Somebody else's heart inside me: a descriptive study of psychological problems after a heart transplantation

This study describes the psychological problems of heart transplant recipients. Using a qualitative research approach, interviews were conducted with 42 patients(35 men and 7 women). Analysis of the data revealed concerns about the donor's heart and how receiving somebody else's heart might affect the recipient's own personality; feelings of guilt for the donor's death and feelings of gratitude towards the donor's family; and concerns about the recipient's own heart. These findings provide health care professionals with pointers that may aid improved information provision and maximise the use of existing coping strategies.     

Active music engagement with emotional-approach coping to improve well-being in liver and kidney transplant recipients

Liver and kidney transplant recipients report elevated psychological distress following transplant in comparison to other types of organ transplant recipients. Negative affective states can lead to immune dysregulation and adverse health behaviors, and therefore may contribute to disease. In contrast, positive affective states can broaden individuals' thoughts and actions to promote the accumulation of coping resources. Coping strategies have traditionally been conceived of as being either problem-focused or emotion-focused in nature, while contemporary theory and research supports a different division: approach-oriented strategies versus avoidance-oriented strategies. Emotional expression and processing may function as an approach-oriented coping strategy. Emotional-approach coping relates to the use of emotional expression, awareness and understanding to facilitate coping with significant life stressors. The current study evaluated the impact of music therapy with and without a specific emphasis on emotional-approach coping. This randomized, controlled trial aimed to use Active Music Engagement with Emotional-Approach Coping to improve well-being in post-operative liver and kidney transplant recipients (N = 29). Results indicated that music therapy using Emotional-Approach Coping led to significant increases in positive affect, music therapy using Active Music Engagement led to significant decreases in pain, and both conditions led to significant decreases in negative affect, an indicator of perceived stress/anxiety.     

Stress, coping, and quality of life in adult kidney transplant recipients

The purpose of this study was to identify specific stressors and coping strategies identified by adult kidney transplant recipients in the first 6 months after transplantation. Quality of life was used as the outcome measure. Subscales were rationally constructed based on literature review and logic for both the stress and coping scales. Health-related items were identified as most stressful including uncertainty about whether the transplant will be a success and concern about risk of infections and/or viruses. Work-related items were least stressful. Strongly endorsed coping strategies included items on the Distancing/detachment and Self-control/accepting responsibility subscales. Quality of life scores were significantly higher after the transplant than before. Total stress was the important predictor of quality of life before transplant. Both total stress and total coping were important predictors of quality of life after transplant. The expanded transplant nursing role provides an opportunity to identify stressors and suggest appropriate coping strategies early in the transplant experience.     

肝移植受者生活质量与医学应对方式、领悟社会支持相关性研究

目的:探讨肝移植受者生活质量现状及与医学应对方式、领悟社会支持的相关性。方法:2019年10月1日~2020年1月1日,选取某三甲医院肝移植门诊随访的203例患者为研究对象,采用一般资料调查表、肝移植后生活质量调查问卷(PLTQ)、医学应对方式问卷(MCMQ)、领悟社会支持量表(PSSS)进行问卷调查。结果:肝移植受者生活质量总分为158(127.5,165)分;生活质量与面对应对方式呈正相关(P<0.01),与回避和屈服应对方式呈负相关(P<0.01),与领悟社会支持呈正相关(P<0.01);屈服、面对和领悟社会支持总分为肝移植受者生活质量的主要影响因素,可解释总变异的74.7%。结论:肝移植受者生活质量处于中等偏上水平,仍有待提高;以面对为主要应付方式的患者生活质量更好,以回避和屈服为主要应对方式的患者生活质量更差;患者的领悟社会支持水平越高,其生活质量越好,医护人员有必要关注患者的应对方式和领悟社会支持水平,以提高患者的生活质量。     

Provision of laboratory services for heart and lung transplantation in Australia.

BACKGROUND: Laboratory services for the support of heart and lung transplantation in Australia have adapted to the special needs of the clinicians looking after the heart and lung transplantation patients. METHODS: Pre-transplantation standardized tests encompassing a wide variety of different parameters are carried out both to establish the suitability of patients for a transplant and to maximize the chance of success following this procedure. Potential solid organ recipients routinely have blood samples sent to a number of centers Australia-wide so that human leukocyte antigen (HLA) presensitization can be checked for at the time a donor becomes available in any state in Australia. Although prospective HLA matching is not performed for thoracic organ transplant recipients, pre-existing antibodies to donor HLA antigens are a contra-indication to transplantation. Following transplantation, the predominant roles of the laboratory are in the monitoring of immunosuppressive drug levels, in the detection of allograft rejection, and in the detection of bacterial infection or viral reactivation. While a number of markers have been proposed in the detection of rejection, we currently rely on interpretation of the histological analysis of biopsies. The treatment with immune suppressive agents, in particular cyclosporin A, has made organ transplantation from non-HLA identical donors possible. As cyclosporin A and other immune suppressive drugs have significant side effects, their concentrations need to be carefully followed to guarantee sufficient immune suppression while avoiding renal failure and other complications including excessive immunosuppression and infectious disease risk. Recently, the role of viral reactivation with the human cytomegalovirus (HCMV) has attained more prominence. HCMV is a potential pathogen in up to 90% of thoracic organ transplant recipients and in the pre-gancyclovir era, it was a major cause of morbidity and mortality in at-risk lung transplant recipients. New PCR-based assays that measure the viral load levels of HCMV allow earlier intervention and more appropriate treatment strategies to prevent the HCMV disease syndromes and optimize the HCMV prophylaxis strategy. CONCLUSIONS: Diagnostic pathology testing to support heart and lung transplantation is a combination of routine testing and specialized testing. Depending on the time-critical nature of the tests, this testing has to be done on site or in more centralized testing facilities. Further developments in the laboratory support of heart and lung transplantation will hopefully continue to improve both the short- and long-term outcomes of thoracic organ transplant recipients.     

Stress, coping, and quality of life in family members of kidney transplant recipients

This study explored specific stressors and identified coping strategies used by family members of kidney transplant recipients in the first 6 months following transplantation. Quality of life was also briefly examined as the outcome measure. Health-related items were identified as most stressful, and work-related items as least stressful. Self-controlling and problem-solving coping strategies were most frequently used, and escape/avoidance strategies were least used. Findings from this study have implications for development of specific teaching plans for transplant recipient families, as well as for collaborative team exploration of family stress and coping.     

Cardiorespiratory function of pediatric heart transplant recipients in the early postoperative period

In this study, we sought to assess the cardiopulmonary functions in three pediatric heart transplant recipients, two of whom are with dilated cardiomyopathy, whereas one is with cyanotic heart disease, in early postoperative period. Cardiopulmonary exercise testing was performed using an incremental cycling at 1 mo after surgery. The results revealed that our study subjects had obvious impairment in workload, oxygen consumption, and oxygen pulse at peak exercise and ventilatory threshold at 1 mo after orthotropic heart transplantation. The pediatric orthotropic heart transplantation recipients also showed a high resting heart rate (90-106 beats/min), a low peak heart rate (109-117 beats/min) during exercise, and continuous heart rate acceleration till 1 to 3 mins after the cessation of exercise. In conclusion, pediatric orthotropic heart transplant recipients have a low cardiopulmonary endurance during the early postoperative period. An early structured, individualized cardiopulmonary rehabilitation program for pediatric orthotropic heart transplant recipients will be an area for future evaluation and research.     

Predictors of perceived coping effectiveness in patients awaiting a heart transplant

BACKGROUND: The wait for a heart transplant (HT) is a very stressful time for patients; how well they cope is essential to quality of life. However, in previous research, factors that contribute to perceived coping effectiveness in HT candidates have not been identified. OBJECTIVE: To identify predictors of perceived coping effectiveness during the wait for a HT. METHODS: Adult HT candidates (N = 535) completed a booklet on multiple factors impacting on quality of life (coping, stressors, symptoms, disability, social support, interventions), plus medical data were collected from charts. The Jalowiec Coping Scale assessed coping behavior. Hierarchical regression was used to analyze five sets of predictors (total = 34) based on Lazarus' theory of stress and coping. RESULTS: The regression model explained 23% of the variance in perceived coping effectiveness. Coping styles explained the most variance, followed by coping resources, illness-related situation factors, stress appraisal, and person factors. Nine predictors were significant: less use of emotive, evasive, and fatalistic coping styles; feeling that the interventions of the HT team were very helpful; longer wait for the HT; foreseeing a favorable post-HT prognosis; more use of optimistic coping; urgent transplant status; and greater satisfaction with social support resources. CONCLUSION: Coping styles, social support, HT wait, perceived prognosis, and transplant status contributed the most to predicting perceived coping effectiveness.     

Living with cardiac resynchronization therapy: Challenges for people with heart failure

The number of people with heart failure requiring implantation of a cardiac resynchronization device is increasing in Iran. Although this intervention is an effective life‐saving treatment, several challenges are associated with patients’ lifestyle after insertion. This study identified the challenges and coping mechanisms of Iranians with heart failure living with cardiac resynchronization therapy. A qualitative approach using conventional content analysis was adopted. Seventeen people with heart failure and three nurses were recruited between December 2014 and November 2015 from a teaching hospital and a private clinic in Rasht, Iran. Participants were interviewed using semi‐structured interviews lasting 30–60 min. Five themes emerged: (i) fear of implantation, (ii) the panic of receiving a shock from the device, (iii) lack of control over life, (iv) inadequacies of the healthcare system, and (v) psychosocial coping. A heightened understanding of these challenges and coping strategies could prepare healthcare professionals to provide better routine care, education, and support to the recipients of cardiac resynchronization therapy prior to implantation, during the recovery period, and for long‐term management.     

Changes in cAMP formation in mononuclear leukocytes of heart and renal transplant recipients

In mononuclear leukocytes (MNL) of renal transplant recipients treated with cyclosporine A and prednisone, an increase of basal cAMP generation has been observed. In order to characterize the mechanisms underlying changes of cAMP generation in patients who were treated with immunosuppressives following heart transplantation, we investigated the β-adrenoceptor—G protein—adenylate cyclase signal transduction cascade in heart transplant recipients and for comparison in renal transplant recipients as well as controls. Basal cAMP formation in MNL was elevated in heart transplant recipients by 27% and in renal transplant recipients by 148% compared to controls. Following β-adrenoceptor stimulation with isoprenaline, cAMP formation in MNL of heart transplant recipients was similar to the controls, but was enhanced in renal transplant recipients to 138%. Investigation of β-adrenoceptor density on MNL as a possible cause for increased cAMP formation revealed similar receptor numbers in controls and in cardiac or renal transplant recipients. Furthermore, the increase of the β-adrenoceptor density on MNL, which is observed following infusion of isoprenaline, was similar in controls and heart transplant recipients. The amount of pertussis- and cholera toxin substrates was the same in heart transplant recipients as in controls. In contrast, MNL of renal transplant recipients showed a marked increase of G_sα by 45% and a smaller albeit significant increase of G_1α by 15%, as judged by cholera toxin and pertussis toxin labeling, respectively. Investigation of inotropic parameters by echocardiography under control conditions and during the infusion of increasing concentrations of isoprenaline revealed no difference in the basal contractility and the inotropic response to β-adrenergic stimulation in controls and heart transplant recipients. It is concluded that changes of G-protein expression are involved in the increase of the cAMP-generation in MNL of heart transplant recipients. These alterations in MNL cannot be taken as a model of cellular function in the transplanted heart, but it is reasonable to suggest that elevations of cAMP formation in MNL may contribute to the immunosuppressive effects of the treatment with cyclosporine A or corticosteroids, the mechanism of which could be an alteration of G_sα or the catalyst in renal transplant recipients and the catalyst in heart transplant recipients which occurs without any changes of β-adrenoceptors.     

Evidence of time-dependent autonomic reinnervation after heart transplantation

BACKGROUND: Confirming the clinical significance of reinnervation is important in understanding and anticipating how heart rate (HR) responses of transplant recipients to physiologic stress differs early and late after transplant from that of normal individuals. OBJECTIVES: To evaluate the functional significance of cardiac reinnervation early and late after heart transplantation. METHODS: Handgrip and deep breathing tests, passive 80 degrees head-up tilt, and heart rate (HR) responsiveness of 33 transplant recipients (n = 16 at < 5 months and n = 17 at > 1 year after transplant) were compared with those of 16 age- and sex-matched control participants. RESULTS: HR responses to handgrip and passive tilt were absent early after transplant. HR acceleration normalized but was blunted late after transplant. These findings are consistent with late (>1 year) sympathetic reinnervation in transplant recipients. CONCLUSIONS: When caring for transplant recipients, nurses should consider the time elapsed since transplant in evaluating HR responsiveness to common procedures and interventions.     

Liver transplant recipients' ability to cope during the first 12 months after transplantation--a prospective study

Little is known about the coping style and coping strategies among liver transplant recipients. The aim of this study was to evaluate the change in the sense of coherence and coping strategies among liver transplant recipients before and during the first year after liver transplantation. The aim was also to study whether or not there was any relationship between the sense of coherence and the coping strategies. Thirty-five patients met the inclusion criteria. Twenty-six-patients gave their verbal consent to participate in this longitudinal study and 21 patients (80%) completed the follow-up study. The Sense of Coherence scale (SOC) was used for investigation of coping style. The Jalowiec Coping Scale (JCS-40) was used to assess general coping behaviour. The Ethics Committee gave approval to perform this study. The group was heterogeneous regarding the change in the sense of coherence with pronounced individual changes in meaningfulness during the first 3 months and in comprehensibility 6-12 months after liver transplantation. The group showed a homogeneous pattern of change in coping strategies. Confrontational coping strategy was commonly used during the period. A relationship was found between comprehensibility and palliative coping. This prospective study indicated that coping style, assessed by the SOC scale, changed primarily at an individual level during the first year after liver transplantation while changes in coping strategies, according to JSC-40, were in common for the group. The usual coping strategy during the first posttransplant year was confrontational coping.     

Clinical experience of anesthesia management in heart transplantation

An experience is described of anesthesiological management of orthotopic heart transplantations performed to 22 males aged 16 to 54 years and 5 females aged 27 to 43 years with dilation cardiomyopathy (20 cases), ischemic heart disease (5 cases), Abramov-Fiedler myocarditis (1 case) and the combination of the aortic valve defect with ischemic heart disease (1 case). Techniques of anesthesiological management in recipients and donors are described. The period necessary for the recovery of the donor heart function is characterized and cardiotropic transplant support is described. Specific clinical course of the anesthesia depending on the pulmonary artery pressure, the type of general anesthesia used in recipients and the use of catecholamines for hemodynamic maintenance in donors during heart excision have been analysed.     

Management of heart transplant recipients: reference for primary care physicians

Heart transplantation is the treatment of choice for a select group of patients with end-stage heart failure. Survival rates have increased and complication rates have decreased due to better immunosuppressive agents, improvement in organ procurement and surgical technique, and overall increase in experience for performing heart transplantation. Involvement from primary care physicians is very important to optimize postoperative management of heart transplant recipients. In this article, we discuss the indications for heart transplantation, physiology of the denervated heart, the standard postoperative care of adult heart transplant recipients, and long-term complications. Primary care physicians must play an increasing role in the management of heart transplant recipients in the age of managed care and increasing survival rates.     

二维应变超声心动图评价移植心脏左心室收缩功能

目的应用二维应变超声心动图检测移植心脏左室壁峰值收缩应变,探讨二维应变超声心动图评价移植心脏左室收缩功能的价值。方法9例心脏移植受者共进行41次超声检查;23例正常人作为对照。记录心尖长轴观、心尖两腔观及心尖四腔观的高帧频二维图像,应用二维应变分析软件测量左室壁各节段的峰值收缩应变及心尖各切面观心肌总的峰值收缩应变、左室整体平均峰值收缩应变。结果无排异反应的心脏移植受者与正常人相比,除了4个心尖节段（后壁心尖段、前间隔心尖段、侧壁心尖段、前壁心尖段）外,左室壁各节段峰值收缩应变均显著降低（P〈0.05）;心尖各切面观心肌总的峰值收缩应变及左室整体平均峰值收缩应变均较正常显著降低（P〈0.05）。急性排异反应与无排异反应的心脏移植受者后室间隔及侧壁各节段相比,峰值收缩应变均有下降趋势,但仅后室间隔心尖段峰值收缩应变降低具有统计学意义（P〈0.05）。急性排异反应的心脏移植受者心尖四腔观心肌总的峰值收缩应变较无排异反应的心脏移植受者则显著降低（P〈0.05）。结论二维应变超声心动图可用于快速准确评价移植心脏左室收缩功能,在排异反应诊断方面具有潜在价值。     

Perceptions and Experiences of Hematopoietic Cell Transplantation Patients During the COVID-19 Pandemic

ObjectivesSince March 2020, the severe acute respiratory syndrome coronavirus-2 pandemic has affected the global community, but poses unique challenges for individuals with cancer. Patients diagnosed with hematologic malignancies undergo aggressive therapies followed by hematopoietic cell transplantation (HCT) as a potential curative treatment. HCT recipients can be immunocompromised for extended periods of time, and even pre-pandemic, transplant patients reported depression and anxiety due to restrictions and infection prevention measures they had to adhere to as part of transplant precautions. This study aimed to understand psychological distress and capture perspectives on coping strategies and access to healthcare in the HCT population during the COVID-19 pandemic.Data SourcesAdult patients who received a transplant or were awaiting transplant and had a scheduled appointment at the transplant clinic were eligible to participate in this cross-sectional study. Participants completed an online survey that included questionnaires, clinical data and demographic information.ConclusionFifty-four participants completed the survey. HCT participants reported relatively high psychological distress during the initial phase of the COVID-19 pandemic, but indicated use of healthy coping mechanisms to deal with stress.Implication for Nursing PracticeStudy data informs healthcare providers that psychological distress and mental health warrants increased attention during periods of heightened stress. Education and resources on healthy, beneficial coping strategies should be provided to support HCT patients. Nurses and advanced nurse practitioners are well poised to interact with HCT patients and provide necessary support or appropriate referral during routine clinical interactions, preparing patients for prolonged effects of the pandemic and similar future events.     

Spouse quality of life before and 1 year after heart transplantation

These results indicate that overall perceived quality of life in spouses of heart transplant patients did not change significantly from the pretransplant period to 1 year posttransplantation. Conversely, specific factors influencing quality of life such as health, socioeconomic satisfaction, family satisfaction, coping styles, and the impact of the transplant experience on the spouses' life did change after transplantation. One year after heart transplantation, spouses reported less satisfaction with their health and socioeconomic status but more satisfaction with their family than they experienced before the transplant. In addition, spouses used less fatalistic, emotive, optimistic, and self-reliant coping styles after transplant than before. Lastly, spouses perceived the transplant experience more positively after the transplant than they did before the transplant. An ideal analysis would encompass data collected at more frequent periods pretransplantation and posttransplantation. The significant negative change found in the spouses' perceived health 1 year after transplant when compared with the spouses' perceived health before the transplant was based on a single-item question. A more comprehensive measure is needed to assess the health changes in the spouse that take place over time. This investigation highlights the importance of studying the impact that a catastrophic illness has on family members and the patient. As health care systems cut costs and streamline production, the needs of spouses and family members are more likely to be ignored. As a result, at some point in the future they could enter the health care arena as patients themselves. Early interventions are thus necessary to support family members of patients during the illness and throughout the recovery trajectory.     

Cyclosporine determinations in heart and liver transplant recipients: comparison of HPLC and FPIA methods on whole blood and plasma

One hundred and eighty five whole blood samples were analysed for cyclosporine levels by fluorescence polarization immunoassay (FPIA) and high performance liquid chromatography (HPLC). 123 came from 4 heart transplant recipients (mean age +/- SD: 47.50 +/- 20.56 years) and 62 from 4 liver transplant recipients (44.50 +/- 16.52 years). FPIA was done on plasma and whole blood in heart transplant recipients, on plasma in the liver recipients. HPLC was always done on whole blood. The results show a good correlation between FPIA on plasma (y) and HPLC (x) in liver recipients (n = 62, r = 0.935, y = 1.23x + 70 ng/ml), slightly worse between FPIA on plasma (y) and HPLC (x) in heart recipients (n = 64, r = 0.610, y = 0.78x + 189 ng/ml) and mediocre for FPIA on whole blood (y) and HPLC (x) in heart recipients (n = 123, r = 0.566, y = 1.35x + 594 ng/ml).     

心脏移植受者服药依从障碍和干预策略的系统评价

目的 对心脏移植受者服药依从障碍和干预策略进行系统评价,为心脏移植科室的护理人员制订护理措施提供循证依据。 方法 检索Cochrane Library、PubMed、Embase、Science Direct、CINAHL、乔安娜布里格斯数据库、中国知网、万方数据库,检索时限为2008年1月—2019年1月,筛选文献、评价纳入研究偏倚风险后,采用内容分析法对结果进行描述性分析。 结果 共纳入23篇文献,包括9篇横断面研究、6篇队列研究、3篇纵向研究、3篇前后对照研究以及2篇随机对照试验。心脏移植受者服药不依从率为9.0%~70.0%,服药依从障碍包括个人因素、疾病相关因素、社会经济因素。干预措施涉及简化用药方案、认知教育、行为干预、情感支持等。结论 青少年、存在内疚负罪感、社会支持度差、社会经济地位低等是心脏移植受者服药依从障碍的影响因素,积极识别依从障碍因素、制订个性化综合干预策略对提高患者的依从性十分重要。