**10. Experiences in our unit**

Our Liver Transplant Unit started the liver transplant program in 1984. In 1987 we began to study QOL using the generic test NHP (Figueras, 1989). Interestingly, this test allowed us to confirm that after one year of having received transplant, alcoholic patients showed a recovery in all questions related to their daily life. Their recuperation was similar to that of female patients transplanted for primary biliary cirrhosis. Our explanation was that exalcoholics, recipients of transplantation, not only resolved their medical problems while abstaining from alcohol but also experienced a global improvement and had better selfesteem. In our experience patients are offered a new outlook on life post-transplant. Even patients who are suffering from self-inflicted damage (ex-alcoholics or ex-drug users) perceive the donation as proof of solidarity, which sometimes results in them strengthening their relationships with family and friends and in some cases, renewing past relationships. Congress of Spanish Liver Transplantation Groups (1992 Murcia), lecture's main focus was to discuss the "QOL after liver transplant" and whether the etiology of alcohol could affect in the results. It is interesting that we have detected some ex-alcoholics who are riskier cases. They have to attend regular visits with the psychiatric team. After liver transplant some patients may relapse and return to alcohol use. Rehabilitation in these cases is also possible. In our experience, severe cases are the exception; younger males (under 50 years old) who have shown a strong tendency to relapse and who have presented severe cases of recidivism, with small likelihood of rehabilitation.

After 2000, due to the relevance of the use of a specific disease questionnaire for QOL assessment in clinical liver diseases and liver transplantation settings, we started using the LDQOL questionnaire, which was translated and adapted to the Spanish population by our group (Casanovas, 2003; 2007).

We then made correlations with clinical and analytical data pre and post-transplant, and with validation and outcome studies (Casanovas, 2010a). The administration of this long questionnaire is time consuming. We are therefore currently planning to administer the SF-LDQOL questionnaire, which has already been validated by its authors ( Kanwal, 2008). Recently, some research on QOL in patients with chronic liver disease, with or without HCC, awaiting liver transplantation and the sensitivity to change of the LDQOL questionnaire to determination of the quality of life of liver transplanted patients prospectively followed for twoyears, has been presented.

The LDQOL 1.0 has proven to be a useful and valid tool for measuring QOL crosssectionally in patients with liver disease. However, its sensitivity to change, or capacity to reflect actual changes in QOL after an intervention of assumed effectiveness, has not been studied to date. Studies on sensibility to change assessed using a prospective follow up from baseline, before transplant to 2 years after transplant, were presented at the AASLD meeting (Casanovas, 2010 b).
