Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 149 No. 0708 (2019)

Health-related quality of life and stress-related post-transplant trajectories of lung transplant recipients: a three-year follow-up of the Swiss Transplant Cohort Study

DOI
https://doi.org/10.57187/smw.2019.20019
Cite this as:
Swiss Med Wkly. 2019;149:w20019
Published
24.02.2019

Abstract

BACKGROUND

Lung transplantation (LTx) provides a viable option for the survival of end-stage lung diseases. Besides survival as a clinical outcome measure, health-related quality of life (HRQoL) and psychological distress have become important outcomes in studies investigating the effectiveness of LTx in the short- and long-term.

OBJECTIVE

To assess and compare HRQoL trajectories of patients after LTx prior to and over a follow-up period of three years post-transplant, and to identify differences regarding distress, HRQoL and patient-related outcomes.

METHODS

In this longitudinal study, 27 lung transplant recipients were prospectively examined for psychological distress (Symptom Checklist short version-9; SCL-K-9), health-related quality of life (EuroQOL five dimensions questionnaire; EQ-5D), depression (HADS-Depression scale), and socio-demographic and medical outcomes at two weeks, three months, six months and three years following LTx. Additionally, potential outcome-related predictors for LTx-outcomes at three years post-transplant were assessed. Data were collected in accordance with guidelines set by the STROBE (strengthening the reporting of observational studies in epidemiology) statement.

RESULTS

Lung transplant recipients showed the most pronounced improvements in HRQoL and reduction in psychological distress between two weeks and three months post-transplant, with relative stable HRQoL and distress trajectories thereafter. The most important predictors of poor somatic health trajectories over time were the pre-transplant disease severity score and the pre-transplant HADS-Depression score. In addition, idiopathic pulmonary fibrosis (IPF) and pre-transplant extracorporeal membrane oxygenation (ECMO)-use predicted poorer survival, while cystic fibrosis was associated with better survival three years post-transplant.

COMCLUSION

Lung transplantation yields significant survival and HRQoL benefits, with its peak improvement at three months post-transplant. The majority of patients can preserve these health changes in the long-term. Patients with a worse HRQoL and higher psychological distress at six months post-transplant tended to have a poorer survival post-transplant. Other risk factors for poorer survival included IPF, pre-transplant ECMO-use, pre-transplant symptoms of depression, high pre-transplant disease severity and worse somatic disease severity trajectories. The majority of LTx-recipients were unable to work due to illness-related reasons.

References

  1. Singer LG, Chowdhury NA, Faughnan ME, Granton J, Keshavjee S, Marras TK, et al. Effects of Recipient Age and Diagnosis on Health-related Quality-of-Life Benefit of Lung Transplantation. Am J Respir Crit Care Med. 2015;192(8):965–73.https://doi.org/10.1164/rccm.201501-0126OC DOI: https://doi.org/10.1164/rccm.201501-0126OC
  2. Seiler A, Klaghofer R, Ture M, Komossa K, Martin-Soelch C, Jenewein J. A systematic review of health-related quality of life and psychological outcomes after lung transplantation. J Heart Lung Transplant. 2016;35(2):195–202. DOI: https://doi.org/10.1016/j.healun.2015.07.003
  3. Thabut G, Mal H. Outcomes after lung transplantation. J Thorac Dis. 2017;9(8):2684–91.https://doi.org/10.21037/jtd.2017.07.85 DOI: https://doi.org/10.21037/jtd.2017.07.85
  4. Inci I, Schuurmans MM, Boehler A, Weder W. Zurich University Hospital lung transplantation programme: update 2012. Swiss Med Wkly. 2013;143:w13836.https://doi.org/10.4414/smw.2013.13836 DOI: https://doi.org/10.4414/smw.2013.13836
  5. Swiss Transplant Cohort Study (STCS). Swiss Transplant Cohort Study Report, May 2008 - December 2016. p. 27. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwjyiqup8rjeAhUszoUKHdTIDL4QFjAAegQICRAC&url=http%3A%2F%2Fwww.stcs.ch%2Finternal%2Freports%2Fstcs_annual_report_june_2017.pdf&usg=AOvVaw0w4aFfWAt_xiPP0Fjw5nbx.
  6. Singer JP, Katz PP, Soong A, Shrestha P, Huang D, Ho J, et al. Effect of Lung Transplantation on Health-Related Quality of Life in the Era of the Lung Allocation Score: A U.S. Prospective Cohort Study. Am J Transplant. 2017;17(5):1334–45.https://doi.org/10.1111/ajt.14081 DOI: https://doi.org/10.1111/ajt.14081
  7. Smith PJ, Blumenthal JA, Snyder LD, Mathew JP, Durheim MT, Hoffman BM, et al. Depressive symptoms and early mortality following lung transplantation: A pilot study. Clin Transplant. 2017;31(2):e12874.https://doi.org/10.1111/ctr.12874 DOI: https://doi.org/10.1111/ctr.12874
  8. Baranyi A, Krauseneck T, Rothenhäusler HB. Overall mental distress and health-related quality of life after solid-organ transplantation: results from a retrospective follow-up study. Health Qual Life Outcomes. 2013;11(1):15.https://doi.org/10.1186/1477-7525-11-15 DOI: https://doi.org/10.1186/1477-7525-11-15
  9. Singer JP, Singer LG. Quality of life in lung transplantation. Semin Respir Crit Care Med. 2013;34(3):421–30.https://doi.org/10.1055/s-0033-1348470 DOI: https://doi.org/10.1055/s-0033-1348470
  10. Kugler C, Fischer S, Gottlieb J, Welte T, Simon A, Haverich A, et al. Health-related quality of life in two hundred-eighty lung transplant recipients. J Heart Lung Transplant. 2005;24(12):2262–8.https://doi.org/10.1016/j.healun.2005.07.005 DOI: https://doi.org/10.1016/j.healun.2005.07.005
  11. Santana MJ, Feeny D, Ghosh S, Lien DC. Patient-reported outcome 2 years after lung transplantation: does the underlying diagnosis matter? Patient Relat Outcome Meas. 2012;3:79–84.https://doi.org/10.2147/PROM.S32399 DOI: https://doi.org/10.2147/PROM.S32399
  12. Vermuelen KM, van der Bij W, Erasmus ME, TenVergert EM. Long-term health-related quality of life after lung transplantation: different predictors for different dimensions. J Heart Lung Transplant. 2007;26(2):188–93.https://doi.org/10.1016/j.healun.2006.11.006 DOI: https://doi.org/10.1016/j.healun.2006.11.006
  13. Rodrigue JR, Baz MA, Kanasky WF, Jr, MacNaughton KL. Does lung transplantation improve health-related quality of life? The University of Florida experience. J Heart Lung Transplant. 2005;24(6):755–63.https://doi.org/10.1016/j.healun.2004.04.012 DOI: https://doi.org/10.1016/j.healun.2004.04.012
  14. Myaskovsky L, Dew MA, McNulty ML, Switzer GE, DiMartini AF, Kormos RL, et al. Trajectories of change in quality of life in 12-month survivors of lung or heart transplant. Am J Transplant. 2006;6(8):1939–47.https://doi.org/10.1111/j.1600-6143.2006.01395.x DOI: https://doi.org/10.1111/j.1600-6143.2006.01395.x
  15. Kugler C, Strueber M, Tegtbur U, Niedermeyer J, Haverich A. Quality of life 1 year after lung transplantation. Prog Transplant. 2004;14(4):331–6.https://doi.org/10.1177/152692480401400408 DOI: https://doi.org/10.1177/152692480401400408
  16. Ricotti S, Martinelli V, Caspani P, Monteleone S, Petrucci L, Dalla Toffola E, et al. Changes in quality of life and functional capacity after lung transplantation: A single-center experience. Monaldi Arch Chest Dis. 2017;87(3):831.https://doi.org/10.4081/monaldi.2017.831 DOI: https://doi.org/10.4081/monaldi.2017.831
  17. Rutherford RM, Fisher AJ, Hilton C, Forty J, Hasan A, Gould FK, et al. Functional status and quality of life in patients surviving 10 years after lung transplantation. Am J Transplant. 2005;5(5):1099–104.https://doi.org/10.1111/j.1600-6143.2004.00803.x DOI: https://doi.org/10.1111/j.1600-6143.2004.00803.x
  18. Seiler A, Jenewein J, Martin-Soelch C, Goetzmann L, Inci I, Weder W, et al. Post-transplant outcome-clusters of psychological distress and health-related quality of life in lung transplant recipients. Swiss Med Wkly. 2015;145:w14236. doi:.https://doi.org/10.4414/smw.2015.14236 DOI: https://doi.org/10.4414/smw.2015.14236
  19. Statement STROBE. Strengthening the reporting of observational studies in epidemiology. 2009, Institute of Social and Preventive Medicine (ISPM): Bern.
  20. Hinz A, Klaiberg A, Brähler E, König HH. [The Quality of Life Questionnaire EQ-5D: modelling and norm values for the general population]. Psychother Psychosom Med Psychol. 2006;56(2):42–8.https://doi.org/10.1055/s-2005-867061 DOI: https://doi.org/10.1055/s-2005-867061
  21. Klaghofer R, Braehler E. Construction and validation of a shor form of the SCL-90-R. 2001: Zeitschrift für Klinische Psychologie, Psychiatrie und Psychotherapie. p. 115-124.
  22. Franke GH. SCL-90-R. Die Symtpomcheckliste von Derogatis - Deutsche Version. 1995, Beltz Test, Göttingen.
  23. De Geest S, Burkhalter H, Berben L, Bogert LJ, Denhaerynck K, Glass TR, et al.; Psychosocial Interest Group, Swiss Transplant Cohort Study. The Swiss Transplant Cohort Study’s framework for assessing lifelong psychosocial factors in solid-organ transplants. Prog Transplant. 2013;23(3):235–46.https://doi.org/10.7182/pit2013250 DOI: https://doi.org/10.7182/pit2013250
  24. Koller MT, van Delden C, Müller NJ, Baumann P, Lovis C, Marti HP, et al. Design and methodology of the Swiss Transplant Cohort Study (STCS): a comprehensive prospective nationwide long-term follow-up cohort. Eur J Epidemiol. 2013;28(4):347–55.https://doi.org/10.1007/s10654-012-9754-y DOI: https://doi.org/10.1007/s10654-012-9754-y
  25. Vaquero Barrios JM, Redel Montero J, Santos Luna F. Comorbidities impacting on prognosis after lung transplant. Arch Bronconeumol. 2014;50(1):25–33.https://doi.org/10.1016/j.arbr.2014.01.001 DOI: https://doi.org/10.1016/j.arbr.2014.01.001
  26. Kugler C, Tegtbur U, Gottlieb J, Bara C, Malehsa D, Dierich M, et al. Health-related quality of life in long-term survivors after heart and lung transplantation: a prospective cohort study. Transplantation. 2010;90(4):451–7.https://doi.org/10.1097/TP.0b013e3181e72863 DOI: https://doi.org/10.1097/TP.0b013e3181e72863
  27. Finlen Copeland CA, Vock DM, Pieper K, Mark DB, Palmer SM. Impact of lung transplantation on recipient quality of life: a serial, prospective, multicenter analysis through the first posttransplant year. Chest. 2013;143(3):744–50.https://doi.org/10.1378/chest.12-0971 DOI: https://doi.org/10.1378/chest.12-0971
  28. Shahabeddin Parizi A, Krabbe PFM, Verschuuren EAM, Hoek RAS, Kwakkel-van Erp JM, Erasmus ME, et al. Patient-reported health outcomes in long-term lung transplantation survivors: A prospective cohort study. Am J Transplant. 2018;18(3):684–95.https://doi.org/10.1111/ajt.14492 DOI: https://doi.org/10.1111/ajt.14492
  29. Trudzinski FC, Kaestner F, Schäfers HJ, Fähndrich S, Seiler F, Böhmer P, et al. Outcome of Patients with Interstitial Lung Disease Treated with Extracorporeal Membrane Oxygenation for Acute Respiratory Failure. Am J Respir Crit Care Med. 2016;193(5):527–33.https://doi.org/10.1164/rccm.201508-1701OC DOI: https://doi.org/10.1164/rccm.201508-1701OC
  30. Kumar A, Kapnadak SG, Girgis RE, Raghu G. Lung transplantation in idiopathic pulmonary fibrosis. Expert Rev Respir Med. 2018;12(5):375–85.https://doi.org/10.1080/17476348.2018.1462704 DOI: https://doi.org/10.1080/17476348.2018.1462704
  31. Smith PJ, Blumenthal JA, Trulock EP, Freedland KE, Carney RM, Davis RD, et al. Psychosocial Predictors of Mortality Following Lung Transplantation. Am J Transplant. 2016;16(1):271–7.https://doi.org/10.1111/ajt.13447 DOI: https://doi.org/10.1111/ajt.13447
  32. Suhling H, Knuth C, Haverich A, Lingner H, Welte T, Gottlieb J. Employment after lung transplantation--a single-center cross-sectional study. Dtsch Arztebl Int. 2015;112(13):213–9. DOI: https://doi.org/10.3238/arztebl.2015.0213
  33. Nau M, Shrider EA, Tobias JD, Hayes D, Jr, Tumin D. High local unemployment rates limit work after lung transplantation. J Heart Lung Transplant. 2016;35(10):1212–9.https://doi.org/10.1016/j.healun.2016.05.002 DOI: https://doi.org/10.1016/j.healun.2016.05.002
  34. Adegunsoye A, Strek ME, Garrity E, Guzy R, Bag R. Comprehensive Care of the Lung Transplant Patient. Chest. 2017;152(1):150–64.https://doi.org/10.1016/j.chest.2016.10.001 DOI: https://doi.org/10.1016/j.chest.2016.10.001

Most read articles by the same author(s)

1 2 3 > >>