**5.6 Issues related to HRQOL in receptors HIV+**

More relevant problems at present are: - Primary disease recurrence, especially Hepatitis C virus, -Scarcity of donors, -Complications related to the chronic administration of immunodepressors (Tomé, 2008) The Spanish Liver Transplant Program for selected HIV+ carriers was initiated in 2002 due to the increasing burden of liver disease in patients with HIV (Joshi, 2011). Some new developments, both in the treatment of HIV+ and in the longterm management of liver transplant recipients have enabled further improvement of the results. (Consensus conference, 2009).

Studies are fragmented. Until recently different constructs and researches covered 1-2 years after transplantation and it is only now that there is a focus on the long term results. In acute liver failure a "better HRQOL related to shorter duration and lesser severity of liver disease" was observed. Disease recurrence has little impact on graft survival rates within 7-10 years of transplantation, in contrast, hepatitis C recurrent disease is an important concern in relation to survival and QOL (Holzner, 2001; Karam, 2003; Sainz-Barriga, 2005).

term survival is good after transplant. However, due to the relative scarcity of donors, the majority of transplant teams do not accept to list patients who are actively consuming

Liver transplant is a well established therapy for patients with autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). The perceived QOL in patients with cholestatic liver disease before and after LT was measured using some aspects of QOL, including symptoms (pruritus, fatigue); physical, social, and emotional functioning; health perceptions (stigma); and overall QOL (Gross, 1999). Changes in these QOL parameters before and after LT were studied and also the relationships between clinical and QOL factors and was demonstrated that cholestatic liver disease displayed the best cost-effectiveness ratio after LT (Longworth, 2003). Following transplantation QOL was substantially better than before transplantation and there were no differences in QOL parameters between patients with AIH, PBC and PSC. Some authors have pointed out that a patient's QOL 1 year after transplant could not be predicted by pre-transplantation QOL

Acute liver failure continues to be associated with a high mortality rate, and emergency liver transplantation is often the only life-saving treatment (Riordan& Williams, 2003). Although, the short-term outcomes are worse in comparison with those for non-urgent cases, due to the initial recovery process, the majority of patients transplanted with acute liver failure, reported that they have a good quality of life (Sargent, 2007; Dobbels, 2010). The keys to long-term success and continued progress in urgent liver transplantation are the use of good-quality whole grafts and a short waiting list time, both of which depend on access to a sufficient pool of organ donors. In this group the pre-transplantation HRQOL data could not be assessed due to patients' clinical situation. However, there have been studies published reporting an acceptable survival and QOL., in the short or medium term (Chan, 2009).

More relevant problems at present are: - Primary disease recurrence, especially Hepatitis C virus, -Scarcity of donors, -Complications related to the chronic administration of immunodepressors (Tomé, 2008) The Spanish Liver Transplant Program for selected HIV+ carriers was initiated in 2002 due to the increasing burden of liver disease in patients with HIV (Joshi, 2011). Some new developments, both in the treatment of HIV+ and in the longterm management of liver transplant recipients have enabled further improvement of the

Studies are fragmented. Until recently different constructs and researches covered 1-2 years after transplantation and it is only now that there is a focus on the long term results. In acute liver failure a "better HRQOL related to shorter duration and lesser severity of liver disease" was observed. Disease recurrence has little impact on graft survival rates within 7-10 years of transplantation, in contrast, hepatitis C recurrent disease is an important concern in

relation to survival and QOL (Holzner, 2001; Karam, 2003; Sainz-Barriga, 2005).

alcohol. (Cowling, 2004), but it is controversial (Mathurin, 2011).

**5.4 Autoimmune and Cholostatic Liver Diseases** 

variables (Krasnoff, 2005; Bownik, 2009).

**5.6 Issues related to HRQOL in receptors HIV+** 

results. (Consensus conference, 2009).

**5.5 Acute Liver Disease** 

Survival of liver transplanted patients at five years depends on when the patients received liver transplant (K. Bjøro, 1999). In recent years, there has been considerable improvement in long-term clinical management and an increase in knowledge about risks, such as developing chronic renal disease, "de novo" tumours, primary disease recurrence etc. Present challenges are related to studies with a longer follow up, 10 to 20 years, some of which have been recently published (de Kroon, 2007; Ruppert, 2010).
