HRQoL in the Low MELD Pre-tx Population (LowMELD)

Health-Related Quality of Life in the Low Model for End-Stage Liver Disease (MELD) Pre Transplant Patient Candidate: A Pilot Study

The purpose of this study is to describe the HRQoL in those with MELD scores </= 15 in a single center for those who are pre-liver transplant candidates

Study Overview

• Status: Completed
• Conditions: Cirrhosis of the Liver

Detailed Description

The liver organ allocation system was significantly revised in 2002, allowing a more objective prioritization of liver transplant candidates. The revised Model for End Stage Liver Disease (MELD) system is based primarily on laboratory test results. Candidates with MELD scores of less than 15 are considered to be low priority for cadaveric liver transplant and have limited treatment options. Yet patients with low MELD scores may suffer from an array of symptoms associated with liver disease such as fatigue, sleep disturbances, and depression - all of which erode health-related quality of life (HRQoL). No previous studies were found that examined HRQoL in low MELD transplant patients. A better understanding of the HRQoL of these patients will allow clinicians to better meet their needs. Therefore, the aims of the proposed pilot capstone project are to examine HRQoL and to identify demographic and clinical characteristics including liver-disease related symptoms, functional status, perceived social support, biological functioning and mental health associated with HRQoL in pre-liver transplant candidates with low MELD scores. The revised Wilson and Cleary Quality of Life Model will be used to guide the project. Fifty pre-transplant liver candidates with MELD scores < 15 will be enrolled in the descriptive, cross-sectional pilot study. Participants will complete a written questionnaire measuring perceived HRQoL and clinical characteristics. Descriptive and correlational statistics will be used to analyze the data. Findings from this project will identify trends in factors that contribute to a HRQoL of this population and provide the foundation for a larger future project.

• Study Type: Observational
• Enrollment (Actual): 50

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Adults who are a candidate for a liver transplant at Northwester Memorial Hospital with MELD score </=15

Description

Inclusion Criteria:

1. Must be a patient in the liver transplant clinic at Northwestern Memorial Hospital or one of its satellite clinics (including Washington, Illinois; Portage, Indiana; Glenview, Illinois, Oakbrook, Illinois; Joliet, Illinois)
2. Adult patient between the ages of 18-75
3. Ability to read and speak English
4. Must be a candidate for liver transplant per Northwestern Memorial Hospital liver transplant multidisciplinary committee
5. Model for End Stage Liver Disease (MELD) score ≤15
6. Cognitive ability to complete measures

Exclusion Criteria:

1. Non-English speaking
2. Those who have already received a liver transplant

3. Hepatic encephalopathy as evidenced by:

   1. Grade II or more West Haven Criteria or Adapted West Haven Criteria
   2. Evidence of Asterixis upon exam at time of consent (if consented in person)
4. Acute liver failure as etiology for liver disease.
5. MELD score > 15
6. Mental retardation or cognitive disabilities preventing completion of the written questionnaire

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceived HRQoL Score. Overall Qualty of Life Index Tool Was Utilized.	Describe perceived HRQoL in patients with low MELD scores (≤15) pre-liver transplant patient population. Overall Qualty of Life Index tool was utilized. The subscales were not utilized. The unit of measurement was scores on a scale. QLI tool has a range of 0-30 for total possible score. With the higher the score the higher the HRQoL.	2-3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Subjects With Depressive Scores Who Had a Poor HRQoL	Identify clinical characteristics such as environmental factors, patient biology, liver-disease related symptoms, functional status, general health perception, characteristics of the individual associated with perceived HRQoL in patients with low MELD scores (≤15) pre-transplant. What characteristics were found to be predictive of poor HRQoL. Tools utilized each assessed the specific variables including patient biology, liver disease symptoms, functional status, general health perception, and characteristics of the individual.	2-3 months

Collaborators and Investigators

• Sponsor: Northwestern University
• Collaborators: Loyola University
• Investigators: Principal Investigator: Rebecca Duke, MSN, Northwestern University

Study record dates

Study Major Dates

• Study Start: March 1, 2012
• Primary Completion (ACTUAL): July 1, 2012
• Study Completion (ACTUAL): July 1, 2012

Study Registration Dates

• First Submitted: April 5, 2012
• First Submitted That Met QC Criteria: April 5, 2012
• First Posted (ESTIMATE): April 9, 2012

Study Record Updates

• Last Update Posted (ESTIMATE): February 28, 2014
• Last Update Submitted That Met QC Criteria: February 27, 2014
• Last Verified: February 1, 2014

More Information

Terms related to this study

• Keywords: Depression; Cirrhosis of the liver; Pre-liver transplant Candidate; Poor social support; Liver disease symptoms; Health releated quality of life
• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Liver Diseases; Fibrosis; Liver Cirrhosis
• Other Study ID Numbers: STU00060397