Quality of life, major medical complications and hospital service utilization in patients with primary biliary cirrhosis after liver transplantation.

Aims/methods: Major medical complications, hospital service utilization and quality of life were investigated in 26 out of 29 consecutive primary biliary cirrhosis transplanted patients who survived at least 2 years after the procedure (90% survival rate).

Results: Before liver transplant, the most relevant clinical data were jaundice (96%), pruritus (92%), ascites (50%), gastrointestinal bleeding (19%), hepatic encephalopathy (12%) and bone pain (12%). During the first postoperative year, the most significant complications were bone pain (58%) and fractures (31%), arterial hypertension (50%), and mild/moderate renal failure (46%). The frequency of these complications remained similar during the second year, but there was a significant reduction in the incidence of bone fractures. Bone pain was the only postoperative complication which correlated with an increased number of unscheduled outpatient and emergency visits. Quality of life was measured cross-sectionally either at or after the second postoperative year. The Karnofsky index was 90 in 69% of the patients and 76% were able to perform usual daily activities. Self-assessed health perception was good or very good in almost all the patients. However, the Nottingham Health Profile showed that approximately 70% of the patients gave a positive response to some questions in areas of pain, sleep, emotional reactions and physical activities.

Conclusions: The results of the present study confirm that patients with primary biliary cirrhosis have a high survival rate after liver transplantation and that bone pain and fractures are important postoperative complications. Good self-perceived health and return to daily activities evidenced in most PBC patients should be balanced with problems identified by more specific tools, which could have an impact on the health service utilization and quality of life.