Determinants of health utility in lung and heart-lung transplant recipients

Bronchiolitis obliterans syndrome (BOS) is associated with poor health-related quality of life (HRQL) following lung and heart-lung transplantation, but few other determinants of HRQL have been described. We performed a cross-sectional study of standard gamble utility, a preference-based measure of HRQL, in 90 stable lung and heart-lung transplant recipients. We used bivariate analyses and multiple linear regression to evaluate associations between utility scores and candidate predictor variables including age, sex, indication for transplant (obstructive, interstitial, suppurative and pulmonary vascular diseases), transplant type (bilateral, single and heart-lung), time since transplant, body mass index, arterial PO(2), creatinine clearance, number of medications, presence of BOS and risk-attitude score. The median utility was 0.88 (inter-quartile range: 0.50-0.99). Multivariable analysis showed that female sex, absence of BOS, better renal function and longer time since transplantation were associated with higher utility scores, and that there were utility differences across diagnostic groups. Although BOS is a major determinant of utility following lung and heart-lung transplantation, other demographic and clinical factors are also associated with significant differences in this measure of HRQL.