title: Assessment of nutritional status and health-related quality of life before and after liver transplantation.
abstract: BACKGROUND
  Patients with chronic liver disease frequently suffer from malnutrition, together with a decline in their health-related quality of life. This study was carried out with the aim of evaluating the nutritional status, complications of medical and surgical care, anxiety, health-related quality of life and dependence level on basic and instrumental activities of daily living in pre- and post-liver transplant patients.
  
  
  METHODS
  A prospective observational study with follow-up of patients on the waiting list for liver transplants who subsequently received a transplant at the University Hospital Complex in A Coruña during the period 2012-2014 (n = 110). All the patients will be followed-up for a maximum of 6 months. For survivors, assessments will be re-evaluated at one, three and six months post- transplant. Informed consent of the patient and ethical review board approval was obtained (Code: 2010/081 and 2010/082). The following variables will be studied: socio-demographic data, reason for the transplant, comorbidity (Charlson Score), analytical parameters, time on transplant waiting list and post-transplant complications. A trained nurse will evaluate the following for each patient: nutritional indices, anthropometric variables and handgrip strength. Validated questionnaires will be used to determine the patients' nutritional status (Subjective Global Assessment), anxiety (STAI questionnaire), Health-Related Quality of Life (LDQoL 1.0 questionnaire), dependence (Barthel Index and Lawton-Brody Scale), nursing diagnoses (NANDA) and post-transplant quality indicators. Multiple linear/logistic regression models will be used to identify variables associated with the events of interest. Changes in nutritional status, quality of life and dependence over time will be analysed with linear mixed-effects regression models. Actuarial survival analysis using Kaplan-Meier curves, Cox regression and competitive risk will be performed Concordance between the different scores that assess nutritional status and interobserver agreement regarding nursing diagnoses will be studied using the statistical Kappa index and Bland Altman method.
  
  
  CONCLUSIONS
  The risk of malnutrition can be considered as a possible prognostic factor in transplant outcomes, associated with anxiety, health-related quality of life and dependence. For this reason we consider interesting to perform a prospective follow-up study of patients who require a transplant to survive, studying their nutritional status and health-related quality of life.
authors.affiliation: Digestive Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Xerencia de Xestión Integrada de A Coruña, SERGAS, Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain. maria.teresa.garcia.rodriguez@sergas.es.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: García-Rodríguez
authors.affiliation: Digestive Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Xerencia de Xestión Integrada de A Coruña, SERGAS, Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain. ma.del.carmen.pinon.villar@sergas.es.
authors.forename: María Del Carmen
authors.initials: Mdel C
authors.lastname: Piñón-Villar
authors.affiliation: Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, 15006, A Coruña, Spain. beatriz.lopez.calvino@sergas.es.
authors.forename: Beatriz
authors.initials: B
authors.lastname: López-Calviño
authors.affiliation: Digestive Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Xerencia de Xestión Integrada de A Coruña, SERGAS, Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain. alejandra.otero.ferreiro@sergas.es.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Otero-Ferreiro
authors.affiliation: Digestive Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Xerencia de Xestión Integrada de A Coruña, SERGAS, Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain. francisco.suarez.lopez@sergas.es.
authors.forename: Francisco
authors.initials: F
authors.lastname: Suárez-López
authors.affiliation: Transplant Coordination, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), SERGAS, Universidade da Coruña, 15006, A Coruña, Spain. manuel.gomez.gutierrez@sergas.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Gómez-Gutiérrez
authors.affiliation: Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, 15006, A Coruña, Spain. salvador.pita.fernandez@sergas.es.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pita-Fernández
mesh_terms: D000203:Activities of Daily Living; D001007:Anxiety / Q000209:etiology; D002908:Chronic Disease; D005500:Follow-Up Studies; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects; D044342:Malnutrition / Q000209:etiology; D015596:Nutrition Assessment; D009752:Nutritional Status; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D012107:Research Design