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Craxì L, Cottone PM, Sacchini D, Burra P, Toniutto P. The Equitable Benefit Approach to guide the assessment of medical and psychosocial factors in liver transplant candidacy. Liver Int 2024. [PMID: 38923733 DOI: 10.1111/liv.16018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/16/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
Lack of available organs poses a significant challenge in meeting the needs of patients with life-threatening liver disease who could benefit from liver transplantation (LT). Psychosocial vulnerability markers have been linked to post-transplant outcomes, raising questions about their use in patient selection. However, their incorporation into selection criteria raises concerns about health equity and potential discrimination. As a result, there is a pressing need to refine fair allocation systems that consider both clinical and psychosocial factors to ensure equitable access and optimize post-transplant outcomes. The Equitable Benefit Approach (EBA) proposed in this paper by the multidisciplinary group of clinical experts in LT from the Italian Society for the Study of the Liver seeks to address these concerns. It presents four procedural principles, the two allocative principles usually applied in transplantation (urgency and utility) and introduces a new one, the principle of health equity. The EBA aims to prioritize patients with the highest transplant benefit while addressing health inequalities. It emphasizes evidence-based decision-making and standardized assessment tools to reliably evaluate psychosocial risk factors. Implementing the EBA involves a multi-step process, including stakeholder engagement, prospective studies to validate its efficacy, development of institutional policies and algorithms, and ongoing monitoring and revision. By following these steps, health care providers can ensure that LT allocation decisions are transparent and responsive to evolving clinical and social contexts. Ultimately, the EBA should offer a comprehensive framework for fair patient selection in LT, considering both biomedical and psychosocial aspects.
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Affiliation(s)
- Lucia Craxì
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Provvidenza M Cottone
- A.R.N.A.S. Hospital Civico-Di Cristina-Benfratelli, Regional Transplant Center, Sicilia, Italy
| | - Dario Sacchini
- Institute of Bioethics, A. Gemelli School of Medicine, University Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Department of Medicine, University of Udine, Udine, Italy
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2
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Kim JS, Wray J, Ridout D, Plumb L, Nitsch D, Robb M, Marks SD. Protocol for a multicentre prospective exploratory mixed-methods study investigating the modifiable psychosocial variables influencing access to and outcomes after kidney transplantation in children and young people in the UK. BMJ Open 2024; 14:e078150. [PMID: 38806415 PMCID: PMC11138291 DOI: 10.1136/bmjopen-2023-078150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 05/02/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION Kidney transplantation is the preferred therapy for children with stage 5 chronic kidney disease (CKD-5). However, there is a wide variation in access to kidney transplantation across the UK for children. This study aims to explore the psychosocial factors that influence access to and outcomes after kidney transplantation in children in the UK using a mixed-methods prospective longitudinal design. METHODS Qualitative data will be collected through semistructured interviews with children affected by CKD-5, their carers and paediatric renal multidisciplinary team. Recruitment for interviews will continue till data saturation. These interviews will inform the choice of existing validated questionnaires, which will be distributed to a larger national cohort of children with pretransplant CKD-5 (n=180) and their carers. Follow-up questionnaires will be sent at protocolised time points regardless of whether they receive a kidney transplant or not. Coexisting health data from hospital, UK renal registry and National Health Service Blood and Transplant registry records will be mapped to each questionnaire time point. An integrative analysis of the mixed qualitative and quantitative data will define psychosocial aspects of care for potential intervention to improve transplant access. ANALYSIS Qualitative data will be analysed using thematic analysis. Quantitative data will be analysed using appropriate statistical methods to understand how these factors influence access to transplantation, as well as the distribution of psychosocial factors pretransplantation and post-transplantation. ETHICS AND DISSEMINATION This study protocol has been reviewed by the National Institute for Health Research Academy and approved by the Wales Research Ethics Committee 4 (IRAS number 270493/ref: 20/WA/0285) and the Scotland A Research Ethics Committee (ref: 21/SS/0038). Results from this study will be disseminated across media platforms accessed by affected families, presented at conferences and published in peer-reviewed journals.
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Affiliation(s)
- Ji Soo Kim
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Deborah Ridout
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Lucy Plumb
- UK Renal Registry, Bristol, UK
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Dorothea Nitsch
- UK Renal Registry, Bristol, UK
- Non-communicable disease epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew Robb
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Stephen D Marks
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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3
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Teh L, Henderson D, Hage C, Chernyak Y. Interitem Psychometric Validation of the Stanford Integrated Assessment for Transplant Scale Among Thoracic Transplant Candidates. J Acad Consult Liaison Psychiatry 2023; 64:418-428. [PMID: 36521680 DOI: 10.1016/j.jaclp.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/14/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Psychosocial evaluations are mandatory for transplant listing, however the methodology for creating psychosocial risk stratifications is unclear. The Standford Psychosocial Integrated Psychosocial Assessment for Transplant Scale is the most commonly used instrument, however its interitem validity has never been examined. OBJECTIVE To investigate the interitem validity of a psychosocial assessment tool for transplant candidates among a sample of thoracic transplant candidates. METHODS Clinic data consisting of Stanford Integrated Psychosocial Assessment for Transplant administrations from 173 heart and lung transplant candidates were fit to a partial credit model. Data were subsequently fit to 4 separate partial credit models based on subscale categories, demonstrating the discrimination parameter estimate of each item. Differential item functioning analyses were conducted on the data within each subscale by sex to investigate potential bias produced by each item. RESULTS The initial partial credit model using the full scale did not converge, indicating the subscales possibly did not measure the same underlying construct. Subscale discrimination parameter estimates demonstrated that most items were adequately or highly discriminative. The item measuring history of substance use demonstrated poor fit and differential item functioning. CONCLUSIONS While the Stanford Integrated Psychosocial Assessment for Transplant has demonstrated strong potential as a standardized framework for psychosocial assessments in transplant, this study identified some areas for improvement in the scoring system. The subscale scores appeared to show greater construct validity when utilized individually than when aggregated to form a total score. The substance use/abuse/dependence item did not fit well into its respective subscale. Future studies should aim to optimize the scoring system and re-asses its construct validity to improve its accuracy in discriminating between high-risk candidates and those needing psychosocial assistance.
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Affiliation(s)
- Lisa Teh
- Montefiore Medical Center, Department of Psychiatry and Behavioral Sciences, Bronx, NY; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN.
| | - Danielle Henderson
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Chadi Hage
- Department of Pulmonology, Allergy, and Critical Care, Indiana University, Indianapolis, IN
| | - Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
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4
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Poor Physical Function Trajectory Predicts Impaired Patient Survival in Older Recipients of Deceased Donor Kidneys: A Prospective Cohort Study. Transplant Direct 2022; 8:e1374. [PMID: 36245999 PMCID: PMC9553385 DOI: 10.1097/txd.0000000000001374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/02/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
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5
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Park MS. Medical Complications of Lung Transplantation. J Chest Surg 2022; 55:338-356. [PMID: 35924543 PMCID: PMC9358167 DOI: 10.5090/jcs.22.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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6
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Jobst S, Schaefer J, Kleiser C, Kugler C. A Systematized Review of Professional Employment Following Thoracic Transplantation. Prog Transplant 2022; 32:55-66. [PMID: 35006009 DOI: 10.1177/15269248211064883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Acknowledging the evolved landscape in thoracic transplantation, professional employment becomes an important outcome measure to quantify the success of this costly procedure. OBJECTIVE We aimed to assess rates of and characterize factors associated with professional employment in patients following thoracic transplantation, and create an evidence-base on the relationship between professional employment and relevant outcome parameters. METHODS We systematically searched Medline, Cinahl, and GoogleScholar to identify studies published between 1998 and 2021 reporting on professional employment following heart and lung transplantation. RESULTS Twenty-two studies from 11 countries with varying sample sizes (N = 27; 10 066) were included. Employment rates ranged from 19.7% to 69.4% for heart, and from 7.4% to 50.8% for lung transplant recipients. Most frequently reported positively associated factors with employment after transplant were younger age, higher education, and history of pretransplant employment. Longer duration of unemployment prior to transplantation and Medicaid coverage were the most frequently reported negatively associated factors. Relationships between professional employment and clinical outcomes included lower rates of acute and chronic rejection, less infection episodes, and better quality of life among working patients; one study reported a lower 5-year-mortality rate. Reasons not to work were "physical or mental health-related," "employment-related," "financial reasons," and "lifestyle choices." DISCUSSION Substantial proportions of patients following thoracic transplantation are not professionally employed, potentially diminishing the success of transplantation on individual and societal levels. Considering adverse clinical outcomes in employed transplant recipients were low, more efforts are needed to identify modifiable factors for employment in these populations.
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Affiliation(s)
- Stefan Jobst
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Jonas Schaefer
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Christina Kleiser
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Christiane Kugler
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
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7
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Battaglia Y, Zerbinati L, Belvederi Murri M, Provenzano M, Esposito P, Andreucci M, Storari A, Grassi L. Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis. J Clin Med 2021; 10:jcm10204747. [PMID: 34682870 PMCID: PMC8540707 DOI: 10.3390/jcm10204747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Although kidney transplant can lead to psychiatric disorders, psychosocial syndromes and demoralization, a positive post-traumatic growth (PTG) can occur in kidney transplant recipients (KTRs). However, the PTG-Inventory (PTGI), a reliable tool to measure PTG is scarcely used to explore the effect of this stressful event in KTRs. Thus, the purpose of our study was to assess the level of PTG and its correlation with demoralization, physical and emotional symptoms or problems via network analysis in KTRs. Additionally, we aimed at exploring the association of PTG with psychiatric diagnoses, Diagnostic Criteria for Psychosomatic Research (DCPR) conditions, and medical variables. A total of 134 KTRs were tested using MINI International Neuropsychiatric Interview 6.0 (MINI 6.0), DCPR interview, PTGI, Edmonton Symptom Assessment System (ESAS), Canadian Problem Checklist (CPC) and Demoralization scale (DS-IT). PTGI was used to investigate the positive psychological experience of patients after KT. It consists of 21 items divided in five factors. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. A symptom network analysis was conducted among PTGI, ESAS and DS-IT. Mean score of PTGI total of sample was 52.81 ± 19.81 with higher scores in women (58.53 ± 21.57) than in men (50.04 ± 18.39) (p < 0.05). PTGI-Relating to Others (16.50 ± 7.99) sub-score was markedly higher than other PTGI factor sub-scores. KTRs with DCPR-alexithymia or International Classification of Diseases, tenth revision (ICD-10) anxiety disorders diagnosis had lower PTGI total score and higher PTGI-Personal Strength sub-score, respectively (p < 0.05). The network analysis identified two communities: PTGI and ESAS with DS-IT. DS-IT Disheartenment, DS-IT Hopelessness and PTGI Relating to Others were the most central items in the network. After 1000 bootstrap procedures, the Exploratory graph analysis revealed the presence of a median of two communities in the network in 97.5% of the bootstrap iterations. A more extensive use of PTGI should be encouraged to identify and enhance the positive psychological changes after KT.
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Affiliation(s)
- Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
- Correspondence:
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (M.B.M.); (L.G.)
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (M.B.M.); (L.G.)
| | - Michele Provenzano
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Pasquale Esposito
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Michele Andreucci
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (M.B.M.); (L.G.)
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8
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Non-pulmonary complications after lung transplantation: Part I. Indian J Thorac Cardiovasc Surg 2021; 38:280-289. [DOI: 10.1007/s12055-021-01223-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/23/2021] [Accepted: 06/03/2021] [Indexed: 01/15/2023] Open
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9
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Villeneuve C, Rerolle JP, Couzi L, Westeel PF, Etienne I, Esposito L, Kamar N, Büchler M, Thierry A, Marquet P, Monchaud C. Therapeutic education as a tool to improve patient-reported and clinical outcomes after renal transplantation: results of the EPHEGREN multicenter retrospective cohort study. Transpl Int 2021; 34:2341-2352. [PMID: 34585793 DOI: 10.1111/tri.14127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/11/2021] [Accepted: 09/06/2021] [Indexed: 12/30/2022]
Abstract
Patients are not always aware of the inconveniences associated with renal transplantation, which they compare with a « rebirth », and from which they expect complete recovery. Therapeutic education is proposed to prepare patients for their life after transplantation. This study evaluated the impact of pretransplant therapeutic education on patient-reported outcomes and rejection-free survival over the first year. We collected data from 383 renal transplant patients followed-up in seven centers. Patients who benefited from therapeutic education before transplantation (N = 182) were compared with patients who did not (N = 139) for quality-of-life, adherence and adverse events using the Pearson's chi-square test, one-way ANOVA or t-test. The association between therapeutic education and time to acute rejection was investigated using Cox models. The patients who benefited from therapeutic education reported adverse events less frequently (e.g., tremor: 9% vs. 32.4%, P = 0.01) and better quality-of-life (MCS-QOL: 50.7 ± 8.1 vs. 47.7 ± 9.5, P = 0.02; PCS-QOL: 49.1 ± 7.1 vs. 46.0 ± 9.2, P = 0.013). No difference was found on adherence. Rejection-free survival was slightly better in the therapeutic education group (HR = 0.44, 95% CI = [0.19-1.01]). This multicenter retrospective cohort study suggests that integrating therapeutic education to care pathways entails clinical benefit, in terms of quality-of-life, self-reported adverse events and rejection-free survival. Randomized clinical trials are necessary to confirm this.
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Affiliation(s)
- Claire Villeneuve
- Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, CHU Limoges, Limoges, France.,UMR-1248, INSERM, Limoges, France.,FHU SUPORT, Limoges, France
| | - Jean-Phillipe Rerolle
- UMR-1248, INSERM, Limoges, France.,FHU SUPORT, Limoges, France.,Department of Nephrology, Dialysis and Transplantation, CHU Limoges, Limoges, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis, Centre Hospitalier Universitaire (CHU) Pellegrin, Bordeaux, France.,CNRS-UMR 5164 Immuno ConcEpT, Bordeaux University, Bordeaux, France
| | - Pierre-Francois Westeel
- Department of Nephrology and Kidney Transplantation, University Hospital of Amiens, Amiens, France
| | - Isabelle Etienne
- Service de Nephrologie, Rouen University Hospital, Rouen, France
| | - Laure Esposito
- Department of Nephrology and Organ Transplantation, CHU Toulouse, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Toulouse, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
| | - Mathias Büchler
- FHU SUPORT, Limoges, France.,University Hospital of Tours, Tours, France.,François Rabelais University, Tours, France
| | - Antoine Thierry
- FHU SUPORT, Limoges, France.,Department of Nephrology, Dialysis and Transplantation, CHU Poitiers, Poitiers, France
| | - Pierre Marquet
- Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, CHU Limoges, Limoges, France.,UMR-1248, INSERM, Limoges, France.,FHU SUPORT, Limoges, France.,Faculty of Medicine, University of Limoges, Limoges, France
| | - Caroline Monchaud
- Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, CHU Limoges, Limoges, France.,UMR-1248, INSERM, Limoges, France.,FHU SUPORT, Limoges, France
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10
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Gallego A, Sarmiento E, Sousa I, Zatarain E, Fernández-Yáñez J, Navarro J, Gil J, Carbone J. Immunologic Abnormalities Associated With Health Status of Heart Recipients Long Term After Transplantation. Transplant Proc 2021; 53:2724-2727. [PMID: 34598808 DOI: 10.1016/j.transproceed.2021.08.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/12/2021] [Accepted: 08/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND With improvements in survival rates, health-related quality of life is an important outcome parameter to evaluate the effectiveness of transplantation. We aimed to identify potential immunologic abnormalities as factors associated with poorer health-related quality of life at distinct scales of the 36-Item Short Form Health Survey in heart transplant recipients long term after transplantation. METHODS One hundred heart transplant recipients were evaluated in a single center. Short-form 36 questionnaires were sent by mail to participants. All patients were clinically and immunologically evaluated after the first year of heart transplantation. RESULTS A high prevalence of several immunologic abnormalities persisted even after the first year of transplantation, including IgG hypogammaglobulinemia, low IgG-specific antipneumococcal antibodies, C4 hypocomplementemia, CD8 T-cell lymphocytopenia, and CD19 B-cell lymphocytopenia. Older recipients (>55 years), posttransplant diabetes, digestive complications, and posttransplant infections were associated with lower physical functioning scores (scale < 60). Older recipients (>55 years), pretransplant diabetes, pretransplant arterial hypertension, posttransplant digestive complications, and lower CD8 counts were associated with lower physical role scores (scale <25). CONCLUSION In a single center study, lower CD8 cell counts were found to be associated with poorer health status in heart recipients after the first year of transplantation.
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Affiliation(s)
- Antonio Gallego
- Servicio de Inmunología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Elizabeth Sarmiento
- Servicio de Inmunología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Iago Sousa
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eduardo Zatarain
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Fernández-Yáñez
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Joaquín Navarro
- Servicio de Inmunología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juana Gil
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Carbone
- Servicio de Inmunología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Departamento de Inmunología, Oftalmología y ORL, Universidad Complutense, Madrid, Spain.
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11
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Visual Release Hallucinations After Facial Allotransplantation. Harv Rev Psychiatry 2021; 29:327-334. [PMID: 34033593 DOI: 10.1097/hrp.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Chernyak Y, Henderson DR, Teh L, Powell AL, Hinton KE, Hage CA. Characterization of the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) in Lung Transplant Candidates. J Clin Psychol Med Settings 2021; 29:137-149. [PMID: 34043137 DOI: 10.1007/s10880-021-09788-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2021] [Indexed: 01/27/2023]
Abstract
The SIPAT is a standardized measure for pre-transplant psychosocial evaluation. Previous SIPAT studies utilized a relatively small lung transplant sample and only included listed patients. This study characterized the SIPAT in 147 lung transplant candidates to better elucidate its utility. The average score corresponded to a minimally acceptable rating and nearly half of the patients had relative or absolute contraindications. Interstitial Lung Disease (ILD) patients scored more favorably than non-ILD patients (U = 7.69, p < .05). The Total (β = - .05, SE = .018, p < .01), Social Support Subscale (β = - .133, SE = .058, p < .05), and Psychosocial Stability and Psychopathology Subscale (β = - .103, SE = .040, p < .05) significantly predicted listing status. The SIPAT has a unique profile in lung transplant candidates and demonstrated utility for guiding transplant decisions. Future research should examine which lung transplant outcomes are significantly associated with SIPAT scores.
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Affiliation(s)
- Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 46202, USA
| | - Danielle R Henderson
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 46202, USA
| | - Lisa Teh
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, The Bronx, NY, USA
| | - Anna-Leigh Powell
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kendra E Hinton
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 46202, USA.
| | - Chadi A Hage
- Department of Pulmonary Critical Care and Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
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13
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Castillo-Mayén R, Luque B, Rubio SJ, Cuadrado E, Gutiérrez-Domingo T, Arenas A, Delgado-Lista J, Pérez-Martínez P, Tabernero C. Positive psychological profiles based on perceived health clustering in patients with cardiovascular disease: a longitudinal study. BMJ Open 2021; 11:e050818. [PMID: 34006562 PMCID: PMC8130737 DOI: 10.1136/bmjopen-2021-050818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Psychological well-being and sociodemographic factors have been associated with cardiovascular health. Positive psychological well-being research is limited in the literature; as such, this study aimed to investigate how patients with cardiovascular disease could be classified according to their perceived mental and physical health, and to identify positive psychological profiles based on this classification and test their stability over time. DESIGN AND SETTING Longitudinal study with patients from a public hospital located in Córdoba (Spain). PARTICIPANTS This study comprised 379 cardiovascular patients (87.3% men) tested at three measurement points. OUTCOME MEASURES Participants reported their sociodemographic variables (age, sex, educational level, employment and socioeconomic status) at phase 1, while their perceived health and variables relating to positive psychological well-being were tested at this and two subsequent time points (average interval time: 9 months). RESULTS The two-step cluster analysis classified participants into three groups according to their mental and physical health levels, p<0.001: high (n=76), moderate (n=113) and low (n=189) perceived health clusters. Low perceived health was the largest cluster, comprising almost half of patients. Clusters significantly differed according to sex, p=0.002, and socioeconomic level, p=0.004. The profile analysis indicated that participants in the high perceived health cluster showed high positive affect, positivity, life satisfaction, and self-efficacy in emotion regulation, and less negative affect and use of passive strategies over the three measurement points (95% CI, all ps<0.01). Moreover, psychological profile stability for each cluster was generally found over an 18-month period, all ps<0.05. CONCLUSION Cardiovascular patients may differ in terms of their perceived health and, accordingly, in terms of other relevant variables. Perceived health clusters generated varying and generally stable psychological profiles based on positive psychological well-being variables. Psychological interventions should be adapted to patients' requirements.
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Affiliation(s)
- Rosario Castillo-Mayén
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Psychology, University of Cordoba, Córdoba, Spain
| | - Bárbara Luque
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Psychology, University of Cordoba, Córdoba, Spain
| | - Sebastián Jesús Rubio
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Specific Didactics, University of Cordoba, Córdoba, Spain
| | - Esther Cuadrado
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Psychology, University of Cordoba, Córdoba, Spain
| | - Tamara Gutiérrez-Domingo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Psychology, University of Cordoba, Córdoba, Spain
| | - Alicia Arenas
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Social Psychology, University of Seville, Sevilla, Spain
| | - Javier Delgado-Lista
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofia University Hospital, Córdoba, Spain
| | - Pablo Pérez-Martínez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofia University Hospital, Córdoba, Spain
| | - Carmen Tabernero
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Instituto de Neurociencias de Castilla y León, University of Salamanca, Salamanca, Spain
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14
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The Psychosocial Burden of HCV Infection and the Impact of Antiviral Therapy on the Quality of Life in Liver and Kidney Transplant Recipients: A Pilot Study. Gastroenterol Res Pract 2020; 2020:8754247. [PMID: 33204255 PMCID: PMC7655256 DOI: 10.1155/2020/8754247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/14/2020] [Accepted: 10/22/2020] [Indexed: 12/30/2022] Open
Abstract
Background Therapy with direct-acting antivirals (DAA) for HCV is safe and effective in the liver (LT) and kidney transplant (KT) recipients; however, data on the quality of life (QoL) of patients are scanty. This pilot study is aimed at prospectively evaluating the QoL in LT and KT recipients before and after DAA treatment. Methods We prospectively enrolled 17 LT and 11 KT recipients with HCV infection starting a sofosbuvir-based antiviral therapy for 12 weeks. All participants before (T0), 12 (T12), and 24 (T24) weeks after the end of the therapy completed the Short Form Health Survey (SF-36) questionnaire, the Zung Self-rating Depression Scale, and State-Trait Anxiety Inventory (STAI—Y1–Y2). Results At T0, LT and KT patients were similar for gender, age, BMI, smoking habits, marital status, mean liver stiffness values at Fibroscan, and HCV genotype distribution (p > 0.05). There were no significant differences between the 2 groups in STAI-Y1, STAI-Y2, Zung, and SF-36 scores (p > 0.05). At T12, all the participants showed a sustained virological response (SVR). All items of the SF-36 questionnaire improved from the pretreatment to posttreatment period within the LT group, and the 4 domains role-physical, bodily pain, social function, role-emotional, and mental health reached statistical significance (p < 0.05 in all cases). On the contrary, in KT patients, there was no significant improvement in SF-36 mean scores compared to at baseline at T12 and T24. Conclusions This pilot study suggested that DAA therapy is associated with a significant improvement of the QoL only in LT recipients. Probably, KT recipients did not consider HCV a “central player” in the course of their disease, and HCV eradication did not significantly impact on their QoL.
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15
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Åberg F. Quality of life after liver transplantation. Best Pract Res Clin Gastroenterol 2020; 46-47:101684. [PMID: 33158471 DOI: 10.1016/j.bpg.2020.101684] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/31/2020] [Indexed: 01/31/2023]
Abstract
Liver transplantation (LT) enables rapid transition from critical illness and poor prognosis back to health. After LT, health-related quality of life (HRQoL) generally becomes comparable to that of the general population, although some deficits in mainly physical domains are frequent. However, recipients continue to have symptoms related to immunosuppression, complications, and other things, which impact HRQoL and the recipient's ability to regain independence and re-establish function in everyday life. Less than half of LT recipients return to work. Reportedly, HRQoL seems to deteriorate slightly over the long-term, but still remains satisfactory. Physical fatigue is common, but recent studies show that structured exercise programs improve both fatigue and HRQoL. Emerging evidence also suggests that continued patient information, structured psychosocial support systems, and caregiver involvement might further help improve long-term HRQoL. More research is needed to gain better understanding of the factors affecting long-term HRQoL, and how to best improve HRQoL.
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Affiliation(s)
- Fredrik Åberg
- Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki University, Helsinki, Finland; The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
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16
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Purnajo I, Beaumont JL, Polinsky M, Alemao E, Everly MJ. Trajectories of health-related quality of life among renal transplant patients associated with graft failure and symptom distress: Analysis of the BENEFIT and BENEFIT-EXT trials. Am J Transplant 2020; 20:1650-1658. [PMID: 31874117 DOI: 10.1111/ajt.15757] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 01/25/2023]
Abstract
Understanding the correlation between transplant symptoms, health-related quality of life (HRQoL), and graft outcomes is needed to support patient-focused drug development and posttransplant management. A post-hoc analysis of patient-reported outcomes from the Phase III belatacept trials was conducted in order to investigate the interrelationship between trajectories of HRQoL, symptom experience, and allograft outcomes. HRQoL and symptom experience were evaluated using Short-Form 36 Survey (SF-36) and Modified Transplant Symptom Occurrence and Distress Scale (MTSOSD-59R), respectively. HRQoL was captured in 831 eligible renal transplant patients at baseline, 12, 24, and 36 months posttransplant. Following transplantation, patients reported improvements in all SF-36 subscales compared to baseline. Latent class analysis revealed four trajectories in perceived general health, which were associated with graft failure after adjustment. Compared to patients with good perceived health, patients with fair and poor perceived health had 4.7 (95% confidence interval [CI] 1.5-14.8, P < .01) and 19.8 (95% CI 5.9-66.0, P < .01) times the risk of graft failure, respectively. Using multinomial logistic regression, different sets of symptoms were associated with perceived general health at baseline and 12 months posttransplant. The study supports monitoring HRQoL and symptom experience to capture each patient's health perspective, improve drug development, and optimize posttransplant management.
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Affiliation(s)
- Intan Purnajo
- Terasaki Research Institute, Los Angeles, California
| | | | | | - Evo Alemao
- Bristol Myers Squibb, Princeton, New Jersey
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17
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Girgenti R, Tropea A, Buttafarro MA, Ragusa R, Ammirata M. Quality of Life in Liver Transplant Recipients: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113809. [PMID: 32471157 PMCID: PMC7313086 DOI: 10.3390/ijerph17113809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study aims to investigate the quality of life and the therapeutic compliance of the patients who received a liver transplant, from a living or deceased donor, at IRCCS ISMETT in the last three years. Liver transplantation is an effective therapeutic strategy for patients with end-stage liver failure. The quality of life (QOL) of liver disease patients is placed under considerable stress due to the debilitating clinical conditions and related issues experienced in everyday life by these individuals. The concept of QOL is being increasingly used to define the individual perception of health, including physical, mental, and social wellbeing. The success of a liver transplant should therefore be intended not only in terms of survival, but also of recovery of a satisfying quality of life. For this reason, our liver transplant recipients are closely monitored and supported from a psychological standpoint. This is done to monitor their ability to adapt to and comply with their clinical condition and to verify their gradual resumption of their path of life Methods: We retrospectively analyzed data collected by the IRCCS ISMETT Clinical Psychology Service during routine psychological follow-up of liver transplant recipients. Data refer to 82 patients who received a liver transplant between January 2017 and September 2019 and describe their QOL and therapeutic adherence. The obtained results were compared with the main studies on this issue available in literature. RESULTS Ninety-four percent of liver transplant recipients reported high mean scores of quality of life and therapeutic adherence 28% of patients reported at least one persistent annoying symptom after transplantation, although in some cases this did not affect the overall QOL. The results also refer to patients with a pre-transplant diagnosis of alcohol-related cirrhosis, who confirm their complete abstinence from alcohol. CONCLUSIONS Our results confirm the efficacy of the liver transplantation to achieve of a good QOL. Furthermore, these patients seem to maintain high therapeutic adherence, thus ensuring a good outcome of the care received during the transplantation process.
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Affiliation(s)
- Rosario Girgenti
- Clinical Psychology Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy; (R.G.); (M.A.B.); (M.A.)
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy;
- Correspondence:
| | - Maria Antonina Buttafarro
- Clinical Psychology Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy; (R.G.); (M.A.B.); (M.A.)
| | - Rosalia Ragusa
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy;
- Health Technology Assessment Committee, University Hospital “G. Rodolico”, 95100 Catania, Italy
| | - Martina Ammirata
- Clinical Psychology Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy; (R.G.); (M.A.B.); (M.A.)
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18
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Beyond Survival in Solid Organ Transplantation: A Summary of Expert Presentations from the Sandoz 6th Standalone Transplantation Meeting, 2018. Transplantation 2020; 103:S1-S13. [PMID: 31449167 DOI: 10.1097/tp.0000000000002846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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19
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Oduncuoğlu BF, Alaaddinoğlu EE, Çolak T, Akdur A, Haberal M. Effects of Renal Transplantation and Hemodialysis on Patient's General Health Perception and Oral Health-Related Quality of Life: A Single-Center Cross-Sectional Study. Transplant Proc 2020; 52:785-792. [PMID: 32113695 DOI: 10.1016/j.transproceed.2020.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/27/2019] [Accepted: 01/20/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with end-stage renal disease have a lower quality of life compared to the general population. Oral health-related quality of life (OHRQoL) is of particular interest as good oral health could influence general health. This study aimed to compare dental and periodontal health status, OHRQoL, and general health perception of renal transplant (TX) and hemodialysis patients (HD) with that of healthy controls. METHODS The study included 64 TX, 63 HD, and 61 healthy patients. TX patients were also grouped according to the time elapsed after transplantation and currently use of immunosuppressive agents. The numbers of decayed, missing, and filled teeth were recorded as DMFT, and periodontal health status was evaluated. Patients' general health perceptions and OHRQoL were assessed using Short Form-36, Oral Health Impact Profile-14, and OHRQoL-United Kingdom questionnaires. RESULTS The HD groups presented significantly higher DMFT scores and periodontal scores than TX and control groups. OHRQoL-United Kingdom total scores of TX and HD groups were lower than controls (P < .05). Oral Health Impact Profile-14 total scores revealed that HD groups' OHRQoL was significantly lower than TX and control groups (P < .05). Perceptions of general health of TX patients were higher than in the HD group. CONCLUSIONS Renal transplantation has shown to increase quality of life and OHRQoL compared to hemodialysis therapy. Neither the immunosuppressive agent nor the time elapsed after transplantation were observed to be significant factors affecting OHRQoL.
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Affiliation(s)
| | | | - Turan Çolak
- Department of Nephrology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Aydıncan Akdur
- Department of General Surgery Division of Transplantation, Başkent University, Ankara, Turkey
| | - Mehmet Haberal
- Department of General Surgery Division of Transplantation, Başkent University, Ankara, Turkey.
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20
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Maldonado JR. Why It is Important to Consider Social Support When Assessing Organ Transplant Candidates? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:1-8. [PMID: 31647756 DOI: 10.1080/15265161.2019.1671689] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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21
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Cannavò A, Passamonti SM, Vincenti D, Aurelio MT, Torelli R, Poli F, Piccolo G, Cardillo M. Quality of Life Before and After Transplantation in Solid Organ Recipients Referred to the North Italy Transplant program (NITp): A Cross-sectional Study. Transplant Proc 2019; 51:1692-1698. [DOI: 10.1016/j.transproceed.2019.02.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/03/2019] [Indexed: 10/26/2022]
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22
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Goetzmann L, Benden C, Ruettner B, Wutzler U, Boehler A, Wittmann L. The experience of transplantation as reflected in dream life: A case study illustrating the mental processing of a lung transplant. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2019; 100:517-539. [PMID: 33945769 DOI: 10.1080/00207578.2019.1589378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although it is well known that a lung transplant enhances the recipient's quality of life, our knowledge of how it is processed mentally is limited. In this study, interviews were conducted with a lung-transplant patient two weeks, three months, and six months after surgery so as to investigate the relevant unconscious processing mechanisms. A dream reported in the first interview was analysed in accordance withapplying the Zurich Dream Process Coding System. A 'transplantation complex' was reconstructed on the basis of various sources of information (the dream and the waking narratives). The principal aspects of the transplantation complex that emerged from both the dream and the waking narratives concerned the oral-sadistic phantasy that the donor had been killed and that his lung, or soul, had been violently incorporated in the patient. The main unconscious themes involved in the processing of the transplant were found to have been already laid down in the dream and to have been presented in it in the form of visual analogues. According to our interpretation of the data analysed, powerful cannibalistic phantasies and death wishes played an important part in the processing of the transplant. These archaic phantasies may have been actualized by the transplant.
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Affiliation(s)
- Lutz Goetzmann
- Department of Psychosomatic Medicine and Psychotherapy, Segeberger Kliniken, Bad Segeberg, Germany
| | - Christian Benden
- Lung Transplantation and CF Center, University Hospital Zurich, Zurich, Switzerland
| | - Barbara Ruettner
- Department of Psychology, Medical School Hamburg, Hamburg, Germany
| | - Uwe Wutzler
- Department of Psychosomatic Medicine and Psychotherapy, Asklepios Fachklinikum Stadtroda, Germany
| | | | - Lutz Wittmann
- International Psychoanalytic University, Berlin, Germany
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23
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Psychosocial Risk Impacts Mortality in Women After Liver Transplantation. PSYCHOSOMATICS 2019; 60:56-65. [DOI: 10.1016/j.psym.2018.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/12/2022]
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24
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Scheel J, Schieber K, Reber S, Jank S, Eckardt KU, Grundmann F, Vitinius F, de Zwaan M, Bertram A, Erim Y. Psychological processing of a kidney transplantation, perceived quality of life, and immunosuppressant medication adherence. Patient Prefer Adherence 2019; 13:775-782. [PMID: 31190759 PMCID: PMC6526178 DOI: 10.2147/ppa.s194254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/07/2019] [Indexed: 01/21/2023] Open
Abstract
Introduction: Though psychosocial well-being and quality of life generally improve after transplantation, a relevant proportion of patients suffers from psychosocial problems. Further analysis of the psychological coping after kidney transplantation is needed to identify patients at risk. The aim of this study was to examine the psychological response after kidney transplantation and its associations with health-related quality of life and immunosuppressant medication adherence. Materials and methods: The coping process after kidney transplantation was investigated with the Transplant Effects Questionnaire (TxEQ; subscales: worry, guilt, disclosure, adherence, responsibility) in 267 adult kidney transplant recipients ≥12 months post-transplantation. Furthermore, perceived health-related quality of life, self-reported immunosuppressant medication adherence, and sub-therapeutic immunosuppressant trough levels as biological markers of adherence were assessed. Results: Patients showed moderate scores concerning the subscales "worry", "guilt", and "responsibility" as well as high scores concerning "disclosure". Except for "adherence", all TxEQ subscales were associated with mental, but not with physical health-related quality of life and self-reported adherence. Sub-therapeutic immunosuppressant trough levels were significantly associated only with the TxEQ subscale "worry". Conclusions: The present results suggest a conditional structure in which mental health-related quality of life is negatively associated with worries, guilt, and responsibility and positively with disclosure. Adherence seems to be a complex behavior, which is not necessarily directly associated with the psychological processing of organ transplantations. As mental health-related quality of life is related to this psychological processing, the TxEQ could be used as a screening tool for problematic psychological processing after kidney transplantation.
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Affiliation(s)
- Jennifer Scheel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Katharina Schieber
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sandra Reber
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sabine Jank
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Franziska Grundmann
- Department II of Internal Medicine, Nephrology, Rheumatology, Diabetes and General Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, University Hospital of Cologne, Cologne, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Germany
| | - Anna Bertram
- Department of Nephrology and Hypertension, Hannover Medical School, Hanover, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Correspondence: Yesim ErimDepartment of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054Erlangen, GermanyEmail
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25
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Rynar LZ, Merchant MS, Dilling DF. Suicidal ideation in lung transplant recipients: A case series. Clin Transplant 2018; 32:e13263. [PMID: 29665073 DOI: 10.1111/ctr.13263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Suicidality, a term referring to suicidal ideation and/or suicide attempts, has been understudied in lung transplant recipients, despite the well-documented period of high stress following transplantation. Understanding the full clinical picture of psychiatric morbidity before and after lung transplant is vital to supporting survival. METHODS Suicidality among lung transplant recipients was examined through case studies of 5 lung transplant recipients at Loyola University Medical Center in Chicago, IL. Medical records were reviewed for demographic and psychosocial variables during the pre- and post-transplant periods to identify common factors. RESULTS Patients presented with suicidal ideation within the first 2 years of receiving lung transplantation; 4 of 5 endorsed a plan and/or intent to act and 2 made suicide attempts. Pretransplant prescription medication mismanagement, pretransplant depression or anxiety, and post-transplant depression and anxiety were each present in at least 3 of 5 cases and appeared related to the development of suicidality. Social support issues were also prominent, including changes in available supports, interpersonal distress, and social isolation or lack of support. CONCLUSION Patients presenting with psychiatric comorbidities or limited social support at any phase of the lung transplant process should be monitored closely. This case report draws into focus the need for systematic and ongoing psychological evaluation following lung transplantation.
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Affiliation(s)
- Lauren Z Rynar
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Mekhala S Merchant
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Medical Center, Maywood, IL, USA
| | - Daniel F Dilling
- Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, IL, USA
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26
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DeMartini KS, Schilsky ML, Palmer A, Fehon DC, Zimbrean P, O'Malley SS, Lee HB, Toll BA. Text Messaging to Reduce Alcohol Relapse in Prelisting Liver Transplant Candidates: A Pilot Feasibility Study. Alcohol Clin Exp Res 2018; 42:761-769. [PMID: 29498753 DOI: 10.1111/acer.13603] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/22/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many liver transplantation programs require documented alcohol sobriety prior to United Network for Organ Sharing (UNOS) listing. This pilot study examined the feasibility of the first mobile, alcohol relapse prevention intervention for liver transplant patients with alcoholic liver disease (ALD). METHODS This was a randomized 8-week pilot feasibility trial of a text message-based alcohol intervention. In-treatment assessment was conducted at 4 weeks (4W), and immediate posttreatment assessment was conducted at 8W. Participants were liver transplant candidates (N = 15) diagnosed with ALD who reported at least 1 drinking episode in the past year. Primary feasibility outcomes were percent of messages responded to and posttreatment intervention satisfaction ratings. Preliminary clinical efficacy outcomes were any biologically confirmed alcohol consumption, stress, abstinence self-efficacy, and alcohol craving. RESULTS On feasibility outcomes, participants responded to 81% of messages received and reported high rates of intervention satisfaction, looked forward to receiving the messages, and found it easy to complete the intervention. On preliminary efficacy outcomes, zero participants in the text message (TM) had positive urine alcohol tests at 8W. Two of the 6 participants in standard care (SC) tested positive at 8W. No effects were seen on craving. For stress, a condition × time interaction emerged. TM participants had less stress at 4W and 8W compared with SC at baseline. They maintained their stress level during the intervention. For self-efficacy, a trend for condition effect emerged. TM participants had higher self-efficacy than SC participants. CONCLUSIONS Participants reported high satisfaction with the intervention, looked forward to the messages, and found it easy to complete. Participants who received the intervention had better treatment outcomes than those who received standard care. They maintained higher levels of self-efficacy and lower stress. Mobile alcohol interventions may hold significant promise to help ALD liver transplant patients maintain sobriety.
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Affiliation(s)
- Kelly S DeMartini
- Department of Psychiatry, Smilow Cancer Hospital at Yale, Yale School of Medicine, New Haven, Connecticut
| | - Michael L Schilsky
- Departments of Medicine and Surgery, Divisions of Digestive Diseases and Transplantation and Immunology, Yale-New Transplantation Center, Yale School of Medicine, New Haven, Connecticut
| | - Amanda Palmer
- Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - Dwain C Fehon
- Liver Transplantation Center, Yale-New Haven Hospital, New Haven, Connecticut
| | - Paula Zimbrean
- Liver Transplantation Center, Yale-New Haven Hospital, New Haven, Connecticut
| | | | - Hochang B Lee
- Department of Psychological Medicine, Yale-New Haven Hospital, New Haven, Connecticut
| | - Benjamin A Toll
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
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27
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Evaluation of the SIPAT instrument to assess psychosocial risk in heart transplant candidates: A retrospective single center study. Heart Lung 2017; 46:273-279. [DOI: 10.1016/j.hrtlng.2017.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 03/31/2017] [Accepted: 04/10/2017] [Indexed: 01/15/2023]
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28
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Role of Personal Resources in Depression and Stress in Heart Transplant Recipients. Transplant Proc 2017; 48:1761-6. [PMID: 27496487 DOI: 10.1016/j.transproceed.2016.01.080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/21/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Heart transplantation is the primary option for heart failure treatment and increases the survival rate and the quality of life for recipients. However, this surgical intervention induces numerous psychological problems, such as depression and anxiety. Protective factors and personal recourses are a significant force behind healthy adjustment to life stresses. The aim of this study was to assess the role of personal recourses in terms of depression and stress in heart transplant recipients. METHODS The study involved a sample of 131 post-heart transplant patients. Standardized instruments were used to measure the key constructs: Beck Depression Inventory Short Form for prevalence of depression, Perceived Stress Scale for prevalence distress, and Sense of Coherence (SOC-29), Life Orientation Test, and General Self-Efficacy Scale for measuring personal resources. RESULTS We found that sense of coherence, optimism, and self-efficacy proved to be significant predictors for the prevalence of both depression and stress. CONCLUSIONS These result suggest that the assessment of coping strategies and sense of coherence in heart transplant recipients requires exploration. Evaluating coping strategies and sense of coherence before surgery seems significant and begins with developing skills in this domain.
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29
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Standardized Evaluation of Candidates Before Liver Transplantation With the Transplant Evaluation Rating Scale. PSYCHOSOMATICS 2017; 58:141-150. [DOI: 10.1016/j.psym.2016.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 01/16/2023]
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30
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Hermann HC, Grimm A, Klapp BF, Neuhaus R, Papachristou C. Body Experience After Liver Transplantation: A Body Grid Examination. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2016. [DOI: 10.1080/10720537.2016.1227736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- H. C. Hermann
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
| | - A. Grimm
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
| | - B. F. Klapp
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
| | - R. Neuhaus
- Department of General, Visceral, and Transplantation Surgery, Charité University Medicine Berlin, Germany
| | - C. Papachristou
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
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De Geest S, Burkhalter H, Berben L, Bogert LJ, Denhaerynck K, Glass TR, Goetzmann L, Kirsch M, Kiss A, Koller MT, Piot-Ziegler C, Schmidt-Trucksäss A. The Swiss Transplant Cohort Study's Framework for Assessing Lifelong Psychosocial Factors in Solid-Organ Transplants. Prog Transplant 2016; 23:235-46. [DOI: 10.7182/pit2013250] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Understanding outcomes after transplant requires a biopsychosocial model that includes biomedical and psychosocial factors. The latter, to date, are assessed only in a limited way as part of transplant registries or cohort studies. The Swiss Transplant Cohort Study (STCS) is a nationwide open cohort study (starting May 2008) to systematically and prospectively assess psychosocial factors. This article describes the framework underpinning STCS's psychosocial assessment. Methods The STCS framework was adapted from the multidimensional conceptual perspective of Dew et al to describe transplant psychosocial domains and specific outcomes by adding a time perspective, a system perspective, and interaction among domains. Results We propose a multidimensional, multilevel biopsychosocial framework representing mutually influencing domains from before to after transplant, and exemplify each domain by factors included in STCS and their measurement. The transplant patient, centrally positioned, is described by clinical and sociodemographic characteristics (eg, socioeconomic status, educational, professional, and relationship status). The following psychosocial domains further describe the patient: (1) physical/functional (eg, perceived health status, sleep quality, daytime sleepiness), (2) psychological (eg, depression, stress), (3) behavioral (eg, medication adherence, smoking, drug use, physical activity, sun protection), (4) social (eg, work capacity/return to work), and (5) global quality of life. Factors associated with health care system level (eg, trust in transplant team) are also included in the model. Conclusion The STCS's psychosocial framework provides a basis for studying the interplay of biomedical, sociodemographic, psychosocial, behavioral, and health care system factors in view of transplant outcomes and therefore has the potential to guide biopsychosocial transplant research.
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Affiliation(s)
- Sabina De Geest
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Hanna Burkhalter
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Lut Berben
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Laura Jane Bogert
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Kris Denhaerynck
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Tracy R. Glass
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Lutz Goetzmann
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Monika Kirsch
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Alexander Kiss
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Michael T. Koller
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Chantal Piot-Ziegler
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Arno Schmidt-Trucksäss
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
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Beckmann S, Künzler-Heule P, Biotti B, Spirig R. Mastering Together the Highs and Lows. Prog Transplant 2016; 26:215-23. [DOI: 10.1177/1526924816654769] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Context: Self-management in chronic illness involves complex medical, role-related, and emotional tasks. Still, while self-management support of patients and their families has become a cornerstone of chronic illness care, information is limited as to how liver transplant (LTx) patients and close caregivers perceive self-management before and after transplantation. Objective: To explore self-management tasks in view of medical, role-related, and emotional tasks in LTx candidates and recipients and their respective close caregivers. Design and Participants: For this qualitative study, focus group interviews were conducted and analyzed using knowledge mapping according to the 3 above-noted self-management categories. German-speaking adults who were wait-listed for or had received LTx and who were being treated in University Hospital Zurich or who were close caregivers to such patients were eligible for participation. As patients’ data were closely related to those of the caregivers, the 2 groups’ data sets were merged during the final development of themes. Results: Thirty participants comprised 7 focus groups. The main theme was “The current state of health determines the daily rhythm.” The essence of how patients and caregivers described their self-management tasks is compiled in “Mastering together the highs and lows” which comprises 3 core themes: mastering medical management, managing roles together, and managing the highs and lows of emotion. Conclusion: Patients and close caregivers prioritized self-management tasks as follows: first medical, then role-related, and finally emotional management. Over the course of LTx, health-care professionals should acknowledge this ranking while providing individualized support to both patients and caregivers.
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Affiliation(s)
- Sonja Beckmann
- Department of Abdomen and Metabolism, University Hospital Zurich, Zurich, Switzerland
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Patrizia Künzler-Heule
- Department of Gastroenterology and Hepatology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Beatrice Biotti
- Department of Abdomen and Metabolism, University Hospital Zurich, Zurich, Switzerland
| | - Rebecca Spirig
- Institute of Nursing Science, University of Basel, Basel, Switzerland
- Department of Nursing and MTTB, University Hospital Zurich, Zurich, Switzerland
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Abstract
BACKGROUND Graft failure risk is highest during emerging adulthood (17-24 years) in kidney and heart transplant. It is unknown whether a similar association exists in liver transplant recipients. METHODS We sought to estimate the relative hazards of graft failure at different current ages, compared with those aged 21 to 24 years. We evaluated 17 181 patients recorded in the Scientific Registry of Transplant Recipients who received a first isolated liver transplant at 40 years or younger (1988-2013) and had 6 months or longer of graft function. We used time-dependent Cox models to estimate the association between current age and failure risk, defined as retransplant or death after graft failure; observation was censored at death with graft function. RESULTS There were 2540 failures. Absolute graft failure rates were highest in ages 25 to 29 years (3.0/100 person-years). Compared with individuals with the same time since transplantation, those aged 21 to 24 years had significantly higher failure rates than those younger than 17 years and older than 34 years; hazards did not differ for those aged 25 to 29 years (1.03 [0.86, 1.24]) and were lower, but not significantly, for those aged 17 to 20 years (hazards ratio, 0.83; 95% confidence interval, 0.68-1.01) and ages 30 to 34 years (hazards ratio, 0.84; 95% confidence interval, 0.70-1.01). CONCLUSIONS Among young first isolated liver transplant recipients, graft failure risks are highest in the period from 21 to 29 years of age.
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Evolution and Determinants of Health-Related Quality-of-Life in Kidney Transplant Patients Over the First 3 Years After Transplantation. Transplantation 2016; 100:640-7. [PMID: 26569063 DOI: 10.1097/tp.0000000000000846] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) usually improved after kidney transplantation; however, a non-negligible number of patients did not benefit from transplantation in HRQOL. The aims of this cohort study were to describe the evolution of HRQOL in kidney transplant recipients to search for subgroups with distinct time profiles and to investigate these determinants. METHODS Three hundred thirty-seven adult patients were followed up from 1 to 36 months after kidney transplantation. Each patient completed repeated HRQOL assessments (median, 5; range, 2-9). K-means for longitudinal data was used to identify homogeneous clusters of HRQOL time profiles obtained for the mental and physical composite scores (MCS and PCS) and for the 8 dimensions of the short-form 36 scale. Covariates associated with these clusters were investigated using random forest analysis. Magnitude and shape of the HRQOL variations over time were investigated using linear regression mixed models. RESULTS Two longitudinal clusters were identified for the time profiles of PCS and MCS. Patients classified in the higher cluster (ie, 60% of the population) exhibited a steady-state HRQOL, similar on average to the general population, whereas in the lower cluster, PCS and MCS scores were significantly lower than in the general population. Muscular weakness in the first year after transplantation explained 19% of the interpatient variability of PCS 3 months after transplantation, whereas associated with anxiety, it explained 24% of interpatient MCS variability. CONCLUSIONS This work suggests to promote (i) physical rehabilitation programs after transplantation to curb the muscular loss and (ii) systematic attention to the patient's anxiety.
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Hitschfeld MJ, Schneekloth TD, Kennedy CC, Rummans TA, Niazi SK, Vasquez AR, Geske JR, Petterson TM, Kremers WK, Jowsey-Gregoire SG. The Psychosocial Assessment of Candidates for Transplantation: A Cohort Study of its Association With Survival Among Lung Transplant Recipients. PSYCHOSOMATICS 2016; 57:489-97. [PMID: 27494985 DOI: 10.1016/j.psym.2016.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The United Network for Organ Sharing mandates a psychosocial assessment of transplant candidates before listing. A quantified measure for determining transplant candidacy is the Psychosocial Assessment of Candidates for Transplant (PACT) scale. This instrument's predictive value for survival has not been rigorously evaluated among lung transplantation recipients. METHODS We reviewed medical records of all patients who underwent lung transplantation at Mayo Clinic, Rochester from 2000-2012. A transplant psychiatrist had assessed lung transplant candidates for psychosocial risk with the PACT scale. Recipients were divided into high- and low psychosocial risk cohorts using a PACT score cutoff of 2. The main outcome variable was posttransplant survival. Mortality was analyzed using the Kaplan-Meier estimator and Cox proportional hazard models. RESULTS This study included 110 lung recipients: 57 (51.8%) were females, 101 (91.8%) Whites, mean age: 56.4 years. Further, 7 (6.4%) recipients received an initial PACT score <2 (poor or borderline candidates) and later achieved a higher score, allowing transplant listing; 103 (93.6%) received initial scores ≥2 (acceptable, good or great candidates). An initial PACT score < 2 was modestly associated with higher mortality (adjusted hazard ratio = 2.73, p = 0.04). CONCLUSIONS Lung transplant recipients who initially received a low score on the PACT scale, reflecting poor or borderline psychosocial candidacy, experienced greater likelihood of mortality. This primary finding suggests that the psychosocial assessment, as measured by the PACT scale, may provide additional mortality risk stratification for lung transplant candidates.
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Affiliation(s)
- Mario J Hitschfeld
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Psychiatry and Mental Health Service, Sotero Del Rio Hospital, Puente Alto, Santiago, Chile
| | - Terry D Schneekloth
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN.
| | - Cassie C Kennedy
- Psychiatry and Mental Health Service, Sotero Del Rio Hospital, Puente Alto, Santiago, Chile; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Shehzad K Niazi
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Adriana R Vasquez
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Jennifer R Geske
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Tanya M Petterson
- Psychiatry and Mental Health Service, Sotero Del Rio Hospital, Puente Alto, Santiago, Chile; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Walter K Kremers
- Psychiatry and Mental Health Service, Sotero Del Rio Hospital, Puente Alto, Santiago, Chile; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Sheila G Jowsey-Gregoire
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN
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Gremigni P, Cappelli G. Psychosocial well-being after kidney transplantation: A matched-pair case-control study. J Health Psychol 2016; 21:599-606. [DOI: 10.1177/1359105314532506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
A number of outcome studies showed that kidney transplantation is associated with improvements in health-related quality of life relative to the pre-transplant period, but comparisons with the general population produced mixed results. This study aimed to compare 30 successful (>1 year) kidney transplantation recipients with 30 matched-pair healthy controls on psychosocial well-being. Independent of gender, age and time since transplantation, transplanted patients equalled healthy people in the intrapersonal domains but scored worse in the interpersonal domains of psychosocial well-being. Identifying aspects of life that remain impaired after kidney transplantation may assist the development of interventions targeted at improving patients’ adjustment.
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The Stanford Integrated Psychosocial Assessment for Transplantation: A Prospective Study of Medical and Psychosocial Outcomes. Psychosom Med 2015; 77:1018-30. [PMID: 26517474 DOI: 10.1097/psy.0000000000000241] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Psychosocial factors may significantly affect post-transplant outcomes. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) was developed as an assessment tool to enhance the pre-transplant psychosocial evaluation. METHODS We identified heart, lung, liver, or kidney transplant recipients assessed with the SIPAT pre-transplantation and transplanted between June 1, 2008, and July 31, 2011, at our institution. We analyzed prospectively accumulated psychosocial and medical outcomes at 1 year of follow-up. RESULTS 217 patients were identified and included in the analysis. The primary outcomes of organ failure and mortality occurred in 12 and 21 patients, respectively, and were not significantly associated with the pre-transplant SIPAT scores. On the other hand, SIPAT scores were significantly correlated with the probability of poor medical and psychosocial outcomes (secondary outcomes). In fact, higher SIPAT scores predicted higher rates of rejection episodes (Spearman ρ = 0.15, 95% 95% confidence interval [CI] = 0.02-0.28, p = .023), medical hospitalizations (ρ = 0.29, 95% CI = 0.16-0.41, p < .001), infection rates (p = .020), psychiatric decompensation (p = .005), and support system failure (area under the curve = 0.70, 95% CI = 0.60-0.79, p < .001). The relationship with nonadherence suggested a trend, but no statistical significance was observed (area under the curve = 0.60, 95% CI = 0.50-0.71, p = .058). CONCLUSIONS Study outcomes suggest that SIPAT is a promising pre-transplantation assessment tool that helps identify candidate's areas of psychosocial vulnerability and whose scores are associated with both psychosocial and medical outcomes after transplantation.
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Šumskienė J, Kupčinskas L, Šumskas L. Health-related quality of life measurement in chronic liver disease patients. MEDICINA-LITHUANIA 2015; 51:201-8. [PMID: 26424183 DOI: 10.1016/j.medici.2015.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Health-related quality of life (HRQOL) is an important health indicator in medical outcome research and clinical practice. This issue tends to attract even more attention with the recent improvements of patient survival after liver transplantation. This review article aims at providing a deeper insight into practices used for evaluating HRQOL in chronic liver diseases (CLDs) and especially cirrhosis patients during different stages of the disease including liver transplantation. MATERIALS AND METHODS A systematic review of the MEDLINE database and Cochrane library was conducted. A search using the Medical Subject Headings (MeSH) major terms "liver disease" AND "quality of life" was applied for the period from 1966 to 2012. RESULTS Our review identified 1483 publications. The searched showed that significant increase of publications (from 362 to 1018) was observed during last decade (period 2003-2012) in comparison with previous. The majority of publications were in English (n=1179). The literature search and analysis provided information on the most common generic and disease-specific HRQOL instruments, which are used in CLD patients: Medical Outcomes Study Short Form-36, the National Institute of Diabetes and Digestive and Kidney Diseases Quality of Life questionnaire, the Chronic Liver Disease questionnaire, the Liver Disease Quality of Life questionnaire, and other. CONCLUSIONS Quality of life instruments are potentially powerful tools for evaluating the functional status, presenting gains of treatment and reflecting patients' ability to return to a normal lifestyle in CLD patients. More attention should be paid by clinicians for integrated use of clinical tests together with HRQOL instruments in liver transplantation for establishing the reference levels of mental, physical, and role-social functioning.
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Affiliation(s)
- Jolanta Šumskienė
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Limas Kupčinskas
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Linas Šumskas
- Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Institute of Health Research, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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Jackson S, Simonds LM, Smith RM. Pancreas and islet transplantation: psychological themes pre- and posttransplant. Curr Opin Organ Transplant 2015; 20:211-5. [PMID: 25856183 DOI: 10.1097/mot.0000000000000164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To date, islet and whole pancreas transplantation have been largely researched and reported separately. Therefore, for the first time, this review seeks to examine together the recently reported psychological issues as they relate to the two different types of transplantation. RECENT FINDINGS In relation to pancreas transplantation, recent findings indicate potential issues relating to energy levels, including sleep problems; mood problems (anxiety, depression, traumatic stress); social interactions; and identity issues. Similarly, the research on islet allotransplantation (ITA) indicates mood disruptions associated with Type I diabetes mellitus (T1DM), which seem to improve as a result of treatment with ITA. SUMMARY The review indicates a need for more research to guide effective intervention to optimize psychological recovery post islet and/or pancreas transplantation for patients with T1DM. Effective psychological intervention for this group relies on researchers eliciting more detailed knowledge of pretransplant psychosocial issues, not only in relation to how these might vary by transplant group, but also in relation to patient health status vis-à-vis microvascular complications and glycaemic control, and how these issues change across the whole transplant journey.
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Affiliation(s)
- Sue Jackson
- aSchool of Psychology, Faculty of Arts & Human Sciences, Elizabeth Fry Building, University of Surrey, Guildford bDepartment of Nephrology, Ipswich Hospital NHS Trust, Heath Road, Ipswich, UK
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Amler S, Sauerland MC, Deiters C, Büchner T, Schumacher A. Factors influencing life satisfaction in acute myeloid leukemia survivors following allogeneic stem cell transplantation: a cross-sectional study. Health Qual Life Outcomes 2015; 13:28. [PMID: 25888906 PMCID: PMC4349480 DOI: 10.1186/s12955-015-0222-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/06/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Allogeneic stem cell transplantation (alloSCT) is the preferred option of postremission therapy for high-risk patients suffering from acute myeloid leukemia (AML). Therefore, monitoring life satisfaction (LS) of long-term survivors following alloSCT is becoming increasingly important for oncologists. The aim of the study was to evaluate individual survivor priority of various general and health-related domains of life and their satisfaction with these domains. Furthermore, we investigated the impact of general and health-related LS on resilience, anxiety, depression and quality of life in AML survivors following alloSCT. METHODS Forty-one AML survivors (median age at time of assessment = 49.0 years) who had undergone alloSCT (median time since transplantation = 3.1 years) were enrolled in the study. Psychosocial parameters were assessed using the following instruments: FLZ(M) (Questions on Life Satisfaction), EORTC QLQ-C30, HADS (Hospital Anxiety and Depression Scale) and the RS-25 (Resilience Scale-25 items). Correlation analyses were computed to reveal the associations between the different questionnaires. RESULTS Independence from help or care, well-regulated living conditions and financial security contributed positively to LS, whereas being off work due to health-reasons and dissatisfaction with physical aspects were negatively associated to the subjective feelings of overall satisfaction. Moreover, a high quality of life was strongly positively correlated with LS (Spearman's rho general LS: 0.643 and health-related LS: 0.726, both p < 0.001). A high degree of resilience was also strongly positively correlated with better LS (general LS: 0.700, health-related LS: 0.675, both p < 0.001). Symptoms of anxiety and depression were associated with an impaired general LS (anxiety: -0.674, depression: -0.698, both p < 0.001). CONCLUSIONS Our results indicate that LS should be considered an important key contributor to the survivors' well-being following alloSCT. Thus, identifying protective psychological and physical factors that relieve stressors is of high importance in order to support long-term AML survivors with their special needs.
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Affiliation(s)
- Susanne Amler
- Institute of Biostatistics and Clinical Research, University of Muenster, Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany.
| | - Maria Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Muenster, Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany.
| | - Christian Deiters
- University Hospital of Muenster, Medicine A - Hematology, Oncology, Hemostaseology and Pneumology, Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany.
| | - Thomas Büchner
- University Hospital of Muenster, Medicine A - Hematology, Oncology, Hemostaseology and Pneumology, Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany.
| | - Andrea Schumacher
- University Hospital of Muenster, Medicine A - Hematology, Oncology, Hemostaseology and Pneumology, Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany.
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Bösche K, Weissenborn K, Christians U, Witzke O, Engler H, Schedlowski M, Hadamitzky M. Neurobehavioral consequences of small molecule-drug immunosuppression. Neuropharmacology 2014; 96:83-93. [PMID: 25529273 DOI: 10.1016/j.neuropharm.2014.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 12/29/2022]
Abstract
60 years after the first successful kidney transplantation in humans, transplant patients have decent survival rates owing to a broad spectrum of immunosuppressive medication available today. Not only transplant patients, but also patients with inflammatory autoimmune diseases or cancer benefit from these life-saving immunosuppressive and anti-proliferative medications. However, this success is gained with the disadvantage of neuropsychological disturbances and mental health problems such as depression, anxiety and impaired quality of life after long-term treatment with immunosuppressive drugs. So far, surprisingly little is known about unwanted neuropsychological side effects of immunosuppressants and anti-proliferative drugs from the group of so called small molecule-drugs. This is partly due to the fact that it is difficult to disentangle whether and to what extent the observed neuropsychiatric disturbances are a direct result of the patient's medical history or of the immunosuppressive treatment. Thus, here we summarize experimental as well as clinical data of mammalian and human studies, with the focus on selected small-molecule drugs that are frequently employed in solid organ transplantation, autoimmune disorders or cancer therapy and their effects on neuropsychological functions, mood, and behavior. These data reveal the necessity to develop immunosuppressive and anti-proliferative drugs inducing fewer or no unwanted neuropsychological side effects, thereby increasing the quality of life in patients requiring long term immunosuppressive treatment. This article is part of a Special Issue entitled 'Neuroimmunology and Synaptic Function'.
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Affiliation(s)
- Katharina Bösche
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital, Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Uwe Christians
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Oliver Witzke
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital, Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital, Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Martin Hadamitzky
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital, Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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Fox KR, Posluszny DM, DiMartini AF, DeVito Dabbs AJ, Rosenberger EM, Zomak RA, Bermudez C, Dew MA. Predictors of post-traumatic psychological growth in the late years after lung transplantation. Clin Transplant 2014; 28:384-93. [PMID: 24750288 DOI: 10.1111/ctr.12301] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although lung transplantation improves quality of life, most psychosocial research focuses on adverse psychological and social functioning outcomes. Positive effects, particularly in the late-term years as physical morbidities increase, have received little attention. We provide the first data on a psychological benefit - post-traumatic growth (PTG) - and we focused on long-term (>5 yr) survivors. METHODS Among 178 patients from a prospective study of mental health during the first two yr post-transplant, we recontacted survivors 6-11 yr post-transplant. We assessed PTG (i.e., positive psychological change resulting from the transplant) and examined its relationship to other patient characteristics with multivariable regression analyses. RESULTS Sixty-four patients (86% of survivors) were assessed (M = 8.1 yr post-transplant, SD = 1.2). Mean PTG exceeded the scale's midpoint (M = 38.6, SD = 10.0; scale midpoint = 25). Recipients experiencing greater PTG were female (p = 0.022), less educated (p = 0.014), and had a history of post-transplant panic disorder (p = 0.005), greater friend support (p = 0.048), and better perceived health (p = 0.032). Neither other pre- or post-transplant mood and anxiety disorders nor transplant-related morbidities (acute rejection, bronchiolitis obliterans syndrome) predicted PTG. CONCLUSIONS PTG exceeded levels observed in other chronic disease populations, suggesting that lung transplantation may uniquely foster positive psychological change in long-term survivors. PTG occurs despite physical and psychiatric morbidities. Whether PTG promotes other positive post-transplant psychosocial outcomes deserves attention.
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Affiliation(s)
- Kristen R Fox
- Department of Psychology, Ohio University, Athens, OH, USA
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Brügger A, Aubert JD, Piot-Ziegler C. Emotions while awaiting lung transplantation: A comprehensive qualitative analysis. Health Psychol Open 2014; 1:2055102914561272. [PMID: 28070345 PMCID: PMC5193305 DOI: 10.1177/2055102914561272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Patients awaiting lung transplantation are at risk of negative emotional and physical experiences. How do they talk about emotions? Semi-structured interviews were performed (15 patients). Categorical analysis focusing on emotion-related descriptions was organized into positive–negative–neutral descriptions: for primary and secondary emotions, evaluation processes, coping strategies, personal characteristics, emotion descriptions associated with physical states, (and) contexts were listed. Patients develop different strategies to maintain positive identity and attitude, while preserving significant others from extra emotional load. Results are discussed within various theoretical and research backgrounds, in emphasizing their importance in the definition of emotional support starting from the patient’s perspective.
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Yang LS, Shan LL, Saxena A, Morris DL. Liver transplantation: a systematic review of long-term quality of life. Liver Int 2014; 34:1298-313. [PMID: 24703371 DOI: 10.1111/liv.12553] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 03/23/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Liver transplantation is the only curative intervention for terminal liver disease. Accurate long-term quality of life (QOL) data are required in the context of improved surgical outcomes and increasing post-transplant survival. This study reviews the long-term QOL after primary liver transplantation in adult patients surviving 5 or more years after surgery. METHODS A literature search was conducted on PubMed for all studies matching the eligibility criteria between January 2000 and October 2013. Bibliographies of included studies were also reviewed. Two authors independently performed screening of titles and abstracts. Consensus for studies included for review was achieved by discussion between authors based on predetermined eligibility criteria. Quality appraisal and data tabulation were performed using predetermined forms. Results were synthesized by narrative review. RESULTS Twenty-three studies (5402 patients) were included. QOL following liver transplantation remains superior to preoperative status up to 20 years post-operatively. More post-operative complications predicted worse QOL scores especially in physical domains. Benefits in functional domains persist long-term with independence in self-care and mobility. Employment rates recover in the short-term but decline after 5 years, and differ significantly between various aetiologies of liver disease. Overall QOL improves to a similar level as the general population, but physical function remains worse. Participation in post-operative physical activity is associated with superior QOL outcomes in liver transplant recipients compared to the general population. QOL improvements are similar compared to lung, kidney and heart transplantation. Heterogeneity between studies precluded quantitative analysis. CONCLUSIONS Liver transplantation confers specific long-term QOL and functional benefits when compared to preoperative status. This information can assist in providing a more complete estimate of the overall health of liver transplant recipients and the effectiveness of surgery. Guidelines for future studies are provided.
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Affiliation(s)
- Linda S Yang
- Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia
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Kugler C, Gottlieb J, Warnecke G, Schwarz A, Weissenborn K, Barg-Hock H, Bara C, Einhorn I, Haverich A, Haller H. Health-related quality of life after solid organ transplantation: a prospective, multiorgan cohort study. Transplantation 2014; 96:316-23. [PMID: 23715048 DOI: 10.1097/tp.0b013e31829853eb] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Short-term posttransplantation survival and health-related quality of life (HRQoL) is exceptionally high for all patients after organ transplantation; however, predictors of the HRQoL outcome are not well understood. Trajectories of patients' perceived benefit/burden ratio associated with the transplant procedure may differ when taking the organ type for transplantation into account. METHODS A prospective, single-center cohort study assessed the trajectories of 354 patients after kidney (n=165), liver (n=53), heart (n=24), and lung (n=112) transplantation at 2, 6, 12, and 24 months with respect to psychosocial outcomes (HRQoL, anxiety, depression, social support, and work performance). RESULTS Mean age was 50±13 years, and 61.6% were male in the overall sample. Demographics differed with respect to organ type. HRQoL measured by the mean SF-36 Physical Component Scale was 36.8 (95% confidence interval, 35.7-37.8) and 48.9 (95% confidence interval, 47.2-49.7) for the Psychosocial Component Scale for the entire sample at 2 months and showed a marginal decrease until 24 months after transplantation. Overall, HRQoL increased for all organ types with differing trajectories. Liver patients reported the lowest HRQoL benefit for the majority of the physical (P≤0.01) and psychosocial (P≤0.01) SF-36 subscales. Anxiety (17.4%) and depression (13.8%) were prevalent in the overall sample. Depression symptoms impaired HRQoL outcomes in both SF-36 components and unemployment impacted the SF-36 psychosocial outcomes. CONCLUSIONS HRQoL improved after transplantation for all four types of transplant, but the trajectories were different. Regular screening for depression symptoms may diminish psychologic disorders and distress after transplantation and thus may further improve outcomes.
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Affiliation(s)
- Christiane Kugler
- Hannover Thoracic Transplant Program, Division of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
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Mittal S, Gough SCL. Pancreas transplantation: a treatment option for people with diabetes. Diabet Med 2014; 31:512-21. [PMID: 24313883 DOI: 10.1111/dme.12373] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/23/2013] [Accepted: 11/17/2013] [Indexed: 11/29/2022]
Abstract
Since the first pancreas transplants in the early 1960s, whole-organ pancreas transplantation, either alone or combined with kidney transplantation, has become commonplace in many countries around the world. Whole-organ pancreas transplantation is available in the UK, with ~200 transplants currently carried out per year. Patient survival and pancreas graft outcome rates are now similar to other solid organ transplant programmes, with high rates of long-term insulin independence. In the present review, we will discuss whole-pancreas transplantation as a treatment for diabetes, focusing on indications for transplantation, the nature of the procedure performed, graft survival rates and the consequences of pancreas transplantation on metabolic variables and the progression of diabetes-related complications.
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Affiliation(s)
- S Mittal
- Nuffield Department of Surgical Sciences, Oxford, UK; Oxford Centre of Diabetes, Endocrinology and Metabolism, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
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De Geest S, Burkhalter H, Bogert L, Berben L, Glass TR, Denhaerynck K. Describing the evolution of medication nonadherence from pretransplant until 3 years post-transplant and determining pretransplant medication nonadherence as risk factor for post-transplant nonadherence to immunosuppressives: the Swiss Transplant Cohort Study. Transpl Int 2014; 27:657-66. [PMID: 24628915 DOI: 10.1111/tri.12312] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/11/2014] [Indexed: 12/30/2022]
Abstract
Although medication nonadherence (MNA) is a major risk factor for poor outcomes, the evolution of MNA from pre- to 3 years post-transplant among the four major organ transplant groups remains unknown. Therefore, this study described this evolution and investigated whether pretransplant MNA predicts post-transplant immunosuppressive medication nonadherence (IMNA). Adult participants (single transplant, pretransplant and ≤1 post-transplant assessment, using medications pretransplant) in the Swiss Transplant Cohort Study (a prospective nation-wide cohort study) were included. Nonadherence, defined as any deviation from dosing schedule, was assessed using two self-report questions pretransplant and at 6, 12, 24 and 36 months post-transplant. Nonadherence patterns were modelled using generalized estimating equations. The sample included 1505 patients (average age: 52.5 years (SD: 13.1); 36.3% females; 924 renal, 274 liver, 181 lung, 126 heart). The magnitude and variability of self-reported MNA decreased significantly from pretransplant to 6 months post-transplant (OR = 0.21; 95% CI: 0.16-0.27). Post-transplant IMNA increased continuously from 6 months to 3 years post-transplant (OR = 2.75; 95% CI: 1.97-3.85). Pretransplant MNA was associated with threefold higher odds of post-transplant IMNA (OR = 3.10; 95% CI: 2.29-4.21). As pretransplant MNA predicted post-transplant IMNA and a continuous increase in post-transplant IMNA was observed, early adherence-supporting interventions are indispensible.
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Affiliation(s)
- Sabina De Geest
- Institute of Nursing Science, University of Basel, Basel, Switzerland
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Anand-Kumar V, Kung M, Painter L, Broadbent E. Impact of organ transplantation in heart, lung and liver recipients: assessment of positive life changes. Psychol Health 2014; 29:687-97. [PMID: 24460459 DOI: 10.1080/08870446.2014.882922] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The majority of psychological studies with organ transplant recipients have examined negative psychological effects. This study aimed to further investigate the positive effects of organ transplantation and to construct a specific measurement instrument. DESIGN The initial pool of 14 items for the Positive Effects of Transplant Scale (PETS) was derived from organ recipient interviews. A cross-sectional postal study included 87 heart, 46 lung and 193 liver transplant recipients. The PETS was subjected to principal components analysis (PCA) using varimax rotation, and associations with other measures investigated. MAIN OUTCOME MEASURES PETS and an open-ended item about positive effects. RESULTS Coding of the open-ended item revealed that the majority of recipients attributed positive life changes to the transplant experience. PCA of the PETS indicated three factors that accounted for 58.82% of the variance. The 12-item questionnaire assesses improvements in: (1) life philosophy, (2) gratitude and (3) health. The total PETS scores exhibited adequate internal consistency and validity. DISCUSSION Most transplant patients report positive psychological effects, which suggests this may be an understudied area. The initial development of an assessment tool provides researchers and clinicians a way to assess the degree and nature of these life changes.
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Affiliation(s)
- Vinayak Anand-Kumar
- a Faculty of Medical and Health Sciences, Department of Psychological Medicine , The University of Auckland , Auckland , New Zealand
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Ríos A, López-Navas A, Ayala-García MA, Sebastián MJ, Abdo-Cuza A, Alán J, Martínez-Alarcón L, Ramírez EJ, Muñoz G, Suárez-López J, Castellanos R, Ramírez R, González B, Martínez MA, Díaz E, Ramírez P, Parrilla P. Spanish-Latin American multicenter study of attitudes toward organ donation among personnel from hospital healthcare centers. Cir Esp 2014; 92:393-403. [PMID: 24565516 DOI: 10.1016/j.ciresp.2013.12.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 12/20/2013] [Accepted: 12/28/2013] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Hospital personnel are a group which has an influence on the opinion of the rest of the population about healthcare matters. Any unfavorable attitude of this group would be an obstacle to an increase in organ donation. OBJECTIVE To analyze the attitude of hospital workers toward the donation of one's own organs in Spanish and Latin American hospitals and to determine the factors affecting this attitude. MATERIAL AND METHOD Eleven hospitals from the "International Collaborative Donor Project" were selected, 3 in Spain, 5 in Mexico, 2 in Cuba and one in Costa Rica. A random sample was stratified by the type of service and job category. Attitude toward donation and transplantation was assessed using a validated survey. The questionnaire was completed anonymously and was self-administered. STATISTICAL ANALYSIS Student's t-test, the χ2 test and logistic regression analysis. RESULTS Of the 2,785 workers surveyed, 822 were from Spain, 1,595 from Mexico, 202 from Cuba and 166 from Costa Rica and 79% (n=2,191) were in favor of deceased organ donation. According to country, 94% (n=189) of Cubans were in favor, compared to 82% (n=1,313) of the Mexicans, 73% (n=121) of the Costa Ricans and 69% (n=568) of the Spanish (P<.001). In the multivariate analysis, the following variables had the most specific weight: 1) originating from Cuba (odds ratio=8.196; P<.001); 2) being a physician (OR= 2.544; P<.001); 3) performing a job related to transplantation (OR = 1.610; P=.005); 4) having discussed the subject of donation and transplantation within the family (OR= 3.690; P<.001); 5) having a partner with a favorable attitude toward donation and transplantation (OR= 3.289; P<.001); 6) a respondent's belief that his or her religion is in favor of donation and transplantation (OR= 3.021; P=.001); 7) not being concerned about the possible mutilation of the body after donation (OR= 2.994; P<.001); 8) the preference for other options apart from burial for treating the body after death (OR= 2.770; P<.001); and 9) acceptance of carrying out an autopsy if one were needed (OR= 2.808; P<.001). CONCLUSIONS Hospital personnel in Spanish and Latin American healthcare centers had a favorable attitude toward donation, although 21% of respondents were not in favor of donating. This attitude was more favorable among Latin American workers and was very much conditioned by job-related and psychosocial factors.
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Affiliation(s)
- Antonio Ríos
- Proyecto Colaborativo Internacional Donante «International Collaborative Donor Project», España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, Murcia, España; Unidad de Trasplantes, Servicio de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Ginecología y Pediatría, Universidad de Murcia, Murcia, España.
| | - Ana López-Navas
- Proyecto Colaborativo Internacional Donante «International Collaborative Donor Project», España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, Murcia, España; Departamento de Psicología, Universidad Católica de San Antonio, Universidad Católica de San Antonio de Murcia, Murcia, España
| | - Marco Antonio Ayala-García
- Cirugía, Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México; Servicio de Cirugía, Hospital General de Zona N.(o) 10, Instituto Mexicano del Seguro Social, Delegación Guanajuato, Guanajuato, México
| | - María José Sebastián
- Coordinación de Trasplantes, Unidad Médica de Alta Especialidad, Hospital de Especialidades N° 25, Instituto Mexicano de la Seguridad Social, Monterrey, México
| | - Anselmo Abdo-Cuza
- Coordinación de Trasplantes, Centro de Investigaciones Médico-Quirúrgicas, La Habana, Cuba
| | - Jeannina Alán
- Departamento de Psicología, Universidad de Costa Rica, Costa Rica
| | - Laura Martínez-Alarcón
- Proyecto Colaborativo Internacional Donante «International Collaborative Donor Project», España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, Murcia, España; Unidad de Trasplantes, Servicio de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - Gerardo Muñoz
- CMN Siglo XXI del Instituto Mexicano del Seguro Social, México
| | | | - Roberto Castellanos
- Coordinación de Trasplantes, Centro de Investigaciones Médico-Quirúrgicas, La Habana, Cuba
| | - Ricardo Ramírez
- Departamento de Psicología, Universidad de Costa Rica, Costa Rica
| | - Beatriz González
- Cirugía, Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México; Universidad de Guanajuato, México
| | | | - Ernesto Díaz
- Cirugía, Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México; Servicio de Cirugía, Hospital General de Zona N.(o) 10, Instituto Mexicano del Seguro Social, Delegación Guanajuato, Guanajuato, México
| | - Pablo Ramírez
- Proyecto Colaborativo Internacional Donante «International Collaborative Donor Project», España; Coordinación Regional de Trasplantes, Consejería de Sanidad y Consumo de la Región de Murcia, Murcia, España; Unidad de Trasplantes, Servicio de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Ginecología y Pediatría, Universidad de Murcia, Murcia, España
| | - Pascual Parrilla
- Unidad de Trasplantes, Servicio de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Cirugía, Ginecología y Pediatría, Universidad de Murcia, Murcia, España
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