Determinants of quality of life after lung transplant: An Italian collaborative study

Background. With the improvement in survival rates after lung transplantation, concern has arisen about evaluating quality of life (QoL). This multicenter cross-sectional study aimed at describing QoL and identifying factors associated with it. Methods. We assessed QoL in 129 lung transplant recipients from 5 centres in Italy, during scheduled followup visits, using the SF-36, GHQ and St George's respiratory questionnaires (SGRQ). Results. The SF-36 e licited impaired QoL in the physical, but not in the mental domains (PCS=44; MCS=53). The GHQ identified 29 patients (23%) with psychological discomfort and the SGRQ scores were significantly better than those of patients with chronic respiratory disease. On multivariate analysis, exertional dyspnea was an independent predictor of the PCS (adjusted Δ -6.3 (p<0.001), while osteoporosis (Δ=-3.1), BOS (Δ=-4.3), acute rejection (Δ=-3.9) and heart and lung transplant (Δ=+6.4) were only marginally associated. Dyspnea was also related to a GHQ score >5. Conclusions. The study identified exertional dyspnea as the main determinant of QoL as measured both by SF36 (PCS) and GHQ. Other objective measures contributed only to the PCS. Thus, the SF-36 (PCS) and GHQ were useful in identifying patients who needed treatment not only for complications but also psychological support and continued physical rehabilitation.