COLORADO SPRINGS — The time has come to consider incorporating anticipated quality of life into decision making regarding liver transplantation—and the Model for End-Stage Liver Disease score is a good place to start, Dr. Eric T. Castaldo said at the annual meeting of the Western Surgical Association.
His prospective study included 209 liver transplant recipients who completed the Short Form-36 health-related quality of life evaluation on four occasions during their first year post transplant. The study showed that the higher the pretransplant MELD score—in other words, the worse their physiologic functioning because of liver disease—the greater their subsequent self-rated improvement in quality of life, said Dr. Castaldo of Vanderbilt University, Nashville, Tenn.
The pretransplant MELD score was significantly related only to the physical component of quality of life on the SF-36. It did not predict posttransplant scores on the mental domains of quality of life, he added.
“Previously, most of the decision making on who should receive a procedure like liver transplant was based on expected survival and perhaps certain complication rates. One of our overarching goals here was to… move on to both objective and subjective quality of life after transplantation,” said senior investigator Dr. C. Wright Pinson.
“The significance of today's analysis is it's totally prospective. Based on this additional data, I think we're willing to begin to explore the idea that objective and subjective quality of life outcomes data should be included,” noted Dr. Pinson, director of the transplant center and professor of surgery at Vanderbilt.