Quality of life, employment, and alcohol consumption after liver transplantation

This is the authors' abstract. We don't add key points for this paper.

This article reviews the main results and describes the most prevalent design characteristics of the 89 studies included in our comprehensive meta-analysis of quality of life, employment, and alcohol consumption after liver transplantation. In general, the health-related quality of life of recipients was impaired before and improved after transplantation. Recipients reported large gains in those aspects of quality of life most affected by physical health and smaller improvements in areas affected by psychologic functioning. No utility-based measures have been used with liver transplant recipients, so the necessary quality-of-life weights for use in cost-effectiveness evaluations of liver transplantation are lacking. Before transplantation, the percentage of candidates with alcoholic liver disease who worked was lower than that of candidates with nonalcoholic liver disease; after transplantation, however, there was no difference in the rates of employment. None of the included articles described the types of wages and benefits associated with jobs before or after transplantation or the extent to which health insurance benefits associated with employment motivated changes in work status. No difference was found in the proportion of recipients with alcoholic and nonalcoholic liver disease that reported using alcohol after transplantation. Posttransplantation abstinence from alcohol use was greater among those patients who had been abstinent for longer than 6 months before transplantation. No difference was found between the rates of posttransplantation employment of alcohol users and nonusers; however, few studies directly evaluated this question. Because the studies in this meta-analysis used nonvalidated heterogeneous instruments to measure quality of life, employment, and alcohol consumption, the ability to combine results among studies and to compare the outcomes for liver transplant recipients with other patient populations was limited. Additional heterogeneity in the selection of control groups prevented comparisons of results among groups of transplant recipients. Because of these design limitations, clinically important questions regarding the quality of life and functional status of liver transplant recipients remain unanswered.