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Monteagudo LJ, Diaz-Guerra GM, Badillo AÁ, Álvarez Martínez CJ, Pablo Gafas AD, Gámez García AP, López López E, Arriscado CM, Hawkins Carranza F. Health-Related Quality of Life Long-Term Study in Lung Transplant Patients: A Single-Center Experience. J Surg Res 2024; 299:313-321. [PMID: 38788468 DOI: 10.1016/j.jss.2024.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/29/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Health-related quality of life (HRQL) assessment plays a crucial role in the follow-up care of lung transplanted (LTx) patients. Previous reports have indicated that the HRQL achieved by these patients is often poorer compared to that of healthy individuals. However, the factors contributing to this lower HRQL remain unclear. This prospective study aimed to assess the effectiveness of using both a generic and a disease-specific HRQL instrument in evaluating the outcomes of patients who have undergone LTx. METHODS A total of 111 LTx patients were enrolled in the study, with 88 survivors completing the 5-year follow-up and 23 nonsurvivors identified within the first 3 y. Among the participants, 84 underwent double LTx, while 27 received a single LTx. Patients were interviewed before LTx, at 6 mo post-transplantation, and annually thereafter. Two validated instruments were utilized: the Euro quality of life five dimensions, a generic measure, and the St. George's Respiratory Questionnaire (SGRQ), a disease-specific questionnaire. RESULTS The study showed significant improvements in Euro Quality of Life five Dimensions scores from 6 mo after LTx. Specifically, the percentage of patients without Mobility problems increased from 23% before LTx to 71% at 5 y (P = <0.001), while the ability to self-care improved from 48% to 100% (P = <0.001). The ability to carry out usual activities improved from 13% to 86% (P = <0.001), and the proportion of patients without anxiety and depression increased from 50% to 86% (P > 0.004). However, there was no significant improvement observed in Pain, with only a slight reduction from 57% to 42.8% (P = 0.22). The SGRQ also showed improvements in all dimensions (symptoms, impact, activities) (P < 0.001). However, by the fifth year, the HRQL scores remained below normal reference values. Chronic graft dysfunction was associated with a decline in SGRQ scores. Bilateral LTx patients exhibited better SGRQ scores compared to unilateral LTx patients from the first year post-transplantation. Notably, there were no differences in scores between nonsurvivors and survivors. CONCLUSIONS The study highlights the long-term improvement in HRQL among LTx patients, with greater improvements observed in physical dimensions compared to psychological dimensions. Bilateral LTx was associated with better SGRQ scores than unilateral LTx, and chronic graft dysfunction primarily affected SGRQ scores. These findings underscore the importance of utilizing both generic and specific HRQL instruments in assessing LTx outcomes.
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Affiliation(s)
| | | | | | | | - Alicia De Pablo Gafas
- Lung Transplant Unit, University Hospital 12 Octubre, Complutense University, Madrid, Spain
| | | | - Eloisa López López
- Department of Anesthesiology, University Hospital 12 Octubre, Madrid, Spain
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Song L, Luo Q, Liu C, Zhou Y, Huang D, Ju C, Chen H, Wong TKS, Chen J, Tan W, Miao C, Ma Y, Chen J. Quality of life and its association with predictors in lung transplant recipients: a latent profile analysis. Front Public Health 2024; 12:1355179. [PMID: 38741913 PMCID: PMC11089158 DOI: 10.3389/fpubh.2024.1355179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
Backgrounds Improving quality of life (QOL) is one of the main aims of lung transplantation (LTx). There is a need to identify those who have poor quality of life early. However, research addressing inter individual quality of life variability among them is lacking. This study aims to identify group patterns in quality of life among lung transplant recipients and examine the predictors associated with quality of life subgroups. Methods In total, 173 lung transplant recipients were recruited from one hospital in Guangdong Province between September 2022 and August 2023. They were assessed using the Lung Transplant Quality of Life scale (LT-QOL), Mindful Attention Awareness Scale (MAAS), Life Orientation Test-Revised scale (LOT-R), and Positive and Negative Affect Scale (PANAS). Latent profile analysis was used to identify QOL subtypes, and logistic regression analysis was used to examine the associations between latent profiles and sociodemographic and psychosocial characteristics. Results Two distinct QOL profiles were identified: "low HRQOL" profile [N = 53 (30.94%)] and "high HRQOL" profile [N = 120 (69.06%)]. Single lung transplant recipients, and patients who reported post-transplant infection, high levels of negative emotion or low levels of mindfulness and optimism were significantly correlated with the low QOL subgroup. Conclusion Using the domains of the LT-QOL scale, two profiles were identified among the lung transplant recipients. Our findings highlighted that targeted intervention should be developed based on the characteristics of each latent class, and timely attention must be paid to patients who have undergone single lung transplantation, have had a hospital readmission due to infection, exhibit low levels of optimism, low levels of mindfulness or high negative emotions.
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Affiliation(s)
- Liqin Song
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Qing Luo
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Chunqin Liu
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Ying Zhou
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Danxia Huang
- Department of Nursing, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chunrong Ju
- Department of Nursing, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huifang Chen
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | | | - Jiani Chen
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Wenying Tan
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Chuyuan Miao
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Yu Ma
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - JingWen Chen
- School of Nursing, Guangzhou Medical University, Guangzhou, China
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Rimmer B, Jenkins R, Russell S, Craig D, Sharp L, Exley C. Assessing quality of life in solid organ transplant recipients: A systematic review of the development, content, and quality of available condition- and transplant-specific patient-reported outcome measures. Transplant Rev (Orlando) 2024; 38:100836. [PMID: 38359538 DOI: 10.1016/j.trre.2024.100836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE We aimed to identify the condition- and transplant-specific patient-reported outcome measures (PROMs) available to measure quality of life (QoL) in solid organ transplant (SOT) recipients, examine their development and content, and critically appraise the quality of their measurement properties, to inform recommendations for clinical and research use. METHODS We systematically searched MEDLINE, Embase, CINAHL, PsycINFO, Cochrane CENTRAL, and Scopus from inception to 27th January 2023. Search hits were screened for eligibility by two independent reviewers; papers reporting the development and/or validation of condition- and transplant-specific PROMs measuring QoL in adult SOT recipients were considered eligible. We abstracted and synthesised data on PROM characteristics, development (item generation and/or reduction), and content (QoL dimensions). Quality appraisal and synthesis were informed by the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines, and included methodological and quality assessment of measurement properties, GRADE levels of evidence, feasibility and interpretability. RESULTS We identified 33 papers reporting 26 QoL PROMs validated in SOT recipients (kidney n = 10 PROMs; liver n = 6; lung n = 3; heart n = 2; pancreas n = 1; multiple organs n = 4). Patient discussions (n = 17 PROMs) and factor analysis (n = 11) were the most common item generation and reduction techniques used, respectively. All PROMs measured ≥3 of nine QoL dimensions (all measured emotional functioning); KDQoL-SF and NIDDK-QA measured all nine. Methodological quality was variable; no PROM had low evidence or better for all measurement properties. All PROMs were COSMIN recommendation category 'B', primarily because none had sufficient content validity. CONCLUSIONS There are many condition- and transplant-specific QoL PROMs validated in SOT recipients, particularly kidney. These findings can help inform PROM selection for clinicians and researchers. However, caution is required when adopting measures, due to the substantial heterogeneity in development, content, and quality. Each PROM has potential but requires further research to be recommendable. Greater consideration of patient and professional involvement in PROM development in this setting is needed to ensure sufficient content validity.
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Affiliation(s)
- Ben Rimmer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Rebeka Jenkins
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Siân Russell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Prather AA, Gao Y, Betancourt L, Kordahl RC, Sriram A, Huang CY, Hays SR, Kukreja J, Calabrese DR, Venado A, Kapse B, Greenland JR, Singer JP. Disturbed sleep after lung transplantation is associated with worse patient-reported outcomes and chronic lung allograft dysfunction. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.10.12.23296973. [PMID: 37873197 PMCID: PMC10593057 DOI: 10.1101/2023.10.12.23296973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Many lung transplant recipients fail to derive the expected improvements in functioning, HRQL, or long-term survival. Sleep may represent an important, albeit rarely examined, factor influencing lung transplant outcomes. Within a larger cohort study, 141 lung transplant recipients completed the Medical Outcomes Study (MOS) Sleep Scale along with a broader survey of patient-reported outcome (PRO) measures and frailty assessment. MOS Sleep yields the Sleep Problems Index (SPI); we also derived an insomnia-specific subscale. Potential perioperative predictors of disturbed sleep and time to chronic lung allograft dysfunction (CLAD) and death were derived from medical records. We investigated associations between perioperative predictors on SPI and Insomnia and associations between SPI and Insomnia on PROs and frailty by linear regressions, adjusting for age, sex, and lung function. We evaluated the associations between SPI and Insomnia on time to CLAD and death using Cox models, adjusting for age, sex, and transplant indication. Post-transplant hospital length of stay >30 days was associated with worse sleep by SPI and insomnia (SPI: p=0.01; Insomnia p=0.02). Worse sleep by SPI and insomnia was associated with worse depression, cognitive function, HRQL, physical disability, health utilities, and Fried Frailty Phenotype frailty (all p<0.01). Those in the worst quartile of SPI and insomnia exhibited increased risk of CLAD (HR 2.18; 95%CI: 1.22-3.89 ; p=0.01 for SPI and HR 1.96; 95%CI 1.09-3.53; p=0.03 for insomnia). Worsening in SPI but not insomnia was also associated with mortality (HR: 1.29; 95%CI: 1.05-1.58; p=0.01). Poor sleep after lung transplant may be a novel predictor of patient reported outcomes, frailty, CLAD, and death with potentially important screening and treatment implications.
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Affiliation(s)
- Aric A Prather
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Ying Gao
- Department of Medicine, University of California San Francisco
| | | | - Rose C Kordahl
- Department of Medicine, University of California San Francisco
| | - Anya Sriram
- Department of Medicine, University of California San Francisco
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Steven R Hays
- Department of Medicine, University of California San Francisco
| | - Jasleen Kukreja
- Department of Surgery, University of California San Francisco
| | - Daniel R Calabrese
- Department of Medicine, University of California San Francisco
- San Francisco Veterans Affairs Health Care System
| | - Aida Venado
- Department of Medicine, University of California San Francisco
| | - Bhavya Kapse
- Department of Medicine, University of California San Francisco
| | - John R Greenland
- Department of Medicine, University of California San Francisco
- San Francisco Veterans Affairs Health Care System
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Takahashi R, Takahashi T, Okada Y, Kohzuki M, Ebihara S. Factors associated with quality of life in patients receiving lung transplantation: a cross-sectional study. BMC Pulm Med 2023; 23:225. [PMID: 37353819 DOI: 10.1186/s12890-023-02526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/20/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND With improved prognosis after lung transplantation (LTx), improving health-related quality of life (HRQL) in patients who have undergone LTx is a key goal. Although HRQL is improved significantly after transplantation, it is poorer than that in ordinary healthy people. However, the factors associated with poor HRQL remain unclear. This cross-sectional study aimed to identify the factors associated with poor HRQL in patients who have undergone LTx. METHODS Between December 2018 and May 2022, 80 patients who had undergone LTx completed St. George's Respiratory Questionnaire (SGRQ) as a disease-specific quality of life measure, the Short Form-12 (SF-12) as a generic quality of life measure, and modified Medical Research Council (mMRC) scale of dyspnea. The groups were assigned according to the median SGRQ-total score and the Japanese population standard for SF-12, and those with good HRQL were compared with those with poor HRQL. Independent factors were evaluated using multivariate analysis. RESULTS With regard to the SGRQ, there were significant differences in the forced expiratory volume in 1 s (FEV1) (P = 0.041), use of bronchodilators (P = 0.026), 6-min walk distance (6MWD) (P < 0.001), and Mmrc (P < 0.001) between better and poorer HRQL. For the SF-12 physical component summary score (PCS), age (P = 0.017), sex (P = 0.011), FEV1 (P < 0.001), forced vital capacity (FVC) (P < 0.001), diagnosis (P = 0.011), handgrip force (P = 0.003), 6MWD (P < 0.001), and Mmrc (P < 0.001) varied. Multivariate analyses revealed that Mmrc was the only independent factor in the SGRQ (P < 0.001, odds ratio [OR] = 6.65, 95% confidence interval [CI]: 2.49-17.74) and SF-12 PCS (P = 0.001, OR = 0.185, 95% CI: 0.07-0.52). There were significant correlations between the SGRQ-Total score and SF-12 PCS (correlation coefficient = -0.612, P < 0.001). CONCLUSIONS Dyspnea may be an independent factor of poor disease-specific and generic HRQL in LTx patients. The management of dyspnea may improve the HRQL in patients who have undergone LTx.
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Affiliation(s)
- Ryo Takahashi
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, 1-1, Seiryo-Machi, Aoba-Ku, Sendai, Japan
| | - Tamao Takahashi
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, 1-1, Seiryo-Machi, Aoba-Ku, Sendai, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Masahiro Kohzuki
- Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Satoru Ebihara
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, 1-1, Seiryo-Machi, Aoba-Ku, Sendai, Japan.
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Storaasli S, Nakagawa S, Singer JP, Fedoronko DA, Zhang Y, Tsapepas D, Rincon ME, Scheffert J, Benvenuto L, Arcasoy SM. Quality of Life Outcomes and Associated Symptoms Reported by Lung Transplant Recipients Amidst COVID-19 Pandemic: Applying a Novel Assessment Tool. Transplant Proc 2022; 54:2680-2687. [PMID: 35940947 PMCID: PMC9271457 DOI: 10.1016/j.transproceed.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/06/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There are 2 main aims of lung transplantation for people with end-stage lung disease: (1) to extend life and (2) to improve its quality. Much consideration is given to how to support the longevity and functioning of the allograft, though less robust studies have been done on the quality of the recipients' lives. With an interest in providing compassionate and holistic patient-centered care, it is vital that the treatment providers accurately understand their patients' lived experience. This study aimed to describe the health-related quality of life experiences of lung transplant recipients. An interest was held for where patients may struggle, thus informing where support might be needed to achieve the best possible outcomes. METHODS This single-center study used a validated Lung Transplant Quality of Life questionnaire, which was sent in autumn of 2020 to all of the lung transplant recipients (n = 581) under the care of Columbia University Irving Medical Center (New York, NY). RESULTS "Anxiety/Depression" had the highest concentration of struggle responses, followed closely by "Pulmonary Symptoms" and "Neuromuscular Symptoms." "Neuromuscular Problems" and "Sexual Problems" had the highest percentage of struggle responses. As the struggles increased, the overall quality of life rating dropped proportionately. There was no correlation between the overall quality of life and graft dysfunction, age, or time out from transplant date. All of the domains held an average rating of "Satisfactory," except "Treatment Burden," which was rated as "Favorable." Those ratings dropped for the cohort of patients who died during the study period. CONCLUSIONS With the goal of providing comprehensive care at the forefront of transplant priorities, we found the newly developed questionnaire invaluable in targeting areas for quality improvements, mostly notably respecting recipient mental health.
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Affiliation(s)
- Sasha Storaasli
- Department of Social Work, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY.
| | - Shunichi Nakagawa
- Adult Palliative Care Service, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Jonathan P Singer
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, CA
| | - David A Fedoronko
- Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Yuan Zhang
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - Demetra Tsapepas
- Department of Quality and Research-Transplantation, New York-Presbyterian Hospital, New York, NY
| | - Maylin E Rincon
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Jenna Scheffert
- Department of Transplant Pharmacy, New York-Presbyterian Hospital, New York, NY
| | - Luke Benvenuto
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Selim M Arcasoy
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
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Grootjans H, Verschuuren EAM, van Gemert JP, Kerstjens HAM, Bakker SJL, Berger SP, Gan CT. Chronic kidney disease after lung transplantation in a changing era. Transplant Rev (Orlando) 2022; 36:100727. [PMID: 36152358 DOI: 10.1016/j.trre.2022.100727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/26/2022] [Accepted: 09/10/2022] [Indexed: 10/14/2022]
Abstract
Lung transplant (LTx) physicians are responsible for highly complex post-LTx care, including monitoring of kidney function and responding to kidney function loss. Better survival of the LTx population and changing patient characteristics, including older age and increased comorbidity, result in growing numbers of LTx patients with chronic kidney disease (CKD). CKD after LTx is correlated with worse survival, decreased quality of life and high costs. Challenges lie in different aspects of post-LTx renal care. First, serum creatinine form the basis for estimating renal function, under the assumption that patients have stable muscle mass. Low or changes in muscle mass is frequent in the LTx population and may lead to misclassification of CKD. Second, standardizing post-LTx monitoring of kidney function and renal care might contribute to slow down CKD progression. Third, new treatment options for CKD risk factors, such as diabetes mellitus, proteinuria and heart failure, have entered clinical practice. These new treatments have not been studied in LTx yet but are of interest for future use. In this review we will address the difficult aspects of post-LTx renal care and evaluate new and promising future approaches to slow down CKD progression.
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Affiliation(s)
- Heleen Grootjans
- Department of Pulmonology and Tuberculosis, Lung Transplantation Program, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Erik A M Verschuuren
- Department of Pulmonology and Tuberculosis, Lung Transplantation Program, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Johanna P van Gemert
- Department of Pulmonology and Tuberculosis, Lung Transplantation Program, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Huib A M Kerstjens
- Department of Pulmonology and Tuberculosis, Lung Transplantation Program, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Stefan P Berger
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - C Tji Gan
- Department of Pulmonology and Tuberculosis, Lung Transplantation Program, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Eisenmenger Syndrome in Case of Extended Goldenhar Complex Treated With Heart-Lung Transplantation. JACC Case Rep 2022; 4:699-703. [PMID: 35734534 PMCID: PMC9207947 DOI: 10.1016/j.jaccas.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022]
Abstract
A patient diagnosed with expanded Goldenhar complex with oculoauriculovertebral spectrum complicated with complex pulmonary and congenital heart disease, underwent successful heart-lung transplantation 21 years ago, with excellent functional outcome and good quality of life. Heart-lung transplantation can be an option of care for patients with expanded Goldenhar complex. (Level of Difficulty: Advanced.)
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Błachut M, Szczegielniak A, Zawadzki F, Wajda-Pokrontka M, Tatoj Z, Stącel T, Urlik M, Latos M, Pelar K, Nowak K, Przybyłowski P, Ochman M. The Quality of Sex Life Among Patients Before and After Lung Transplantation: A Single-Center Study. Transplant Proc 2022; 54:1109-1114. [PMID: 35654636 DOI: 10.1016/j.transproceed.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lung transplantation (LTx) is the only effective method of treatment for patients with end-stage lung diseases; LTx prolongs and increases the quality of life (QoL). An important aspect of QoL that changes in the course of severe diseases is the quality of sex life. This aspect is yet to be discussed in relationship to LTx. We aim to compare patients' quality of sex life at the qualification process with patients' who underwent LTx. METHODS The studied group consisted of 100 patients (24 women before and 16 after LTx, 39 men before and 21 after LTX) who were admitted to the lung transplantology department for qualification or to control the function after LTx. To assess the patients' quality of sex life, we used The Changes in Sexual Functioning Questionnaire (CSFQ) and World Health Organization (WHO) QoL-BREF. To assess lung function, patients underwent a 6-Minute-Walk-Test (6MWT). RESULTS Patients after LTx obtained higher results-compared to patients qualified for LTx-in the WHO QoL-BREF in every domain (somatic, psychological, social, and environment). Men after LTx got more points in every domain and better total score (53 ± 5.62 vs 44.23 ± 10.28 point; P < .05) in CSFQ. Women before and after LTx obtained comparable results in CSFQ. Results of 6-Minute-Walk-Test were better among patients after LTx than in qualified patients (523.62 ± 95.71 vs 333.14 ± 145.38 and 524.12 ± 56.17 vs 317.20 ± 141.6, respectively for men and women). CONCLUSIONS Patients after LTx show better pulmonary function and quality of sex life than qualified. Preliminary results encourage us to conduct research on a larger group.
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Affiliation(s)
- Michał Błachut
- Departments of Psychiatry in Tarnowskie Góry, Medical University of Silesia, Katowice, Poland
| | - Anna Szczegielniak
- Department of Psychoprophylaxis, Medical University of Silesia, Katowice, Poland
| | - Fryderyk Zawadzki
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland.
| | - Marta Wajda-Pokrontka
- Clinical Department of Cardiac Anesthesia and Intensive Therapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Zofia Tatoj
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Tomasz Stącel
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Maciej Urlik
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Magdalena Latos
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Kaja Pelar
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Klaudia Nowak
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Piotr Przybyłowski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Marek Ochman
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
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Weisenburger G, Gault N, Roux A, Tran-Dinh A, Bunel V, Godet C, Mordant P, Montravers P, Castier Y, Mal H, Gaudry S, Messika J. Patient-important outcomes in lung transplantation: a systematic review. Respir Med Res 2022; 81:100896. [DOI: 10.1016/j.resmer.2022.100896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
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Glinskii V, Lyn R, Thomas C, de Jesus Perez VA. Recommended Reading from the Pulmonary and Critical Care Medicine Fellowship Program at Stanford University Medical Center. Am J Respir Crit Care Med 2021; 205:242-244. [PMID: 34714222 DOI: 10.1164/rccm.202102-0462rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Rachel Lyn
- Stanford University, Medicine, Stanford, California, United States
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12
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Hamada R, Oshima Y, Sato S, Yoshioka Y, Nankaku M, Kondo T, Chen-Yoshikawa TF, Ikeguchi R, Nakajima D, Date H, Matsuda S. Changes in the health-related quality of life and social reintegration status after lung transplantation following hematopoietic stem cell transplantation. Support Care Cancer 2021; 30:1831-1839. [PMID: 34609584 DOI: 10.1007/s00520-021-06592-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Late-onset non-infectious pulmonary complications (LONIPCs) after allogeneic hematopoietic stem cell transplantation are fatal; however, lung transplantation might achieve good survival. Nevertheless, improving the health-related quality of life (HRQoL) is still a major concern. This study aimed to investigate, in detail, the recovery in HRQoL and social reintegration status after lung transplantation in patients with LONIPC after allo-HSCT. METHODS This prospective cohort study involving 18 patients examined changes in the health and social reintegration status after lung transplantation following LONIPC. RESULTS Physical function and HRQoL were lowest before lung transplantation. Two years after lung transplantation, the dyspnea scores and performance status improved. Most patients had made a successful return to society, and patients who achieved social reintegration were significantly younger and had a good performance status. However, their Physical Functioning score and Physical Component Summary did not show significant improvement after lung transplantation. Moreover, recipients who were unemployed before lung transplantation were likely to remain unemployed and continued to show poor HRQoL. CONCLUSIONS These results showed poor recovery of HRQoL, especially in terms of physical function, and the likelihood of failure to reintegrate into society within 2 years after lung transplantation. It is necessary to consider long-term follow-up and physical training to improve social reintegration and HRQoL.
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Affiliation(s)
- Ryota Hamada
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yohei Oshima
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Susumu Sato
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.,Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Shogoin, 54 Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuji Yoshioka
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Graduate of School of Medicine, Kyoto University, Shogoin, 54 Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toyofumi F Chen-Yoshikawa
- Department of Thoracic Surgery, Graduate of School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Graduate of School of Medicine, Kyoto University, Shogoin, 54 Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate of School of Medicine, Kyoto University, Shogoin, 54 Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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13
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Smith P, Kandakatla A, Frankel CW, Bacon DR, Bush E, Mentz RJ, Snyder LD. Sleep quality, depressive symptoms, and transplant outcomes: Follow-up analyses from the ADAPT prospective pilot study. Gen Hosp Psychiatry 2021; 72:53-58. [PMID: 34298477 DOI: 10.1016/j.genhosppsych.2021.06.011] [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: 09/14/2020] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous studies suggested that depressive symptoms and sleep quality may be important for long-term clinical outcomes following cardiothoracic transplant. Few studies, however, have systematically examined objective markers of these behavioral factors among ambulatory transplant recipients, or their association with clinical outcomes. METHODS We examined sleep quality and depressive symptoms with subsequent clinical outcomes (hospitalizations and death) in a sample of 66 lung or heart transplant recipients using a single-center, prospective cohort study. Recipients were assessed at approximately 6 months post-transplant and completed one week of actigraphy assessment to examine sleep quality and self-report measures of mood (Centers for Epidemiologic Studies of Depression [CESD]). Recipients were followed for clinical outcomes. RESULTS At 6-months following transplantation, recipients spent the majority of daytime activity at a sedentary level (61% of daily activity [SD = 10]) and elevated depressive symptoms were common (subclinical = 17%, mild = 12%, or moderate = 8%). Over a median follow-up of 4.5 years (IQR = 0.9, 5.1), 51 participants (77%) had at least one unplanned hospitalization and 11 (17%) participants died. In addition, sleep efficiency measurements suggested that a subset of participants exhibited suboptimal sleep (mean efficiency = 87% [SD = 7]). Poorer sleep quality, indexed by lower sleep efficiency and greater sleep fragmentation, was associated with greater depressive symptoms (r's = 0.37-0.50, P < .01). Better sleep quality at 6-months (HR = 0.75 [0.60, 0.95], P = .015), including sleep efficiency (HR = 0.74 [0.56, 0.99], P = .041) and sleep fragmentation (HR = 0.71 [0.53, 0.95], P = .020) were associated with lower risk of hospitalization or death. Compared with individuals without elevated depressive symptoms or sleep difficulties, individuals with either factor (HR = 1.72 [1.05, 2.81], P = .031) or both factors (HR = 2.37 [1.35, 4.18], P = .003) exhibited greater risk of clinical events in adjusted analyses. CONCLUSIONS Sleep quality is associated with depressive symptoms among cardiothoracic transplant recipients and enhances the prognostic association between biobehavioral risk factors and clinical outcomes.
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Affiliation(s)
- PatrickJ Smith
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America; Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America.
| | - Apoorva Kandakatla
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Courtney W Frankel
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Daniel R Bacon
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, United States of America
| | - Erika Bush
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Robert J Mentz
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America
| | - Laurie D Snyder
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America
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14
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Ikeda M, Oga T, Chen-Yoshikawa TF, Tokuno J, Oto T, Okawa T, Okada Y, Akiba M, Tanaka S, Yamada Y, Yutaka Y, Ohsumi A, Nakajima D, Hamaji M, Isomi M, Chin K, Date H. Patient-reported dyspnea and health predict waitlist mortality in patients waiting for lung transplantation in Japan. Respir Res 2021; 22:116. [PMID: 33882928 PMCID: PMC8061007 DOI: 10.1186/s12931-021-01715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Waitlist mortality due to donor shortage for lung transplantation is a serious problem worldwide. Currently, the selection of recipients in Japan is mainly based on the registration order. Hence, scientific evidence for risk stratification regarding waitlist mortality is urgently needed. We hypothesized that patient-reported dyspnea and health would predict mortality in patients waitlisted for lung transplantation. METHODS We analyzed factors related to waitlist mortality using data of 203 patients who were registered as candidates for lung transplantation from deceased donors. Dyspnea was evaluated using the modified Medical Research Council (mMRC) dyspnea scale, and the health status was determined with St. George's Respiratory Questionnaire (SGRQ). RESULTS Among 197 patients who met the inclusion criteria, the main underlying disease was interstitial lung disease (99 patients). During the median follow-up period of 572 days, 72 patients died and 96 received lung transplantation (69 from deceased donors). Univariable competing risk analyses revealed that both mMRC dyspnea and SGRQ Total score were significantly associated with waitlist mortality (p = 0.003 and p < 0.001, respectively) as well as age, interstitial lung disease, arterial partial pressure of carbon dioxide, and forced vital capacity. Multivariable competing risk analyses revealed that the mMRC and SGRQ score were associated with waitlist mortality in addition to age and interstitial lung disease. CONCLUSIONS Both mMRC dyspnea and SGRQ score were significantly associated with waitlist mortality, in addition to other clinical variables such as patients' background, underlying disease, and pulmonary function. Patient-reported dyspnea and health may be measured through multi-dimensional analysis (including subjective perceptions) and for risk stratification regarding waitlist mortality.
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Affiliation(s)
- Masaki Ikeda
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | | | - Junko Tokuno
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahiro Oto
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Tomoyo Okawa
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Miki Akiba
- Division of Organ Transplantation, Tohoku University Hospital, Sendai, Japan
| | - Satona Tanaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshito Yamada
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yojiro Yutaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Maki Isomi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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15
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Stącel T, Jaworska I, Zawadzki F, Wajda-Pokrontka M, Tatoj Z, Urlik M, Nęcki M, Latos M, Szywacz W, Szczerba A, Antończyk R, Pióro A, Przybyłowskia P, Zembala M, Ochman M. Assessment of Quality of Life Among Patients After Lung Transplantation: A Single-Center Study. Transplant Proc 2020; 52:2165-2172. [PMID: 32682577 DOI: 10.1016/j.transproceed.2020.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/09/2020] [Accepted: 03/30/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lung transplantation (LTx) is the only effective method of treatment to improve the health and quality of life (QoL) of patients with end-stage lung diseases. After LTx, medical examination accompanied by quality of life assessment should be performed on routine follow-up visits. The aim of the study was to assess the QoL of patients after LTx. MATERIAL AND METHODS The study group consisted of 60 patients (29 women and 31 men); 20 patients received single lung transplantation (SLT), and 40 received double lung transplantation (DLT). To determine the patient's QoL, the General Health Questionnaire (GHQ), the World Health Organization Quality of Life Test-BREF (WHOQOL-BREF), and the Saint George Respiratory Questionnaire (SGRQ) were used. Spirometry and the 6-minute walk test were analyzed to examine efficiency of transplanted organs. RESULTS In SGRQ there are differences between patients with cystic fibrosis and interstitial lung disease in symptom domain (20.28% vs 39.26%, P = .025) and total score (19.38% vs 32.47%, P = .028). As reported in the GHQ, men had worse overall results than women in sten scale (5.22 points vs 4.69 points). Patients after SLT achieved similar scores in every questionnaire. CONCLUSION Studies assessing QoL should be an important addition to lung function tests and an integral part of control during postoperative follow-up visits. This study is one of the important contributions to understanding of how essential QoL is after LTx. The authors of this study realize that their work does not cover the whole issue, and further studies in this area are warranted.
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Affiliation(s)
| | - Izabela Jaworska
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Fryderyk Zawadzki
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland.
| | - Marta Wajda-Pokrontka
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Zofia Tatoj
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Maciej Urlik
- Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Magdalena Latos
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Wioletta Szywacz
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Alicja Szczerba
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Remigiusz Antończyk
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Anna Pióro
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Piotr Przybyłowskia
- First Chair of General Surgery, Jagiellonian University, Medical College, Kraków, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
| | - Marek Ochman
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland
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16
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Analysis of Optimal Health-Related Quality of Life Measures in Patients Waitlisted for Lung Transplantation. Can Respir J 2020; 2020:4912920. [PMID: 32211085 PMCID: PMC7077042 DOI: 10.1155/2020/4912920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 11/21/2019] [Indexed: 01/02/2023] Open
Abstract
Background Improving health-related quality of life (HRQL) is an important goal of lung transplantation, and St. George's Respiratory Questionnaire (SGRQ) is frequently used for assessing HRQL in patients waitlisted for lung transplantation. We hypothesized that chronic respiratory failure (CRF)-specific HRQL measures would be more suitable than the SGRQ, considering the underlying disease and its severity in these patients. Methods We prospectively collected physiological and patient-reported data (HRQL, dyspnea, and psychological status) of 199 patients newly registered in the waiting list of lung transplantation. CRF-specific HRQL measures of the Maugeri Respiratory Failure Questionnaire (MRF) and Severe Respiratory Insufficiency Questionnaire (SRI) were assessed in addition to the SGRQ. Results Compared to the MRF-26 and SRI, the score distribution of the SGRQ was skewed toward the worse ends of the scale. All domains of the MRF-26 and SRI were significantly correlated with the SGRQ. Multiple regression analyses to investigate factors predicting each HRQL score indicated that dyspnea and psychological status accounted for 12% to 28% of the variance more significantly than physiological measures did. The MRF-26 Total and SRI Summary significantly worsened from the baseline to 1 year (p < 0.001 and p < 0.001 and p < 0.001 and. Conclusions The MRF-26 and SRI are valid, discriminative, and responsive in patients waitlisted for lung transplantation. In terms of the score distribution and responsiveness, CRF-specific measures may function better in their HRQL assessment than the currently used measures do.
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17
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Blumenthal JA, Smith PJ, Sherwood A, Mabe S, Snyder L, Frankel C, McKee DC, Hamilton N, Keefe FJ, Shearer S, Schwartz J, Palmer S. Remote Therapy to Improve Outcomes in Lung Transplant Recipients: Design of the INSPIRE-III Randomized Clinical Trial. Transplant Direct 2020; 6:e535. [PMID: 32195326 PMCID: PMC7056276 DOI: 10.1097/txd.0000000000000979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/21/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Impaired functional capacity and emotional distress are associated with lower quality of life (QoL) and worse clinical outcomes in post lung transplant patients. Strategies to increase physical activity and reduce distress are needed. METHODS The Investigational Study of Psychological Interventions in Recipients of Lung Transplant-III study is a single site, parallel group randomized clinical trial in which 150 lung transplant recipients will be randomly assigned to 3 months of telephone-delivered coping skills training combined with aerobic exercise (CSTEX) or to a Standard of Care plus Education control group. The primary endpoints are a global measure of distress and distance walked on the 6-Minute Walk Test. Secondary outcomes include measures of transplant-specific QoL, frailty, health behaviors, and chronic lung allograft dysfunction-free survival. RESULTS Participants will be evaluated at baseline, at the conclusion of 3 months of weekly treatment, at 1-year follow-up, and followed annually thereafter for clinical events for up to 4 years (median = 2 y). We also will determine whether functional capacity, distress, and health behaviors (eg, physical activity, medication adherence, and volume of air forcefully exhaled in 1 second (FEV1), mediate the effects of the CSTEX intervention on clinical outcomes. CONCLUSIONS Should the CSTEX intervention result in better outcomes compared with the standard of care plus post-transplant education, the remotely delivered CSTEX intervention can be made available to all lung transplant recipients as a way of enhancing their QoL and improving clinical outcomes.
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Affiliation(s)
- James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Stephanie Mabe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Laurie Snyder
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Courtney Frankel
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Daphne C. McKee
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Natalie Hamilton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Sheila Shearer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Jeanne Schwartz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Scott Palmer
- Department of Medicine, Duke University Medical Center, Durham, NC
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18
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Barnes H, Morisset J, Molyneaux P, Westall G, Glaspole I, Collard HR. A Systematically Derived Exposure Assessment Instrument for Chronic Hypersensitivity Pneumonitis. Chest 2020; 157:1506-1512. [PMID: 31958445 DOI: 10.1016/j.chest.2019.12.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/06/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic hypersensitivity pneumonitis (CHP) is an immune-mediated interstitial lung disease (ILD) caused by inhalational exposure to environmental antigens, resulting in parenchymal fibrosis. By definition, a diagnosis of CHP assumes a history of antigen exposure, but only half of all patients eventually diagnosed with CHP will have a causative antigen identified. Individual clinician variation in eliciting a history of antigen exposure may affect the frequency and confidence of CHP diagnosis. METHODS A list of potential causative exposures were derived from a systematic review of the literature. A Delphi method was applied to an international panel of ILD experts to obtain consensus regarding technique for the elicitation of exposure to antigens relevant to a diagnosis of CHP. The consensus threshold was set at 80% agreement, and median ≤ 2, interquartile range = 0 on a 5-point Likert scale (1, strongly agree; 2, tend to agree; 3, neither agree nor disagree; 4, disagree; 5, strongly disagree). RESULTS In two rounds, 36/40 experts participated. Experts agreed on 18 exposure items to ask every patient with suspected CHP. Themes included CHP inducing exposures, features that contribute to an exposure's relevance, and quantification of a relevant exposure. Based on the results from the literature review and Delphi process, a CHP exposure assessment instrument was derived. Using cognitive interviews, the instrument was revised by patients with ILD for readability and usability. CONCLUSIONS This Delphi survey provides items that ILD experts agree are important to ask in all patients presenting with suspected CHP and provides basis for a systematically derived CHP exposure assessment instrument. Clinical utility of this exposure assessment instrument may be affected by different local prevalence patterns of exposures. Ongoing research is required to clinically validate these items and consider their impact in more geographically diverse settings.
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Affiliation(s)
- Hayley Barnes
- Department of Medicine, University of California, San Francisco, CA; Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia.
| | - Julie Morisset
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Philip Molyneaux
- National Heart and Lung Institute, Imperial College London, England; Royal Brompton Hospital, London, England
| | - Glen Westall
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Ian Glaspole
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Harold R Collard
- Department of Medicine, University of California, San Francisco, CA
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19
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Klinger RY, Cunniff C, Mamoun N, Cooter M, Hashmi N, Hopkins T, Smith P, Hartwig M, Bottiger B. Patient-Reported Chronic Pain Outcomes After Lung Transplantation. Semin Cardiothorac Vasc Anesth 2019; 24:96-103. [DOI: 10.1177/1089253219882432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic pain after lung transplantation is a significant concern, in particular given the heterogeneity of the patient population and the challenges of achieving adequate pain control amid concerns related to complex immunosuppressant regimens and the possibility of respiratory depression. We undertook a patient-reported outcomes (PRO) survey administered via our electronic health care portal to examine the postoperative incisional pain prevalence in a cohort of lung transplant recipients at a single, high-volume center where bilateral thoracosternotomy is the preferred surgical approach. The Patient Reported Outcomes Measurement Information System (PROMIS) Global Health and Pain Intensity short forms were sent to a total of 173 lung transplant recipients who were more than 2 months postsurgery at the time of the study. A total of 64 patients responded to both PROMIS surveys (response rate 38%). In the cohort of survey respondents, we observed a chronic pain incidence of 58% after lung transplantation (median pain score 1/10) and an overall good quality of life score (median score 4/5); however, only 9.4% reported moderate-severe pain (pain score ≥5/10). Survey nonrespondents had higher rates of pretransplant opioid and psychiatric medication use compared with respondents. In this study, we demonstrated the feasibility of using an electronic PRO survey for assessing postoperative pain outcomes after lung transplantation. However, measuring pain outcomes using this type of tool highlights issues of response rate and potential selection bias. Larger studies are needed to adequately assess the risk and predictors of chronic pain after lung transplantation and its impact on quality of life.
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20
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Tawil JN, Adams BA, Nicoara A, Boisen ML. Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation. Semin Cardiothorac Vasc Anesth 2019; 23:171-187. [PMID: 31064319 DOI: 10.1177/1089253219845408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Publications of note from 2018 are reviewed for the cardiothoracic transplant anesthesiologist. Strategies to expand the availability of donor organs were highlighted, including improved donor management, accumulating experience with increased-risk donors, ex vivo perfusion techniques, and donation after cardiac death. A number of reports examined posttransplant outcomes, including outcomes other than mortality, with new data-driven risk models. Use of extracorporeal support in cardiothoracic transplantation was a prominent theme. Major changes in adult heart allocation criteria were implemented, aiming to improve objectivity and transparency in the listing process. Frailty and prehabilitation emerged as targets of comprehensive perioperative risk mitigation programs.
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Affiliation(s)
| | | | | | - Michael L Boisen
- 4 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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21
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Swigris JJ. A New Tool to Capture Patients' Perceptions of the Effects of Lung Transplantation. Am J Respir Crit Care Med 2019; 199:941-943. [PMID: 30457877 PMCID: PMC6467303 DOI: 10.1164/rccm.201810-2001ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jeffrey J Swigris
- 1 Interstitial Lung Disease Program National Jewish Health Denver, Colorado
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