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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 24, 2016; 6(4): 703-711
Published online Dec 24, 2016. doi: 10.5500/wjt.v6.i4.703
Quality of life 10 years after liver transplantation: The impact of graft histology
Vincent Karam, Mylène Sebagh, Kinan Rifai, Funda Yilmaz, Prashant Bhangui, Colette Danet, Faouzi Saliba, Didier Samuel, Denis Castaing, René Adam, Cyrille Feray
Vincent Karam, Mylène Sebagh, Colette Danet, Faouzi Saliba, Didier Samuel, Denis Castaing, René Adam, Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Hôpital Paul Brousse, F-94804 Villejuif, France
Kinan Rifai, Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany
Funda Yilmaz, Department of Pathology, Faculty of Medicine, University of Ege, 35100 Bornova, Izmir, Turkey
Prashant Bhangui, Medanta Institute of Liver Transplantation and Regenerative Medicine, Gurgaon, Haryana 122001, India
Cyrille Feray, INSERM, U955, Institut Mondor de Recherche Biomédicale, 94010 Créteil, France
Author contributions: Karam V designed and performed the research and wrote the paper; Sebagh M reviewed the biopsies, collected pathology data and reviewed the paper; Danet C contributed to acquisition of data; Rifai K contributed to acquisition of data and reviewed the paper; Yilmaz F, Bhangui P, Saliba F, Samuel D, Castaing D and Adam R revised the paper critically before final approval of the version to be submitted; Feray C contributed to the study design and supervised the research.
Institutional review board statement: The study was approved by the Institutional review board at Assistance Publique - Hôpitaux de Paris, Centre Hépatobiliaire - Hôpital Paul Brousse, Villejuif, France.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors who have taken part in this study declare that they do not have anything to disclose regarding conflict of interest with respect to this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vincent Karam, PhD, Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Hôpital Paul Brousse, 12-14, Avenue Paul Vaillant Couturier, B.P. 200, F-94804 Villejuif, France.
vincent.karam-ext@aphp.fr
Telephone: +33-1-45593437 Fax: +33-1-45593437
Received: May 30, 2016
Peer-review started: June 3, 2016
First decision: July 25, 2016
Revised: September 6, 2016
Accepted: September 21, 2016
Article in press: September 23, 2016
Published online: December 24, 2016
Processing time: 197 Days and 20.7 Hours
AIM
To evaluate the relationship between the state of transplanted liver graft and the recipient quality of life (QOL) of histologically proven lesions in a 10-year post liver transplantation (LT) cohort of patients.
METHODS
Seventy-two recipients with a functional first graft at 10 years post-LT underwent liver biopsy and completed a QOL questionnaire. Logistic regression analysis was used to explore associations between histological, clinical and QOL criteria.
RESULTS
Ten years after LT, fibrosis was detected in 53% of patients, and affected the general health perception, while ductopenia, present in 36%, affected the well-being (P = 0.05). Hepatic steatosis (HS) was present in 33% of patients and was associated with the worst QOL score on multiple domains. When compared to patients without HS, patients with HS had significantly higher incidence of fibrosis (P = 0.03), hepatitis C virus (HCV) infection (P = 0.007), and more patients had retired from their job (P = 0.03). Recurrent or de novo HCV-associated fibrosis and patient retirement as objective variables, and abdominal pain or discomfort and joint aches or pains as subjective variables, emerged as independent determinants of HS.
CONCLUSION
Long-term liver graft lesions, mainly HS presumably as a surrogate marker of HCV infection, may have a substantial impact on QOL 10 years after LT.
Core tip: Objective and subjective parameters are helpful in the accurate assessment of long-term outcome in liver transplantation recipients. The main finding of this study was that histological lesions in the transplanted liver 10 years after liver transplantation can affect the recipient quality of life. Hepatic steatosis had the most significant impact on quality of life and this was independent of alcohol consumption, fibrosis, diabetes and body mass index. The strongest determinants of a worse quality of life in patients with hepatic steatosis were hepatitis C virus infection and retirement from job irrespective of patient-age.
