Poster (15W204)

Immunosuppression post Orthotopic Liver Transplantation: impact on patient quality of life among a cohort at St Vincent’s University Hospital

Author(s)

O'Reilly S, McHugh N, Doherty A, Coffey A, Harmon C, O'Farrelly C, Hoti E, Houlihan DD

Department(s)/Institutions

National Liver Unit, St Vincent's University Hospital, Elm Park, Dublin 4

Introduction

Immunosuppression (IS) post liver transplantation has been proven to increase risk of infection, malignancy and cardiovascular disease reducing patient survival. Additionally, multiple side effects such as fatigue and nausea, are associated with immunosuppression which may impact on a patient’s quality of life. Some recent studies have shown that it is possible, in a select group of patients, to safely withdraw immunosuppressive therapy.

Aims/Background

To examine patient compliance with immunosuppressive therapy. To explore patient’s attitudes towards immunosuppression and its impact on their quality of life.

Method

We collected basic patient demographics, year of transplantation and aetiology of disease. We used a modified version of the previously validated BMQ1 questionnaire to examine patient compliance and attitudes towards immunosupressive therapy. We used the SF36 questionnaire to assess quality of life.

Results

100 patients (52 female) completed the questionnaire. Patients identified the following reasons for their transplant: Cirrhosis (16), Alcoholic liver disease (14), Autoimmune hepatitis (11), Primary sclerosing cholangitis (10), Hepatocellular carcinoma (10), Hepatitis C infection (8), Fulminant hepatic failure (7), Budd Chiari syndrome (3), alpha-1-antitrypsin deficiency (3) and Biliary atresia (2). 66 patients were >10 years post OLT, 11 were >20 years. Using the 8 domains of SF36, the results below were found (see table). All patients reported that they take their immunosuppression daily. 10 patients admitted to missing >1 doses per week, and 5 did not take the full dose most of the time. 31 patients were ‘a little’ bothered by taking immunosuppression, and 6 said it bothered them ‘a lot’, the remainder stating it didn't bother them at all. 63 worried about the long term effects of their medication on their health. 85 patients said that if given the opportunity, they would like to stop their immunosuppression. For statistical analysis, we compared this cohort to the average score in a large healthy population study by Hopman et al (CMAJ 2000) using chi square testing.

Conclusions

This analysis showed that in an age/sex-matched population, post OLT patients have a statistically significantly poorer quality of life in the domains of physical function, limitations due to physical health, emotional well-being, social functioning and general health than those who have not had a transplant. The majority of patients attribute these limitations to immunosuppressive medications. While compliance is good, side effects were reported in a large number. 85% of patients wish to stop their immunosuppression if at all possible. Further analysis for comparison with a cohort of healthy patients at our centre is planned. These data provide additional support for an Irish trial of Immunosuppression withdrawal in liver transplant recipients.

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