**11. Recommendations for future QOL after liver transplant studies**

Areas of future research related to QOL might help to settle long term problems associated with liver transplantation. There are a number of reliable and valid instruments, however none of them can be considered as the gold standard outcome to be used in all situations.

In future studies, more attention should be paid to the QOL outcomes in liver transplant recipients with alcoholic liver disease, hepatocellular carcinoma and those with hepatitis C. Some articles also suggest that female liver transplant recipients should receive special attention (Russell, 2008).

Others point out the importance of focusing on the recovering functions both during the initial period post-transplant and on the long term results. How the new available immunosuppressor drugs have to be adjusted will depend on further research incorporating HRQOL results. (Crone, 2006)

In relation to patients with previous addictions, there is no definitive biochemical test to identify alcohol relapse and the tests available have poor sensitivity and specificity, so emphasis on QOL is also important. More research is required in this field to detect alcohol ingestion before it has an effect on the new liver or when social and familiar behaviour could be difficult to manage. (Stilley, 2010)

More attention for caregivers, usually wives because men are more frequently affected by liver diseases, is required. In single patients, it is necessary to identify a circle of friends or other family members who are willing to support and take care of them. (Carver, 2005; Day, 2009; De Blesser, 2009).

Considering factors that could condition differences in the evolution, future researches should assess a larger number of cases than those done to date,and implement prospective studies.
