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
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.
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.
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.
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.
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.
- 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
- 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.
- 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
- 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
- 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.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Statement STROBE. Strengthening the reporting of observational studies in epidemiology. 2009, Institute of Social and Preventive Medicine (ISPM): Bern.
- 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
- 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.
- Franke GH. SCL-90-R. Die Symtpomcheckliste von Derogatis - Deutsche Version. 1995, Beltz Test, Göttingen.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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.
- 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
- 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