Influence of liver-disease etiology on long-term quality of life and employment after liver transplantation

The etiology of liver disease would expectedly affect health-related quality of life (HRQoL) and employment after liver transplantation (LT), but studies are scarce. We sent the 15D HRQoL instrument and an employment questionnaire to all 401 adult LT patients alive in Finland in 2007. The response rate was 89% (n=353; mean of eight yr since LT). In age-adjusted analysis, patients transplanted for primary sclerosing cholangitis (PSC; n=56), primary biliary cirrhosis (PBC; n=72), acute liver failure (ALF; n=76), alcoholic cirrhosis (n=38), or liver tumor (n=22) exhibited comparable HRQoL, whereas the combined group of miscellaneous chronic liver diseases (n=89) exhibited significantly higher HRQoL scores (p=0.003). Among working-aged patients (2065yr at LT), employment rates were highest in the PSC (56%) group and lowest in the ALF (39%) and PBC (29%) groups. In age-adjusted logistic regression, patients with PSC or alcoholic cirrhotics were 2.4- and 2.5-fold more likely to resume work after LT than patients with PBC. In conclusion, HRQoL scores late after LT were in general relatively high and comparable among disease groups. Patients with PSC or alcoholic cirrhosis were most likely to resume work after LT. The relatively low employment among patients with ALF may merit enhanced rehabilitation efforts.