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Psychological Functioning and Quality of Life in Lung Transplant Candidates and Recipients^*

^* From the Toronto Lung Transplant Program (Ms. Limbos and Dr. Chan), The Toronto Hospital, Toronto, Ontario, Canada; St. Michaels Hospital (Dr. Joyce), Toronto, Ontario, Canada; and Boehringer-Ingelheim Pharmaceuticals (Dr. Kesten), Ridgefield, CT.

Correspondence to: Steven Kesten, MD, FCCP, Boehringer-Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Rd, Ridgefield, CT 06877-0368; e-mail: skesten{at}rdg.boehringer-ingelheim.com

Objective: The purpose of this study was to examine the psychological functioning and quality of life (QOL) of lung transplant candidates and recipients.

Methods: The following measures were completed by 36 lung transplant candidates (the pretransplant group [PRE]) and 73 recipients (the posttransplant group [POST]): the Rand-36 Item Health Survey 1.0 (RAND-36), visual analog scale of overall QOL (OQOL), Brief Symptoms Inventory (BSI), Derogatis Sexual Functioning Inventory (DSFI), Hospital Anxiety and Depression Scale (HAD), Rosenberg Self-Esteem Scale (RSES), and Body Cathexis Scale (BC).

Results: Compared to the PRE, POST patients had significantly better scores on the following measures: RAND-36 total, physical health, role limitations due to physical health, general health, vitality, and social functioning subscales (all p < 0.0001); visual analog scale of OQOL (p < 0.0001); BSI (p < 0.05); BC (p < 0.05); HAD anxiety (p < 0.05) and depression (p < 0.0001); and RSES (p < 0.05). Despite better scores, some areas did not differ between the PRE and the POST, and many patients continued to experience impairments in psychological functioning. Specifically, the RAND-36 emotional health and role limitations due to emotional health subscale scores did not differ between the PRE and the POST and they remained lower than published norms. A significant proportion of patients in both groups (44% of PRE patients and 28% of POST patients) had borderline or clinical levels of anxiety (ie, the HAD). Finally, PRE and POST mean scores were significantly lower than published norms on the RSES (p < 0.05) and the body image scale of the DSFI (p < 0.05).

Conclusions: Although lung transplant recipients have better general, physical, and psychological health than their pretransplant counterparts, the present research suggests that both groups experience impairment in several areas of psychological functioning. Future research into the QOL of the lung transplant population should be aimed at recognizing, intervening, and improving patients’ psychological and emotional well-being.

Key Words: anxiety • body satisfaction • depression • lung disease • lung transplantation • quality of life • self-esteem • sexual functioning

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