Most studies found an improvement in mental and physical quality of life components after liver transplantation [1–4]. However the great majority of these studies evaluated decompensated liver disease patients, with a very disabling disease at the time of liver transplantation.
To our knowledge, this is the first study evaluating mental and physical quality of life FAP patients after liver transplantation, and in fact this is a very particular group of liver transplanted patients. FAP patients have a genetic disease, invariably fatal without treatment, and are now being transplanted at a very early stage, with a paucity of symptoms [6, 7]. There are some studies about the clinical progression of these patients after transplantation, the majority demonstrating a slowing in the progression of neurological symptoms [8–11].
The fact that liver transplantation had a less beneficial impact in mental quality of FAP patients is difficult to explain. It cannot be explained by the paucity of symptoms that FAP patients have before transplantation, since when comparing them with liver disease patients with few symptoms, such as Child-Pugh A, they still have a worse evolution of their mental quality of life, although the improvement in physical quality of life was similar.
One possible explanation could relate to a particular psychological profile of these patients. Telles-Correia 2008 et al found that there was a high prevalence of psychiatric diagnosis (mostly depression and anxiety) in familial amyloid polyneuropathy patients waiting for transplantation and that these patients had a different personality characteristics comparing to other liver transplant candidates . This might be due to the emotional stress of being exposed to a chronic sensation of being carrier of a fatal genetic disease . This chronic emotional stress added to a maintained exposure to doubt and uncertainty feelings might explain the development of great expectations towards liver transplantation, and partially explain the difference towards mental quality of life changes found in the present study. These hypotheses must be confirmed by other studies.
On the other hand, our findings that liver transplantation has a less beneficial impact in physical component of quality of life in FAP patients is easier to explain, because FAP patients are not so much disabled by their disease at the moment of liver transplantation, than decompensated liver disease patients.
One of the main weaknesses of the present study is the small number of FAP patients included, what relates to the difficulty of doing a prospective study in such a rare disease. More studies in this area are needed to confirm our findings and further explore our knowledge of the FAP psychological profile, in order to better deal with these patients and improve their quality of life after liver transplantation.