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Thursday, November 1, 2012

Living Donors Fare Well Following Liver Transplantation

Developing ‘Comorbid’ Conditions Post-transplant Reduces Donor Quality of Life

Researchers in Japan report that health-related quality of life (HRQOL) for donors following living donor liver transplantation (LDLT) was better than the general Japanese population (the norm). This study—one of the largest to date—found that donors who developed two or more medical problems (co-morbidities) after donation had significantly decreased long-term HRQOL. Full findings are published in the November issue of Liver Transplantation, a journal of the American Association for the Study of Liver Diseases (AASLD).

The shortage of viable donor organs continues to be a critical issue for the transplant community. Livers, in particular, are in short supply, with the Organ Procurement and Transplantation Network (OPTN) reporting that in the U.S. more than 16,000 patients are currently on the waiting list. To ease the shortage of deceased donor organs, transplant specialists are turning to LDLT—a widely accepted alternative approach, especially in Japan, where one study shows that close to 6,000 of these procedures were performed by December 2008.

“With LDLTs being performed at increasing rates, it is important to understand the long-term outcomes for living donors,” explains lead study author Dr. Yasutsugu Takada with the Ehime University Graduate School of Medicine in Japan. “Our study is the largest to investigate living liver donors’ quality of life and to determine potential risk factors following transplantation.”

The team contacted 997 living donors who provided a piece of liver for transplantation, which were performed at Kyoto University Hospital between 1990 and 2004. Researchers mailed the 36-item short-form health survey to all donors and 578 (58%) responded. The survey responses are summarized by: the physical component summary, mental component summary, and role/social components by component. A norm-based scoring system was used to report survey results.

Findings indicate that norm-based HRQOL scores for the 367 left- and 211 right-lobe donors were better than the Japanese norm across all time periods. The median post-transplant follow-up period was nearly 7 years. Further analysis determined that decreased HRQOL scores, specifically lower mental health and social functioning, were significantly associated with age of donor, persistence of symptoms, emergence of additional diseases, or other consequences (additional hospital visits, continued work absence) following donation.

Dr. Takada concludes, “Kyoto University Hospital is one of the high volume transplant centers in Asia, as such, we are keenly aware of the necessity and responsibility to report donor long-term QOL. Our findings suggest that careful follow-up and counseling are necessary for donors at risk for poor quality of life.”

In a related editorial, Drs. Leona Kim-Schluger and Sander Florman from The Mount Sinai Medical Center in New York highlight that the importance of the Takada et al study is the sheer size of the living donor cohort and the long-term follow-up of donors to evaluate HRQOL. They write, “We must strive to study and comprehend the motivations leading to donation, the financial and economic impact of donation, and learn to alleviate the fears pre and post donation, with the one goal of safely getting the living donors through the donor process medically, surgically, and psychologically.”


This study and editorial are published in Liver Transplantation. Media wishing to receive a PDF of the articles may contact sciencenewsroom@wiley.com Full citations: “Long-Term Quality of Life of Donors After Living Donor Liver Transplantation.” Yasutsugu Takada, Yoshimi Suzukamo, Fumitaka Oike, Hiroto Egawa, Satoshi Morita, Shunichi Fukuhara, Shinji Uemoto and Koichi Tanaka. Liver Transplantation; (DOI: 10.1002/lt.23509) Print Issue Date: November, 2012.
URL: http://doi.wiley.com/10.1002/lt.23509

Editorial: “Quality of Life After Living Donor Liver Transplant: What Have We Learned and How Can We Do Better.” Leona Kim-Schluger and Sander Florman. Liver Transplantation; (DOI: 10.1002/lt.23528) Print Issue Date: November, 2012. .
URL: http://doi.wiley.com/10.1002/lt.23528

About the Author: To arrange an interview with Dr. Takada please contact the press office at Kyoto University Hospital hisyokoh@kuhp.kyoto-u.ac.jp. Media wishing to speak with Drs. Kim-Schluger or Florman may contact Kevin Orozovich at Kevin.Orozovich@mountsinai.org.
About the Journal:
Liver Transplantation is published by Wiley on behalf of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Since the first application of liver transplantation in a clinical situation was reported more than twenty years ago, there has been a great deal of growth in this field and more is anticipated. As an official publication of the AASLD and the ILTS, Liver Transplantation delivers current, peer-reviewed articles on surgical techniques, clinical investigations and drug research — the information necessary to keep abreast of this evolving specialty. For more information, please visit http://wileyonlinelibrary.com/journal/livertransplantation

About Wiley
Founded in 1807, John Wiley & Sons, Inc. has been a valued source of information and understanding for more than 200 years, helping people around the world meet their needs and fulfill their aspirations. Wiley and its acquired companies have published the works of more than 450 Nobel laureates in all categories: Literature, Economics, Physiology or Medicine, Physics, Chemistry, and Peace. Wiley is a global provider of content and content-enabled workflow solutions in areas of scientific, technical, medical, and scholarly research; professional development; and education. Our core businesses produce scientific, technical, medical, and scholarly journals, reference works, books, database services, and advertising; professional books, subscription products, certification and training services and online applications; and education content and services including integrated online teaching and learning resources for undergraduate and graduate students and lifelong learners. Wiley's global headquarters are located in Hoboken, New Jersey, with operations in the U.S., Europe, Asia, Canada, and Australia. The Company's Web site can be accessed at http://www.wiley.com. The Company is listed on the New York Stock Exchange under the symbols JWa and JWb.

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