Impact of lung transplantation on recipient quality of life: a serial, prospective, multicenter analysis through the first posttransplant year

Abstract

Background: Quality of life (QOL) is an important but understudied outcome after lung transplantation. Previous cross-sectional, single-center studies suggest improved QOL, but few prior longitudinal multicenter data exist regarding the effect of transplantation on the patient’s QOL.

Methods: We hypothesized that lung transplantation confers a 1-year QOL benefit in both physical and psychologic well-being; we further hypothesized that the magnitude of benefit would vary by sex, native disease, age, or type of transplant operation. To test these hypotheses, we conducted a secondary analysis using QOL data prospectively and serially measured with the Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36) in a multicenter cytomegalovirus prevention clinical trial. Linear mixed-effects models were used to assess the impact of transplantation on the recipient’s QOL.

Results: Over the first year after lung transplantation, the SF-36 Physical Component Score significantly increased an average of 10.9 points from baseline levels (P < .0001). A positive benefit was observed for all native diseases; however, the magnitude varied slightly by native disease (P = .04) but not by sex (P = .35), age (P = .06), or transplant type (P = .30). In contrast, the SF-36 Mental Component Score did not change from baseline (P = .36) and remained well below population norms.

Conclusions: Our results demonstrate that lung transplantation confers clinically important QOL benefits in physical domains but not in psychologic well-being. A better understanding of the barriers to psychologic well-being after transplant is critical to enhancing the benefits of lung transplantation.

Figure 1.

CMV prevention trial participants included in the QOL study cohort. CMV = cytomegalovirus; QOL = quality of life; SF-36 = Medical Outcomes Study 36-Item Short-Form Health Survey, version 2.

Figure 2.

The trajectory of 1-year mean PCS QOL scores increased after lung transplant (P = .03), nearing US population norms, whereas MCS QOL remained flat (P = .92). See Figure 1 legend for expansion of other abbreviation.

Figure 3.

The trajectory of 1-year mean PCS QOL scores varied slightly by native disease (P = .04), with patients with CF experiencing the greatest benefit. See Figure 1 legend for expansion of other abbreviation.

Figure 4.

The trajectory of 1-year mean PCS QOL scores did not vary by transplant type after accounting for native disease among patients without CF (P = .45). See Figure 1 and 3 legends for expansion of other abbreviations.