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


Sample Description

The questionnaire was administered to 511 patients (71% men) with a mean age of 63.1 yrs (SD ± 10.8). Data on socio-demographic and clinical information on tobacco and alcohol use are reported in Table 1.

Preliminary Analyses to Select Quality of Life-related Variables

Means, standard deviations and bivariate correlations of the SF-12 physical (PCS-12) and mental (MCS-12) with age, sedentary activity score of the IPAQ (SA-IPAQ) and the MEDI-LITE score are shown in Table 2. We observed statistically relevant correlations of the PCS-12 score with age and the MEDI-LITE score (p < .01). Moreover, a significant negative correlation was observed between MCS-12 and the IPAQ sedentary activity score (p < .05). All the other correlations were not significant.

Female patients scored significantly lower than male patients on the PCS-12 and MCS-12 (t[507] = 2.52, p < .05; Cohen's d = .25 and t[509] = 3.61, p < .001; Cohen's d = .35 respectively), indicating that, in general, women experienced lower physical and mental health. Additionally, those who had a caregiver scored significantly higher on the PCS-12 (t[507] = 2.22, p < .05; Cohen's d = −.25), but not on MCS-12 (t[509] = 1.33, p = .19; Cohen's d = −13). Group mean PCS-12 and MCS-12 scores are displayed in Figure 1.

Figure 1.

Mean scores of the physical and mental scores of the Short Form health survey (SF-12) across gender, caregiver presence and smoking habit (*p < .05, **p < .001)

One-way ANOVAs showed differences in the PCS-12 score by place of stay (F[2, 506] = 6.88, p < 0.01, ηp 2 = .026), occupation (F[2, 506] = 9.98, p < 0.001, ηp 2 = .038), level of physical activity (F[2, 506] = 22.89, p < 0.001, ηp 2 = .083) and alcohol habit (F[2, 506] = 6.32, p < 0.01, ηp 2 = .024). Post hoc tests revealed that patients from Central Italy showed higher physical health than patients from other areas (p < 0.01), inactive/retired patients experienced lower physical health than blue (p < 0.01) and white (p < 0.01) collars. Patients with low physical activity reported lower physical health than those with medium (p < 0.001) or high (p < 0.001) activity, and patients who occasionally consume alcohol showed better physical health than patients who never (p < 0.05) or continuously (p < 0.01) drink alcohol. Mean PCS-12 and MCS-12 scores in relation to these parameters are displayed in Figure 2.

Figure 2.

Mean scores of the physical and mental scores of the Short Form health survey (SF-12) across place of stay, educational level, occupation, time from transplantation, physical activity and alcohol habit (*p < .05, **p < .01, ***p < .001)

Multivariate Analysis to Identify Predictors of Impaired Quality of Life

Preliminarily, PCS-12 and MCS-12 outcome variables were dichotomized using the 25th percentile (corresponding to 41 and 42 respectively). Since inactive/retired patients reported lower PCS-12 scores when compared to blue and white collars, but no differences were detected between these two groups, the predictor variable "occupation" was transformed in a dichotomous variable (i.e., inactive/retired vs. blue/white collars). Similarly, because medium and high activity patients did not differ on PCS-12, the predictor "physical activity" was also dichotomised (i.e., low physical activity vs. medium/high activity). Finally, place of stay was not included as predictor because the variable is specifically related to the geographical characteristics of Italy and the geographical location of the Hepatology Units.

In Table 3, we reported frequencies and percentages for each predictor and the relative statistics tests to compare the two groups defined upon the 25th percentile of the PMC-12 and MCS-12 scores (i.e., impaired vs. not impaired QoL groups). Except for the difference in the MEDI-LITE score that was observed also between groups based on the 25th percentile of the MCS-12, results are in line with the previous reported analyses, and they can be resumed as follows. Comparing the impaired versus not impaired physical health groups, higher percentages of female, unemployed/retired, low activity, low adherence to the diet, older patients belonged to the impaired group. Comparing the impaired versus not impaired mental health groups, higher percentages of female, sedentary activity and low adherence to the diet patients belonged to the impaired group.

The specific weight of each predictor is reported in Table 4. Female patients were 1.65 times more likely to report impaired PCS-12 than males. Occupation and physical activity also displayed a significant positive in relation to QoL, indicating that workers or patients with medium/high activity were less likely to report impaired PCS-12 than unemployed/retired or low activity patients (Odds ratio 1.77 and 3.71 respectively). MEDI-LITE score was also a relevant predictor, and for each one-point increase in the score, the patient was .84 times less likely to report impaired QoL.

When mental health was analysed (Table 4), female patients were 1.78 times more likely to report impaired MCS-12 than male patients. Sedentary activity and the MEDI-LITE score were additional significant predictors, and for each one-point increase in the score, the patient was 1.51 more likely and .88 times less likely to report impaired MCS-12 respectively.