Quality of Life in Liver Transplant Recipients During the Corona Virus Disease 19 Pandemic

A Multicentre Study

Stefano Gitto; Lucia Golfieri; Nicolò Mannelli; Maria Rosa Tamè; Ivo Lopez; Roberta Ceccato; Stanislao Montanari; Margherita Falcini; Giovanni Vitale; Nicola De Maria; Danilo Lo Presti; Luca Marzi; Andrea Mega; Giovanna Valente; Alberto Borghi; Francesco Giuseppe Foschi; Silvana Grandi; Paolo Forte; Matteo Cescon; Fabrizio Di Benedetto; Pietro Andreone; Giulio Arcangeli; Paolo De Simone; Andrea Bonacchi; Francesco Sofi; Maria Cristina Morelli; Marco Petranelli; Chloe Lau; Fabio Marra; Francesca Chiesi; Francesco Vizzutti; Vittoria Vero; Roberto Di Donato; Sonia Berardi; Paolo Pianta; Sharon D'Anzi; Filippo Schepis; Noemi Gualandi; Francesca Miceli; Erica Villa; Guido Piai; Marco Valente; Claudia Campani; Erica Lynch; Paolo Magistri; Carmela Cursaro; Annarita Chiarelli


Liver International. 2022;42(7):1618-1628. 

In This Article

Abstract and Introduction


Background: Liver transplant recipients require specific clinical and psychosocial attention given their frailty. Main aim of the study was to assess the quality of life after liver transplant during the current pandemic.

Methods: This multicentre study was conducted in clinically stable, liver transplanted patients. Enrollment opened in June and finished in September 2021. Patients completed a survey including lifestyle data, quality of life (Short Form health survey), sport, employment, diet. To examine the correlations, we calculated Pearson coefficients while to compare subgroups, independent samples t-tests and ANOVAs. To detect the predictors of impaired quality of life, we used multivariable logistic regression analysis.

Results: We analysed data from 511 patients observing significant associations between quality of life's physical score and both age and adherence to Mediterranean diet (p < .01). A significant negative correlation was observed between mental score and the sedentary activity (p < .05). Female patients scored significantly lower than males in physical and mental score. At multivariate analysis, females were 1.65 times more likely to report impaired physical score than males. Occupation and physical activity presented significant positive relation with quality of life. Adherence to Mediterranean diet was another relevant predictor. Regarding mental score, female patients were 1.78 times more likely to show impaired mental score in comparison with males. Sedentary activity and adherence to Mediterranean diet were further noteworthy predictors.

Conclusions: Females and subjects with sedentary lifestyle or work inactive seem to show the worst quality of life and both physical activity and Mediterranean diet might be helpful to improve it.


Coronavirus Disease 19 (COVID-19) is an acute respiratory disorder caused by the SARS-CoV-2 zoonotic virus actually responsible of a global pandemic.[1–3] People are experiencing dramatic clinical and psychological consequences, severe economic and social crisis and wide restrictions of personal and social freedom, culminating in lockdown and quarantine.[1] The Italian National Institute of Statistics (ISTAT) reported, in the last annual report of "Fair and sustainable well-being (BES 2020)," that the uncertainty related to the current health, economic and employment crisis has led a vast part of the population to express worry for the next 5 years.[4]

Today, many subpopulations could require specific clinical and psychosocial attention, given their risk factors in terms of mental and physical health. Among them, patients who underwent liver transplantation (LT) are especially vulnerable, and previous research indicated higher depression and need for social support than general population.[5] Transplant recipients often experience negative psychological outcomes, such as re-experiencing, avoidance, a sense of anticipation and responsibility towards the donor, clinicians and family members.[6–8]

LT represents the standard of care for patients with severe acute or chronic liver diseases or hepatocellular carcinoma, with 1- and 5-year patient survival rates of more than 90% and 70% respectively.[9,10] With these remarkable survival rates, quality of life (QoL) should represent today a chief independent measure of transplant outcome.[11,12] Notably, the goal of LT should be not only to achieve an acceptable QoL, but to return to the levels present before the onset of liver disease.[13,14]

Considering the relevance of QoL in the overall assessment of the success of LT, this study was undertaken to examine the QoL of a large population of LT recipients during the COVID-19 pandemic. Specifically, we aimed (a) to analyse the correlation between personal data, lifestyle patterns, physical activity, employment and adherence to Mediterranean diet and QoL of LT recipients during the COVID-19 pandemic; and (b) to detect the predictors of impaired QoL.