frith, J., Pairman, J., Jones, D. E. J. and Newton, J. L. (2011), Reduction in functional ability is significant postliver transplantation compared with matched liver disease and community dwelling controls. Transplant International, 24: 588–595. doi: 10.1111/j.1432-2277.2011.01240.x
- Issue online: 28 APR 2011
- Version of Record online: 8 MAR 2011
- Received: 5 November 2010 Revision requested: 1 January 2011 Accepted: 7 February 2011 Published online: 8 March 2011
- functional ability;
We compared functional ability and symptom severity in liver transplant recipients and matched chronic liver disease (CLD) and community controls. A total of 103/140 consecutive liver transplant recipients from a single centre (73%) and matched controls completed the patient-reported functional outcome measure: Patient-Reported Outcomes Measurement Information System, Health Assessment Questionnaire (PROMIS HAQ). Symptoms frequently seen in CLD were quantified by (i) Fatigue Impact Scale (FIS), (ii) Orthostatic Grading Scale (OGS: autonomic dysfunction), (iii) Cognitive Failures Questionnaire (CFQ) and (iv) Epworth Sleepiness Scale (ESS: Daytime somnolence). Liver transplant recipients exhibited significant reduction in function (P < 0.0001) across all domains of the PROMIS HAQ suggesting that functional impairment is broad-based. Seventy-seven per cent of all postliver transplants identified some difficulty with activities of daily living. There was no relationship between PROMIS HAQ and liver biochemistry (r2 = 0.04, P = NS) or time since transplant (r2 = 0.1, P = NS). Elevation in PROMIS HAQ (and therefore functional impairment) strongly associated with symptoms, particularly fatigue, cognitive impairment and daytime somnolence. Fatigue severity was independently associated with functional impairment (FIS) (Beta 0.727, P < 0.0001). Symptoms or functional ability was not different between liver transplant recipients and matched chronic liver disease controls. Although survival postliver transplantation is improving, our cross-sectional study suggests that functional ability may not improve postliver transplantation. Further study is warranted to address the mechanisms responsible for post-transplant functional impairment and to develop effective rehabilitation regimes to maximize function following liver transplantation.