Patient-Reported Quality of Life in Lung Transplantation: Prospective Cohort Study.

Abstract

Background: Lung transplantation (LTx) is an established treatment for patients with end-stage lung diseases and can substantially improve survival. However, posttransplant recovery involves complex physical, psychological, and functional challenges, making quality of life (QoL) an important outcome beyond survival alone. Evidence on early longitudinal QoL changes after LTx remains limited, particularly in Chinese recipients and when assessed using disease-specific patient-reported outcome instruments.

Objective: This study aimed to assess QoL and track its longitudinal changes in patients who underwent LTx using a disease-specific patient-reported outcome instrument.

Methods: This single-center prospective cohort study screened 66 patients for enrollment who underwent LTx at the Xi'an Jiaotong University Lung Transplantation Center in China from June 2023 to December 2025. QoL was assessed using the Chinese version of the Lung Transplant Quality of Life questionnaire at baseline (preoperative) and serially at 1, 2, 3, 4, 5, and 6 months after surgery. The Lung Transplant Quality of Life questionnaire comprises 40 items across 7 domains, and each domain score was calculated as the item mean (range 0-4). Random-intercept linear mixed models (LMMs) with both categorical and linear time specifications were fitted separately for each domain to evaluate longitudinal changes, accounting for repeated measures and incomplete follow-up under the missing at random assumption.

Results: A total of 203 interviews from 51 eligible patients were included in this study, with a median of 5 (IQR 2-6) interviews for each patient. LMM analysis revealed significant overall time effects in 6 of 7 domains (likelihood ratio test: P<.01 in all cases). Health perceptions showed the earliest and largest improvement (LMM-adjusted mean difference [MD] -1.58 at month 6; β=-0.23 points per month; P<.001), followed by respiratory symptoms (MD -0.95 at month 6; β=-0.15 per month), anxiety and depression (MD -0.82 at month 6; β=-0.13 per month), digestive symptoms (MD -0.50 at month 6; β=-0.10 per month), and cognitive limitations (MD -0.51 at month 6; β=-0.09 per month; P<.001 in all cases). Global well-being was the only domain with a positive trajectory (MD 1.18 at month 6; β=0.13 per month; P=.002), with significant improvement already evident at month 1 (MD 0.71; P=.23).

Conclusions: LTx significantly improved QoL in patients with end-stage lung diseases, with the most substantial gains in health perceptions and respiratory symptoms. Patient-reported outcome-based monitoring can capture clinically meaningful QoL changes and should be integrated into routine posttransplant care to identify critical intervention time points and optimize long-term recovery.