title: Mode of allocation and social demographic factors correlate with impaired quality of life after liver transplantation.
abstract: BACKGROUND
  Health-related Quality of life (HRQoL) is a major goal of clinical management after liver transplantation (LTx). There is still disagreement on the effects of social-demographic factors and changes in the allocation system on HRQoL. The aim of this study was to evaluate the impact of social-demographic factors, mode of organ-allocation, waiting time and hepatocellular carcinoma (HCC) on HRQoL after LTx.
  
  
  METHODS
  HRQoL was assessed using the EORTC-QLQ-C30 questionnaire, which was sent to 238 recipients. Investigated parameters included age, sex, distance to transplant center, follow-up at hospital, size of hometown, highest education, marital status, having children, background liver disease, waiting time, mode of allocation, HCC, hospitalization after LTx and diagnosis of malignancy after LTx. All evaluated parameters were entered into multivariate linear regression analysis.
  
  
  RESULTS
  Completed questionnaire were returned by 73% of the recipients. After LTx, the HRQoL-function scales increased over time. Age, marital status, highest education, completed professional training, working status, job position, duration of waiting time to LTx, distance to transplant center, place offollow, HU-statuts, mode of organ allocation and duration of hospitalization were associated with significantly worse function- and significantly lower symptom scales. HCC as a primary disease did not affect HRQoL.
  
  
  CONCLUSIONS
  Low HRQoL correlated significantly with MELD-based organ allocation, more than 28-day hospitalization, divorced status, lower education- and non-working status, higher distance to transplant center, follow up at transplant center, HU-status, shorter waiting time to LTx and younger age. Improvement of HRQoL after LTx may require clinical management of pain, psychotherapy and financial support.
authors.affiliation: Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany. nils.heits@uksh-kiel.de.
authors.forename: Nils
authors.initials: N
authors.lastname: Heits
authors.affiliation: Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany. gunnarmeer@hotmail.com.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Meer
authors.affiliation: Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany. Alexander.Bernsmeier@uksh.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bernsmeier
authors.affiliation: Institute of Department of Internal Medicine I, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany. rguenther@1med.uni-kiel.de.
authors.forename: Rainer
authors.initials: R
authors.lastname: Guenther
authors.affiliation: Reference Center for Quality of Life, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany. Bjoern.malchow@uksh-kiel.de.
authors.forename: Bjoern
authors.initials: B
authors.lastname: Malchow
authors.affiliation: Reference Center for Quality of Life, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany. th.kuechler@t-online.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuechler
authors.affiliation: Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany. thomas.becker@uksh-kiel.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.affiliation: Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller Strasse 3 (Haus 18), 24105, Kiel, Germany. Felix.Braun@uksh-kiel.de.
authors.forename: Felix
authors.initials: F
authors.lastname: Braun
mesh_terms: D000328:Adult; D001294:Attitude to Health; D005195:Family Relations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011184:Postoperative Period; D011788:Quality of Life / Q000523:psychology*; D012923:Social Class; D011795:Surveys and Questionnaires