Symptom experience, nonadherence and quality of life in adult liver transplant recipients

Survival outcomes after liver transplantation in adult patients have gradually improved with a five-year survival of about 70% and a ten-year survival of about 60%. The present review focuses on relevant patient-reported outcomes such as self-perceived side effects of immunosuppressive drugs, medication nonadherence and long-term health-related quality of life after liver transplantation. These entities are interrelated but have often been studied separately. Self-perceived symptom experience in liver transplant recipients has not been studied extensively. Symptoms that cause distress differ between men and women, e.g. symptoms related to cosmetic side effects of drugs. Medication nonadherence seems to be infrequent, but if present may have serious consequences. Important risk factors were found to be the costs of drugs, age >40 years, psychiatric disorders, side effects of drugs, beliefs that drugs were harmful, and large influence of the liver transplant on the patient's life. Health-related quality of life is satisfactory, but below the level of the general population. Results, however, must be interpreted with caution as quality-of-life improvements may have been overstated due to variables such as selection bias (e.g. exclusion of severely ill and deceased patients), too many short-term studies, and suboptimal methodology. Presently we lack data on the influence of recurrence of disease, 'de novo' diseases and gender differences on health-related quality of life in liver transplanted patients.