Improvements in Health-Related Quality of Life with Lung Transplantation: A Prospective Multicenter Cohort Study

Purpose Lung transplant improves health-related quality of life (HRQL) for many recipients. However, with increasing lung disease severity and higher acuity candidates, it is not clear the early trajectory of improvement and the specific early clinical factors that might be associated with this improvement. Understanding post transplant HRQL trajectories and clinical factors that influence those trajectories is an unmet need. Methods As part of a prospective multi center cohort study, lung transplant recipients completed the Short Form-36 (SF-36) and the St George's Respiratory Questionnaire (SGRQ) pre-transplant and at 1, 3, 6, 9 and 12 months post-transplant. A longitudinal repeated measures linear mixed model was constructed with separate slopes prior to and post day 91 due to evidence of time-varying associations. The impact of key clinical factors on HRQL changes was modeled in secondary analyses. Results For the SF-36 physical component score and all SGRQ domains, lung transplant recipients had large improvements in the first 3 months post-transplant that remained mostly stable over the remainder of the first year. In particular, younger patients, patients with cystic fibrosis and patients with worse pre-transplant HRQL had the greatest improvements in the early period after transplant. The mean SF-36 mental component score was in the normal range pre-transplant and remained stable post-transplant. Conclusion Lung transplant recipients have dramatic and sustained improvement in HRQL by SF-36 and SGRQ domains with the greatest improvements evident within 3 months that may differ by age, native lung disease pre-transplant HRQL. Lung transplant improves health-related quality of life (HRQL) for many recipients. However, with increasing lung disease severity and higher acuity candidates, it is not clear the early trajectory of improvement and the specific early clinical factors that might be associated with this improvement. Understanding post transplant HRQL trajectories and clinical factors that influence those trajectories is an unmet need. As part of a prospective multi center cohort study, lung transplant recipients completed the Short Form-36 (SF-36) and the St George's Respiratory Questionnaire (SGRQ) pre-transplant and at 1, 3, 6, 9 and 12 months post-transplant. A longitudinal repeated measures linear mixed model was constructed with separate slopes prior to and post day 91 due to evidence of time-varying associations. The impact of key clinical factors on HRQL changes was modeled in secondary analyses. For the SF-36 physical component score and all SGRQ domains, lung transplant recipients had large improvements in the first 3 months post-transplant that remained mostly stable over the remainder of the first year. In particular, younger patients, patients with cystic fibrosis and patients with worse pre-transplant HRQL had the greatest improvements in the early period after transplant. The mean SF-36 mental component score was in the normal range pre-transplant and remained stable post-transplant. Lung transplant recipients have dramatic and sustained improvement in HRQL by SF-36 and SGRQ domains with the greatest improvements evident within 3 months that may differ by age, native lung disease pre-transplant HRQL.