Health-related quality-of-life determinants in lung transplantation

In light of recent reviews, we examined the effect of individual and clinical factors, associated with lung transplantation (LTx), on health-related quality of life (HRQL).

HRQL was measured cross-sectionally on 34 candidates and 71 lung transplant recipients, using the Short Form 36-item questionnaire (SF-36), of the Medical Outcomes Study. Multivariate analysis was used to model each of the 8 SF-36 health domains as a function of individual determinants associated with LTx. The original model included: transplant status; age; gender; time since LTx; forced expiratory volume in 1 second (% predicted); type of LTx received; lung disease; whether within 1 month of the interview the participant was hospitalized; days in hospital (LOS); and whether infection or rejection occurred. Final models were chosen using a statistical cutoff of alpha < or = 0.10 to remain in the model.

After adjusting for important predictors, lung transplantation was positively associated with all domains (p < 0.005). Although time since transplantation negatively influenced the physical- and social-related domains (p < 0.05), the effect was small. Clinically meaningful effects on physical HRQL domains were observed with disease (p < 0.01), type of transplant received (p < 0.05) and hospital stay (p < 0.05). Gender played a role in mental health (p < 0.05).

Clinical events leading to hospitalization limit some HRQL domains. Different factors influence the physical, social and mental health domains, and thus future studies should focus on domain-specific variables to optimize HRQL. The HRQL benefit conferred from LTx renders it a worthwhile option for end-stage lung disease patients with important physical limitations.