From January 2007 to September 2010, 92 consecutive liver donors at West China Hospital of Sichuan University were approached for participation. The investigation extended from September 2010 to March 2011. Inclusion criteria were: age ≥ 18 years, an understanding of Chinese, and greater than 6 mo recovery from surgery. Exclusion criteria were: severe medical complications and limited ability to self-express. Clinical and demographic data were collected from medical records and self-report questionnaires (completed by interview or mail).

HRQoL was assessed using the Chinese version (2002)[8] of the Medical Outcomes Study Short Form-36 (SF-36)[9,10]. The SF-36 is a valid, self-administered questionnaire used internationally to measure 8 domains of health: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health during the last 12 mo. The raw scores of each subscale were transformed into scores that ranged from 0 to 100, with higher scores indicating higher levels of functioning or well-being. The level of HRQoL was assessed by comparing the mean value for the study sample with the mean value for a representative sample of the general population of Sichuan province in China[11]. Scores representing overall physical functioning and mental functioning were calculated from the subscales and presented as the physical component summary scale (PCS) and mental component summary scale (MCS).

The Symptom Checklist-90-Revised (SCL-90-R)[12] is a 90-item self-report symptom inventory used to measure the psychological symptoms patterns of community, medical, and psychiatric respondents. It is a simple questionnaire that has been validated in a number of languages. The Chinese version was adapted by Wang[13]. Each of the items is rated on a five-point scale of distress ranging from ‘‘not at all’’ (1) to ‘‘extremely’’ (5). The nine primary symptom dimensions were labeled as: somatization, obsessive-compulsive behavior, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. We assessed the level of psychological health of our sample and compared it with the Chinese norm[14].

The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the West China Hospital of Sichuan University Ethics Committee. All participants were asked to sign an informed consent form.

Statistical analysis was performed using SPSS statistical software, version 13.0. Between-group differences in HRQoL and psychological health were examined with independent sample t tests, analysis of variance, or nonparametric tests, as appropriate. Multiple comparisons for observed means were tested using the Student-Newman-Keuls procedure when equal variances could be assumed, and by the Games-Howell procedure when equal variances could not be assumed. Pearson correlation analysis were used to analyze the relationships between HRQoL and psychological symptoms. Statistical significance was set at P < 0.05.

Informed consents for participation were obtained from 92 donors. In the end, 71 (77.2%) validated questionnaires were returned. The results of SF-36 and SCL-90-R completed by interview or mail were not statistically different. All donors received a right hepatectomy without middle hepatic vein, and the vast majority of them reported that they would donate again. All donor relationships with liver recipient and recipient families were improved after donation. The demographics and clinical characteristics of the study population are shown in Table 1. The mean age of participants was 38.94 ± 10.44. Most donors were married (87.3%). More than half of the donors were male (56.3%), peasants (50.7%), and had achieved a secondary education level (64.8%). A total of 7.0% of donors experienced early or late complications including slight biliary leakage, pulmonary infection, and bodily pain. Many (47.9%) donor operations occurred 1-2 years before completing the questionnaires. Most donors worked full- or part-time after donation (87.3%). All donors were related to recipients, and most of them were close relatives (77.6%). The majority of recipients (78.9%) were in good health at the time of investigation.

The majority of scores on SF-36 domains did not significantly differ between donors and a representative sample (n = 1603) from the general population of Sichuan province in China (Table 2). Only scores in bodily pain (t = -2.387, P < 0.05) and social functioning (t = -2.246, P < 0.05) were significantly lower in donors compared to the general population, while the average donor physical functioning score was significantly higher than the general population (t = 2.230, P < 0.05).

The average SCL-90-R scores of the general population were significantly greater than average donor scores in the areas of obsessive-compulsive behavior (t = -2.119, P < 0.05), interpersonal sensitivity (t = -4.183, P < 0.001), phobic anxiety (t = -5.312, P < 0.001), and paranoid ideation (t = -3.472, P < 0.01) (Table 3). These results indicate that the psychological well-being of liver transplant donors was higher than the general population in these dimensions.

The general health domain of the SF-36, was significantly lower for female donors compared to male donors (t = 2.661, P < 0.05). Donors more than 40 years old scored higher in social functioning (t = 2.269, P < 0.05) and mental health (t = 2.184, P < 0.05). Donors who underwent surgery more than two years before the current study scored highest in physical functioning (F = 9.394, P = 0.001) and bodily pain (F = 3.513, P < 0.05), while those undergoing surgery less than one year prior to the study scored lowest. Quality of life differed significantly depending on donor employment status. Donors with full-time employment scored highest in role-physical (F = 5.790, P = 0.005), vitality (F = 9.018, P = 0.001), social functioning (F = 4.786, P < 0.05) and mental health (F = 11.051, P < 0.001). Interestingly, recipient health condition also influenced donor general health (t = 2.121, P < 0.05), social functioning (t = 2.763, P = 0.010), and role-emotional (t = 2.603, P < 0.05) (Table 4). Marital status, educational status, categories of occupation, complications, or donor-recipient relationship did not significantly affect quality of life.

To reduce the number of outcome variables regarding HRQoL, outcomes among donors were also compared using the PCS and the MCS of the SF-36. PCS (F = 11.051, P < 0.001) and MCS (F = 32.748, P < 0.001) scores were highest in donors with full-time employment and lowest in unemployed donors (Table 4). Other demographic and clinical factors did not affect PCS or MCS scores.

Table 5 presents the correlation coefficients between PCS and MCS scores of the SF-36 and the scores on the SCL-90-R subscales. MCS scores were significantly (all P < 0.05) correlated with obsessive-compulsive behavior (r = -0.421), interpersonal sensitivity (r = -0.545), depression (r = -0.557), anxiety (r = -0.393), and hostility (r = -0.456). There were no significant correlations between PCS scores and SCL-90-R scores.

Living-donor liver transplantation (LDLT) is an effective treatment for end-stage liver disease in selected recipients, especially in Asian countries where the cadaveric graft supply is markedly limited. The graft and recipient survival rates are excellent and equivalent to those after deceased-donor liver transplantation. However, the donor of LDLT is exposed to risks inherent to a surgical procedure, and may suffer a considerable psychological burden. Therefore, the safety of the donor operation and the health related quality of life (HRQoL) of the donor after surgery is critical while maintaining graft viability.

Currently, Not much researches about HRQoL and psychological well-being of the living liver donors have been reported after LDLT. There is a lack of comprehensive and systemic assessment data on donors’ HRQoL and psychological well-being after LDLT. So the present study evaluated the HRQoL and psychological well-being on the LDLT donors and identified some potential factors affecting their HRQoL.

This article is one of the few literatures on the quality of life and psychological well-being of the living liver donors after LDLT. The study is well constructed and well planned, and is a comprehensive and systemic assessment data on donors’ HRQoL and psychological well-being after LDLT.

The present study yielded important preliminary findings on reseaches of the donors’ quality of life and psychological well-being. The findings will have a significant impact on future clinical strategies.

LDLT is a procedure in which a living person donates a portion of his or her liver to another. HRQoL is a multi-dimensional concept that includes domains related to physical, mental, emotional and social functioning.

This is a good study contributing to this important area of liver transplantation. The authors have shown that the right donor hepatectomy is an acceptable procedure.