Does lung transplantation improve health-related quality of life? The University of Florida experience.

BACKGROUND

Health-related quality of life (HRQoL) is an important clinical end-point in evaluating the overall success of lung transplantation. The primary purpose of this study, therefore, was to document the degree of change in HRQoL in a sample of patients evaluated before and after lung transplantation.

METHODS

Sixty-six adults who underwent single or bilateral lung transplantation at the University of Florida between March 1994 and May 2001 completed assessments of HRQoL (SF-36 Health Survey, Transplant Symptom Frequency Questionnaire), both before and after transplant. Pre- and post-transplant assessments of forced expiratory volume in 1 second (FEV1) percent predicted and 6-minute walk test performance were also obtained.

RESULTS

HRQoL before transplant was significantly lower than in normative samples of chronic obstructive pulmonary disease (COPD) patients and adults in the general population. However, repeated measures analyses of co-variance showed significant improvements on 7 of 8 SF-36 sub-scales, as well as the physical component summary and the mental component summary. Improvements in FEV1 percent predicted and 6-minute walk test performance were also found. Patients with longer time since transplantation reported more frequent and problematic symptoms commonly associated with immunosuppression, including depression, headaches and changes in physical appearance, among others.

CONCLUSIONS

Lung transplantation appears to yield significant HRQoL benefits for patients. Many patients do, however, experience frequent symptoms associated with immunosuppression that may limit the full benefit of transplantation, and some of these symptoms appear to worsen over time. Future research efforts should focus on the development, implementation and evaluation of clinical interventions designed to optimize HRQoL both before and after lung transplantation.