**2.3.4 National Institutes of Diabetes and Digestive and Kidney (NIDDK)**

The Liver Transplant Data Base (NIDDK-LTD), (Belle, 1997) which was developed from standardized instruments it is a QOL questionnaire for adults, which includes both physical and mental domains and specific areas. Unlike the previous specific instruments, it has not been developed in other cultures.

#### **2.4 Complementary QOL indexes**

Some complementary QOL indexes and questionnaires may allow implementation research. The opinion of several authors, such as Jay et al. however, is that, the lack of a gold-standard QOL instrument for liver transplant recipients is an impediment to cross-study comparisons. Depending on the objective of the study or the target population, complementary questionnaires should be used, since other areas may be affected in advanced liver disease (Foster, 1998; Dwigt, 2000; Gutteling, 2006).

In addition to a standard SF-36 generic core, comprised of eight scales, HQLQ contains five generic items consisting of two questions for the social functioning scale and one question each for physical role, emotional role and vitality scales to augment existing SF-36 scales. HQLQ is addressed only to hepatitis C patients. This instrument will be useful in studies of health outcome among patients with chronic hepatitis C, a condition whose health burden

This instrument introduced in 2000, has two parts: the generic SF-36 and six specific scales, with a number of individual items: abdominal symptoms, fatigue, systemic symptoms, activity, emotional function and worry. These items were selected based on 60 chronic liver disease patients, 20 liver experts and a review of the literature. Younossi et al. established construct validity according to significant differences in CLDQ scores according to Child's

LDQOL is a targeted instrument which incorporates the generic SF-36 as well as 12 diseasetargeted multi-item scales: liver disease-related symptoms, liver disease-related effects on activities of daily living, concentration, memory, sexual functioning, sexual problems, sleep, loneliness, hopelessness, quality of social interaction, health distress, and self-perceived stigma of liver disease. This questionnaire was designed for patients with liver disease, such as transplant candidates or liver transplant recipients. Gralnek et al., established the validity of this instrument for measuring QOL in patients with chronic liver disease in a multi-center study of patients referred for liver transplant evaluation. More recently a prospective validation of a short form version of the LDQOL including 36 targeted items representing

The LDQOL was published in 2000, but has only been introduced to clinics recently and some studies have been published (Dias Teixeira, 2005; Kim, 2007; Gotardo, 2008; Casanovas

The Liver Transplant Data Base (NIDDK-LTD), (Belle, 1997) which was developed from standardized instruments it is a QOL questionnaire for adults, which includes both physical and mental domains and specific areas. Unlike the previous specific instruments, it has not

Some complementary QOL indexes and questionnaires may allow implementation research. The opinion of several authors, such as Jay et al. however, is that, the lack of a gold-standard QOL instrument for liver transplant recipients is an impediment to cross-study comparisons. Depending on the objective of the study or the target population, complementary questionnaires should be used, since other areas may be affected in advanced liver disease

**2.3.1 Hepatitis quality of life questionnaire (HQLQ) (Bayliss, 1998)** 

**2.3.2 Chronic Liver Disease Questionnaire (CLDQ) (Younossi, 1999)** 

**2.3.3 Liver Disease Quality of Life Questionnaire (LDQOL) (Gralnek, 2000)** 

nine domains in addition to the SF-36 has been published (Kanwal, 2008).

**2.3.4 National Institutes of Diabetes and Digestive and Kidney (NIDDK)** 

appears to have been underestimated in studies to date.

classification.

2010;).

been developed in other cultures.

**2.4 Complementary QOL indexes** 

(Foster, 1998; Dwigt, 2000; Gutteling, 2006).
