Qualidade de vida relacionada à saúde pós-transplante de fígado: experiência em um centro transplantador no interior de Minas Gerais

Abstract

Liver transplant (LxT) has been an effective and well-established therapeutic measure for the treatment of patients with terminal liver disease, fulminant hepatitis and hepatocellular carcinoma, with excellent long-term results. New focus of interest emerges concerning these patients: the quality of life (QoL) after the transplantation. This study analyzed health-related quality of life (HRQoL) in patients submitted to LxT in a transplant center in the interior of Minas Gerais, using the post-Liver Transplant Quality of Life (pLTQ) instrument, validated for the Brazilian population, through a quantitative, transversal and analytical approach. Variables were investigated by structured questionnaire, contemplating the socio-demographic characteristics and related to the pre and post-transplant moments. Were descriptive in absolute and percentage values and the variables of the instruments of measurement of QoL were evaluated by comparison of means, using Mann-Whitney U-test. Pearson's correlation was also verified between the domains of pLTQ and generic instrument – 12-Item Health Survey (SF-12). Were evaluated 74 patients, with the predominance of men and the mean age was 52.9 years. The predominant LxT indication was terminal liver disease, with ethanolic liver cirrhosis being the most common. The mean waiting time in the LxT was 95.3 ± 110.4 days, with a mean Model for End-Stage Liver Disease (MELD) of 17.5 ± 5.7. All patients received grafts from deceased donors. Two patients underwent simultaneous double transplantation: liver-kidney. The immunosuppressive regimen was predominantly composed of tacrolimus. The mean post-LxT time was 3.7 ± 3.2 years. The pLTQ had a mean score of 5.93 ± 0.64 points. The highest and lowest mean scores were, respectively, in the Medications (6.47 ± 0.88) and Emotional (5.16 ± 1.16) domains. Sex and schooling did not correlate with pLTQ scores. When the income was evaluated, patients with up to one salary had lower values (p = 0.010). The cause of the transplant and the time in the queue did not contribute with any differences in the Total score and in the domains. The MELD value, when higher than 16, presented a statistically significant difference in the Pain domain (p = 0.001), as well as when the time between the transplantation and the interview was ≤ 180 days in the Physical Function domain (p = 0.032). Renal and infectious complications had repercussions in the areas of Pain (p = 0.016) and Physical Function (p = 0.009), respectively. Although biliary complications were the second most frequent, they showed no correlation with pLTQ. The number of rehospitalizations, motivated by conditions related to LxT or not, also did not affect the scores. By the analysis, LxT was beneficial to the patients, as it ensured a longer life expectancy and it was possible to demonstrate HRQoL among the transplanted patients, when evaluated by the pLTQ, being the data ratified by a generic instrument.