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Forsberg A, Jansen N, Paredes D, Maple H. Time for transplant care professionals to face recipients' fear of graft rejection-an opinion paper. FRONTIERS IN TRANSPLANTATION 2023; 2:1277053. [PMID: 38993928 PMCID: PMC11235246 DOI: 10.3389/frtra.2023.1277053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/18/2023] [Indexed: 07/13/2024]
Affiliation(s)
- Anna Forsberg
- Institute of Health Sciences at Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden
- Chair of European Transplant Allied Healthcare Professionals (ETAHP), a Section of the European Society for Organ Transplantation, Padua, Italy
| | - Nichon Jansen
- Policy Department, Dutch Transplant Foundation, Leiden, Netherlands
- Past-Chair of European Donation and Transplantation Coordination Organization (EDTCO), a Section of the European Society for Organ Transplantation, Padua, Italy
| | - David Paredes
- Past-Chair of European Donation and Transplantation Coordination Organization (EDTCO), a Section of the European Society for Organ Transplantation, Padua, Italy
- Donation and Transplant Coordination Unit, Hospital Clinic, Associate Professor Surgical Department, University of Barcelona, Barcelona, Spain
| | - Hannah Maple
- Department of Transplantation, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- Chair of Ethical, Legal, and Psychosocial Aspects of Transplantation (ELPAT), a Section of the European Society for Organ Transplantation, Padua, Italy
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2
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Grady KL, Kao A, Spertus JA, Hsich E, Dew MA, Pham DT, Hartupee J, Petty M, Cotts W, Pamboukian SV, Pagani FD, Lampert B, Johnson M, Murray M, Takeda K, Yuzefpolskaya M, Silvestry S, Kirklin JK, Andrei AC, Elenbaas C, Baldridge A, Yancy C. Health-Related Quality of Life in Older Patients With Heart Failure From Before to Early After Advanced Surgical Therapies: Findings From the SUSTAIN-IT Study. Circ Heart Fail 2022; 15:e009579. [PMID: 36214123 PMCID: PMC9561242 DOI: 10.1161/circheartfailure.122.009579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Restoring health-related quality of life (HRQOL) is a therapeutic goal for older patients with advanced heart failure. We aimed to describe change in HRQOL in older patients (60–80 years) awaiting heart transplantation (HT) with or without pretransplant mechanical circulatory support (MCS) or scheduled for long-term MCS, if ineligible for HT, from before to 6 months after these surgeries and identify factors associated with change.
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Affiliation(s)
- Kathleen L. Grady
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | - Andrew Kao
- St. Luke’s Medical Center, Kansas City, MO (A.K.)
| | | | | | | | - Duc-Thinh Pham
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | | | - Michael Petty
- University of Minnesota Medical Center, Minneapolis (M.P.)
| | | | | | | | | | | | | | - Koji Takeda
- Columbia University, New York, NY (K.T., M.Y.)
| | | | | | | | - Adin-Cristian Andrei
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | - Christian Elenbaas
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | - Abigail Baldridge
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
| | - Clyde Yancy
- Northwestern University, Chicago, IL (K.L.G., D.-T.P., A.-C.A., C.E., A.B., C.Y.)
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Zhou C, Yue XD, Zhang X, Shangguan F, Zhang XY. Self-efficacy and mental health problems during COVID-19 pandemic: A multiple mediation model based on the Health Belief Model. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021; 179:110893. [DOI: 10.1016/j.paid.2021.110893] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 02/05/2023]
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Sotomayor CG, Bustos NI, Yepes-Calderon M, Arauna D, de Borst MH, Berger SP, Rodrigo R, Dullaart RPF, Navis GJ, Bakker SJL. Plasma Vitamin C and Risk of Late Graft Failure in Kidney Transplant Recipients: Results of the TransplantLines Biobank and Cohort Study. Antioxidants (Basel) 2021; 10:631. [PMID: 33919075 PMCID: PMC8143099 DOI: 10.3390/antiox10050631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
Recent studies have shown that depletion of vitamin C is frequent in outpatient kidney transplant recipients (KTR) and that vitamin C is inversely associated with risk of death. Whether plasma vitamin C is associated with death-censored kidney graft failure remains unknown. We investigated KTR who participated in the TransplantLines Insulin Resistance and Inflammation Biobank and Cohort Study. The primary outcome was graft failure (restart of dialysis or re-transplantation). Overall and stratified (pinteraction < 0.1) multivariable-adjusted Cox regression analyses are presented here. Among 598 KTR (age 51 ± 12 years-old; 55% males), baseline median (IQR) plasma vitamin C was 44.0 (31.0-55.3) µmol/L. Through a median follow-up of 9.5 (IQR, 6.3‒10.2) years, 75 KTR developed graft failure (34, 26, and 15 events over increasing tertiles of vitamin C, log-rank p < 0.001). Plasma vitamin C was inversely associated with risk of graft failure (HR per 1-SD increment, 0.69; 95% CI 0.54-0.89; p = 0.004), particularly among KTR with triglycerides ≥1.9 mmol/L (HR 0.46; 95% CI 0.30-0.70; p < 0.001; pinteraction = 0.01) and among KTR with HDL cholesterol ≥0.91 mmol/L (HR 0.56; 95% CI 0.38-0.84; p = 0.01; pinteraction = 0.04). These findings remained materially unchanged in multivariable-adjusted analyses (donor, recipient, and transplant characteristics, including estimated glomerular filtration rate and proteinuria), were consistent in categorical analyses according to tertiles of plasma vitamin C, and robust after exclusion of outliers. Plasma vitamin C in outpatient KTR is inversely associated with risk of late graft failure. Whether plasma vitamin C‒targeted therapeutic strategies represent novel opportunities to ease important burden of graft failure necessitates further studies.
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Affiliation(s)
- Camilo G. Sotomayor
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.Y.-C.); (M.H.d.B.); (S.P.B.); (G.J.N.); (S.J.L.B.)
- Faculty of Medicine, University of Chile, 8330033 Santiago, Chile; (N.I.B.); (R.R.)
| | - Nicolas I. Bustos
- Faculty of Medicine, University of Chile, 8330033 Santiago, Chile; (N.I.B.); (R.R.)
| | - Manuela Yepes-Calderon
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.Y.-C.); (M.H.d.B.); (S.P.B.); (G.J.N.); (S.J.L.B.)
| | - Diego Arauna
- Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Universidad de Talca, 3460000 Talca, Chile;
| | - Martin H. de Borst
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.Y.-C.); (M.H.d.B.); (S.P.B.); (G.J.N.); (S.J.L.B.)
| | - Stefan P. Berger
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.Y.-C.); (M.H.d.B.); (S.P.B.); (G.J.N.); (S.J.L.B.)
| | - Ramón Rodrigo
- Faculty of Medicine, University of Chile, 8330033 Santiago, Chile; (N.I.B.); (R.R.)
| | - Robin P. F. Dullaart
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands;
| | - Gerjan J. Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.Y.-C.); (M.H.d.B.); (S.P.B.); (G.J.N.); (S.J.L.B.)
| | - Stephan J. L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.Y.-C.); (M.H.d.B.); (S.P.B.); (G.J.N.); (S.J.L.B.)
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Toward Advancing Long-Term Outcomes of Kidney Transplantation with Artificial Intelligence. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
After decades of pioneering advances and improvements, kidney transplantation is now the renal replacement therapy of choice for most patients with end-stage kidney disease (ESKD). Despite this success, the high risk of premature death and frequent occurrence of graft failure remain important clinical and research challenges. The current burst of studies and other innovative initiatives using artificial intelligence (AI) for a wide range of analytical and practical applications in biomedical areas seems to correlate with the same trend observed in publications in the kidney transplantation field, and points toward the potential of such novel approaches to address the aforementioned aim of improving long-term outcomes of kidney transplant recipients (KTR). However, at the same time, this trend underscores now more than ever the old methodological challenges and potential threats that the research and clinical community needs to be aware of and actively look after with regard to AI-driven evidence. The purpose of this narrative mini-review is to explore challenges for obtaining applicable and adequate kidney transplant data for analyses using AI techniques to develop prediction models, and to propose next steps in the field. We make a call to act toward establishing the strong collaborations needed to bring innovative synergies further augmented by AI, which have the potential to impact the long-term care of KTR. We encourage researchers and clinicians to submit their invaluable research, including original clinical and imaging studies, database studies from registries, meta-analyses, and AI research in the kidney transplantation field.
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Forsberg A, Kisch AM, Paulsson A, Ragntoft C, Dalvindt M, Lennerling A. Fear of graft rejection after heart transplantation - a nationwide cross-sectional cohort study. Eur J Cardiovasc Nurs 2020; 20:71-79. [PMID: 33570598 DOI: 10.1177/1474515120937838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cellular rejection is most common 3-6 months after heart transplantation while chronic rejection, that is, cardiac allograft vasculopathy and malignancy are the most common causes of death in heart-transplant recipients beyond the third year after transplantation. However, the heart transplantation recipient's perceived threat of graft rejection has never been explored. AIM The aim was to explore perceived threat of the risk of graft rejection and its relationship to psychological wellbeing, fatigue, health literacy, adherence and self-efficacy 1-5 years after heart transplantation. METHODS In a nationwide, cross-sectional study that constituted part of the Self-management after thoracic transplantation project, 79 heart recipients (68% men and 32% women with a mean age of 52.6 years) were investigated after one year (n=28), two years (n=17), three years (n=11), four years (n=17) and five years (n=6). The instruments used were: the Perceived Threat of the Risk of Graft Rejection, the Psychological General Well-being, Self-efficacy for Managing Chronic Disease, the Multidimensional Fatigue Inventory, the Newest Vital Sign and the Basel Assessment of Adherence to Immunosuppressive Medication Scale. RESULTS Twenty-eight per cent of the heart transplantation recipients perceived graft rejection as a serious threat. Intrusive anxiety was low and 37% perceived the threat of the risk of graft rejection as being beyond their control. Heart transplant recipients with high level of fatigue and low psychological well-being reported stronger intrusive anxiety and less control. CONCLUSION A perceived threat of the risk of graft rejection is present in the everyday lives of heart transplantation recipients and is strongly related to overall psychological well-being.
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Affiliation(s)
- Anna Forsberg
- Institute of Health Sciences, Lund University, Sweden.,Department of Thoracic surgery, Skåne University Hospital, Lund, Sweden
| | - Annika M Kisch
- Institute of Health Sciences, Lund University, Sweden.,Department of Haematology, Skåne University Hospital, Lund, Sweden
| | - Annika Paulsson
- Department of Thoracic surgery, Skåne University Hospital, Lund, Sweden
| | - Cecilia Ragntoft
- Department of Thoracic surgery, Skåne University Hospital, Lund, Sweden
| | - Marita Dalvindt
- Institute of Health Sciences, Lund University, Sweden.,Department of Thoracic surgery, Skåne University Hospital, Lund, Sweden
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden
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Forsberg A, Nilsson M, Jakobsson S, Lennerling A, Kisch A. Fear of graft rejection 1-5 years after lung transplantation-A nationwide cohort study. Nurs Open 2018; 5:484-490. [PMID: 30338093 PMCID: PMC6177545 DOI: 10.1002/nop2.184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/21/2018] [Indexed: 11/25/2022] Open
Abstract
AIM To explore the perceived threat of the risk of graft rejection and its relationship to psychological general well-being and self-efficacy 1-5 years after lung transplantation. DESIGN A nationwide, cross-sectional cohort study as a part of the Self-management after thoracic transplantation study. METHODS A total of 117 lung transplant recipients due for their yearly follow-up one (N = 35), two (N = 28), three (N = 23), four (N = 20) and 5 years (N = 11) after lung transplantation were included. We used three instruments; the Perceived Threat of the Risk of Graft Rejection, the Psychological General Well-being and Self-efficacy in chronic illness. RESULTS The lung recipients reported an overall low perceived threat of the risk of graft rejection with no gender differences. Intrusive anxiety explained 24.7% of the variance in the PGWB-sum (p ≤ 0.001) and makes a statistically significant (β = -497; p ≤ 0.001) unique contribution to the overall psychological general well-being (95%CI 3.004-1.515).
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Affiliation(s)
- Anna Forsberg
- Institute of Health SciencesLund UniversityLundSweden
- Department of Thoracic Transplantation and CardiologySkåne University HospitalSkåneSweden
| | - Madeleine Nilsson
- Queen Silvia Children´s Hospital, Sahlgrenska University HospitalGothenburgSweden
| | - Sofie Jakobsson
- Institute of Health and Care SciencesUniversity of GothenburgGothenburgSweden
| | - Annette Lennerling
- Institute of Health and Care SciencesUniversity of GothenburgGothenburgSweden
- The Department of TransplantationSahlgrenska University HospitalGothenburgSweden
| | - Annika Kisch
- The Department of HaematologySkåne University HospitalSkåneSweden
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Aguiar MIFD, Alves NP, Braga VAB, Souza ÂMAE, Araújo MÂM, Almeida PCD. ASPECTOS PSICOSSOCIAIS DA QUALIDADE DE VIDA DE RECEPTORES DE TRANSPLANTE HEPÁTICO. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-070720180003730016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: avaliar a dimensão psicossocial da qualidade de vida de pacientes antes e depois do transplante hepático. Método: estudo descritivo, transversal, com abordagem quantitativa, com 150 pacientes submetidos ao transplante de fígado em seguimento a partir do sexto mês, no ambulatório de um centro de referência em transplante hepático. A coleta de dados foi realizada a partir da aplicação de um instrumento com dados sociodemográficos/clínicos e do questionário Liver Disease Quality of Life. Foi utilizada análise estatística descritiva, teste t de Student para comparação das médias dos domínios e Games-Howell para comparações múltiplas. Resultados: houve melhoria nos níveis de qualidade de vida pós-transplante nos quatro domínios avaliados (<0,0001), com maior elevação de escores para os domínios: preocupação (55,5 vs 87,9) e estigma da doença hepática (58,6 vs 93,7). Conclusão: o estudo demonstrou que os pacientes submetidos ao transplante hepático obtiveram uma melhoria significativa da percepção da qualidade de vida no que diz respeito à dimensão psicossocial, sendo mais perceptiva nos domínios preocupação e estigma da doença hepática.
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Craig JA, Miner D, Remtulla T, Miller J, Zanussi LW. Piloting a Coping Skills Group Intervention to Reduce Depression and Anxiety Symptoms in Patients Awaiting Kidney or Liver Transplant. HEALTH & SOCIAL WORK 2017; 42:e44-e52. [PMID: 28395080 DOI: 10.1093/hsw/hlw064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/26/2016] [Indexed: 06/07/2023]
Abstract
The authors evaluated the use of a coping skills group (CSG) therapy intervention to decrease depression and anxiety and increase healthy coping skills in a population of kidney and liver transplant candidates. The study, using a pre-posttest design, piloted a CSG with a convenience sample of 41 consenting participants on a waiting list or in workup for kidney or liver transplant. Two transplant social workers led five eight-week closed psychoeducational groups. Coping skills, depression symptoms, and anxiety symptoms were assessed preintervention, postintervention, and at follow-up one month later. Results suggest that the CSG group created significant changes in some coping areas, such as decreasing the use of denial and self-blame and increasing the use of acceptance, religion, and instrumental supports. In this study, instrumental supports are strategies such as seeking assistance, finding information, or asking for advice about what to do. The effects on instrumental supports did not sustain at the one-month follow-up. Anxiety and depression scores were significantly reduced, and these changes were sustained at one-month follow-up. This study supports the use of a group-based psychosocial intervention for the pretransplant population and will be most relevant to social workers practicing in the transplant field.
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Affiliation(s)
- Julie Anne Craig
- Forensic Adolescent Program, Alberta Health Services, Sunridge Professional Building, 2675 36th Street, NW, Calgary, Alberta, Canada
| | - Dee Miner
- Southern Alberta Transplant Program, Foothills Medical Centre, Alberta Health Services, Calgary, Canada
| | - Tasneem Remtulla
- Southern Alberta Transplant Program, Foothills Medical Centre, Alberta Health Services, Calgary, Canada
| | - Janet Miller
- Mount Royal University, Calgary, Alberta, Canada
| | - Lauren W Zanussi
- Department of Psychiatry, Foothills Medical Centre, and assistant professor, University of Calgary, Alberta, Canada
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Denny B, Kienhuis M, Gavidia-Payne S. Explaining the quality of life of organ transplant patients by using crisis theory. Prog Transplant 2015; 25:324-31. [PMID: 26645927 DOI: 10.7182/pit2015904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT Ubiquitous findings regarding the quality of life (QOL) of transplant patients have yet to be explained from a theoretical perspective. OBJECTIVE To investigate transplant patients' QOL by using the conceptual framework of crisis theory. DESIGN Cross-sectional study to explore differences in transplant patients' experiences of stress, coping, and QOL. Regression analysis was used to test crisis theory in relation to QOL, stress, and coping. PARTICIPANTS A total of 226 participants representing transplant candidates, transplant recipients, and nontransplant individuals participated via survey-based data collection. RESULTS Results showed that transplant candidates experience lower QOL than transplant recipients and nontransplant individuals. No significant differences were detected regarding stress levels or coping styles. Stress made a significant contribution to patients' QOL. CONCLUSIONS Current findings suggest important QOL benefits of organ transplant. Using a theoretical model is an effective way to investigate the QOL of people experiencing chronic illness such as end-stage organ failure. Further investigation is required to reach a conclusive understanding of the complex interaction between transplant patients' QOL, stress, and coping.
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Forsberg A, Lennerling A, Fridh I, Karlsson V, Nilsson M. Understanding the Perceived Threat of the Risk of Graft Rejections: A Middle-Range Theory. Glob Qual Nurs Res 2015; 2:2333393614563829. [PMID: 28462294 PMCID: PMC5342851 DOI: 10.1177/2333393614563829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/17/2014] [Indexed: 11/18/2022] Open
Abstract
From a clinical viewpoint, graft rejection is one of the greatest threats faced by an organ transplant recipient (OTR). We propose a middle-range theory (MRT) of Perceived Threat of the Risk of Graft Rejection (PTRGR) as a contribution to the practice of transplant nursing. It could also apply to the detection of risky protective behavior, that is, isolation, avoidance, or non-adherence. The proposed MRT covers the following concepts and the relationship between them: transplant care needs, threat reducing interventions, intervening variables, level of PTRGR, protective strategies, and evidence-based practice. Parts of this theory have been empirically tested and support the suggested relationship between some of the concepts. Further tests are needed to strengthen the theoretical links. The conceptual framework might serve as a guide for transplant nurses in their efforts to promote post-transplant health and reduce threat-induced emotions.
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Affiliation(s)
- Anna Forsberg
- Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
| | - Annette Lennerling
- Sahlgrenska University Hospital, Gothenburg, Sweden.,University of Gothenburg, Göteborg, Sweden
| | - Isabell Fridh
- University of Gothenburg, Göteborg, Sweden.,University of Borås, Borås, Sweden
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Adey DB. Women and kidney transplantation. Adv Chronic Kidney Dis 2013; 20:427-32. [PMID: 23978549 DOI: 10.1053/j.ackd.2013.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 06/20/2013] [Accepted: 06/21/2013] [Indexed: 12/22/2022]
Abstract
Kidney transplant is the best kidney replacement treatment for end-stage kidney disease. The first step in moving toward kidney transplantation is referral to a transplant center for transplant evaluation. Education of dialysis staff and health-care providers may help increase referrals for evaluation. Patient education has been shown to enhance patient completion of the evaluation process. Patients have difficulty asking others to donate a kidney, but this process can be improved with home and community education. Living donors are more likely to be women than men, especially spousal donors. Deceased donors are more likely to be males younger than 35 years of age. There is a slight decrease in the rate of transplantation of women as compared with men, although not statistically significant. Pretransplant development of anti-human leukocyte antigen antibodies is more common amongst women and can be a barrier to successful transplantation and may prolong the waiting time for transplant. The long-term management of cardiovascular risk factors, osteoporosis, and age-appropriate cancer screening need to be addressed with posttransplant recipients. Women have an overall increased patient and graft survival as compared with men after transplant.
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