2013 - ISBTS 2013 Symposium


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Mini-Oral Communications 2

26.357 - QOL and performance status before and after small intestinal transplantation.

Presenter: Charlotte , Pither, , United Kingdom
Authors: Charlotte Pither1, Samantha Duncan1, Rui Gao1, Andrew Butler2, Susanna West1, Jeremy Woodward1, Simon Gabe3, Stephen Middleton1

QOL and performance status before and after small intestinal transplantation.

Charlotte Pither1, Samantha Duncan1, Rui Gao1, Andrew Butler2, Susanna West1, Jeremy Woodward1, Simon Gabe3, Stephen Middleton1

1Gastroenterology, Cambridge university hospitals NHS Foundation trust, Cambridge, United Kingdom; 2Transplantation Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; 3Intestinal Failure Unit, St Marks hospital and academic institute, London, United Kingdom

 

Introduction:
Intestinal transplantation (IT) is considered for patients with irreversible intestinal failure who develop life threatening complications of parenteral nutrition (PN) or who have extensive intra-abdominal disease requiring evisceration. Developing indications may include quality of life (QOL) considerations and therefore assessment of QOL and performance status (PS) after IT is important.
We report QOL and PS before and after IT in our cohort
Methods:
Consecutive patients undergoing IT were included. QOL was assessed using the generic SF36 tool at assessment and 6 month intervals post-transplant. Performance was assessed using a visual analogue scale (VAS) and Karnofsky scale (KS) at 3 time points: pre-morbidly, at listing, after transplant.
Results.
Data was available for 21 patients. There were 11 complete SF-36 datasets and 15 performance scores.  Data was not available from 3 patients, overall response rate 60%. Overall there was a trend for improved SF-36 scores post-transplant  in about half of the patients with scores remaining stable in about a third. SF-36 significantly improved in 1 patient (P<0.001) and significantly declined in 1 patient (p<0.001). A trend for improved scores with increasing time since transplant was seen.
After IT, 66% of patients had better VAS scores than at listing and >75% of patients scored better or the same in KS compared to status at listing. However performance status after IT did not improve to premorbid levels.
Conclusion: We found a trend for QOL scores to improve in about half of patients compared to status at listing, remain static in about a third and a minority experience a decline. For the majority differences were not statistically significant.  Performance status of patients after transplant is equal or better than that at listing in 75% but rarely reaches that of the pre-morbid status. Longer term studies may reveal better post operative QOL and PS scores.


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