Waiting for lung transplantation: quality of life, mood, caregiving strain and benefit, and social intimacy of spouses

BACKGROUND: The emotional and physical well-being of lung transplant patients is enhanced by the availability and stability of a primary caregiver. METHODS: We describe the quality of life (QOL), mood, caregiving strain and benefits, and social intimacy of 73 lung transplant caregivers who completed the QOL Inventory, SF-36 Health Survey, Profile of Mood States, Caregiver Strain Index, Caregiver Benefit Index, and Miller Social Intimacy Scale. RESULTS: Clinically low QOL was reported by 17.8-35.6% of spouses. Relative to a normative sample, spouses reported significantly lower physical (z = 4.01, p < 0.001) and emotional (z = 7.01, p < 0.001) QOL. Over half (56.2%) had clinically elevated caregiving strain. Heightened physical strain (80.8%), inconvenience (79.5%), feeling confined (72.6%), feeling upset that patient has changed so much (69.9%) contributed most to caregiver strain, while discovering inner strength (60.3%), support from others (53.4%), and realizing what is important in life (42.5%) were noted caregiving benefits. Higher caregiving strain was associated with more mood disturbance (r = 0.42, p < 0.001), lower emotional QOL (r = -0.39, p < 0.002), lower social intimacy (r = -0.37, p < 0.002), and longer disease duration (r = 0.55, p < 0.001). CONCLUSION: Spouses of patients awaiting lung transplantation may experience QOL deficits and high caregiver strain. Interventions to improve QOL and reduce caregiver strain are needed.     

Improvement of quality of life in tacrolimus-based pediatric renal transplant recipients and their caregivers, including donors

INTRODUCTION: To date, no reports have concurrently investigated the quality of life (QOL) of both pediatric renal transplant recipients and their caregivers. We conducted a survey at nine institutions in Japan with regard to changes in QOL before and after renal transplantation. METHODS: We chose 68 pediatric renal transplant recipients whose surgery was followed by tacrolimus-based immunosuppressive therapy. Both patients and their caregivers were asked to complete self-rating questionnaires. For the patients' surveys, we used 29 questions relevant to pediatric patients, which were excerpted from Kidney Disease Quality of Life (Japanese version). The SF-36 (Japanese version) was taken by their caregivers. RESULTS: Fifty-six patients (82.4%) responded to the questionnaires. The mean age at renal transplantation and at the time of the survey was 11.1 and 15.3 years old, respectively. The general questions of the patients' survey indicated a significant QOL improvement in each of the subscales (such as physical functioning and vitality) after transplantation as compared to prior. In the questions pertaining to kidney diseases, significant QOL improvement was observed in many subscales, such as symptoms/problems and effects of kidney disease. Of the 54 caregivers (79.4%) who answered SF-36 questionnaires, 47 (87.0%) were living donors. After renal transplantation surgery for the children, a significant improvement of QOL was seen in the subscales for caregivers' mental well-being. However, a significant decrease was observed for QOL in regard to physical health.     

Mood,body image,fear of kidney failure,life satisfaction,and decisional stability following living kidney donation: Findings from the KDOC study

Prior studies demonstrate that most living kidney donors (LKDs) report no adverse psychosocial outcomes; however, changes in psychosocial functioning at the individual donor level have not been routinely captured. We studied psychosocial outcomes predonation and at 1, 6, 12, and 24 months postdonation in 193 LKDs and 20 healthy controls (HCs). There was minimal to no mood disturbance, body image concerns, fear of kidney failure, or life dissatisfaction, indicating no incremental changes in these outcomes over time and no significant differences between LKDs and HCs. The incidence of any new‐onset adverse outcomes postdonation was as follows: mood disturbance (16%), fear of kidney failure (21%), body image concerns (13%), and life dissatisfaction (10%). Multivariable analyses demonstrated that LKDs with more mood disturbance symptoms, higher anxiety about future kidney health, low body image, and low life satisfaction prior to surgery were at highest risk of these same outcomes postdonation. It is important to note that some LKDs showed improvement in psychosocial functioning from pre‐ to postdonation. Findings support the balanced presentation of psychosocial risks to potential donors as well as the development of a donor registry to capture psychosocial outcomes beyond the mandatory 2‐year follow‐up period in the United States.     

Caregivers of lung transplant candidates: do they benefit when the patient is receiving psychological services?

BACKGROUND: We recently demonstrated that a targeted psychological intervention has quality of life, mood, and social intimacy benefits for patients awaiting lung transplantation. OBJECTIVE: To evaluate the impact of the patient's participation in treatment on caregiver functioning. DESIGN AND INTERVENTION: Caregivers of patients participating in a randomized clinical trial designed to compare 2 telephone-based psychological interventions completed outcome measures at baseline and at 1 and 3 months after patients completed treatment. Patients were randomized to receive either supportive therapy (emotional and educational support) or quality-of-life therapy (a cognitive-behavioral intervention that provided specific intervention strategies to boost happiness and satisfaction in life domains that compromise overall quality of life). Caregivers did not participate directly in the interventions. Setting and Participants-Participants were 28 caregivers from a large lung transplant center in the southeastern United States. MAIN OUTCOME MEASURES: Quality of life (Quality of Life Inventory), mood disturbance (Profile of Mood States-Short Form), and social intimacy (Miller Social Intimacy Scale). RESULTS AND CONCLUSIONS: Caregivers reported higher quality of life and lower mood disturbance scores, and comparable social intimacy scores relative to the patients for whom they were caring. Caregivers whose patients received quality-of-life therapy reported vicarious gains in quality of life, mood disturbance, and social intimacy, relative to those whose patients received support therapy. Finally, the degree of change in patients' quality of life, mood disturbance, and social intimacy contributed significantly to predicting caregivers' functioning at the 3-month follow-up assessment. These findings suggest that telephone-based quality-of-life therapy has beneficial effects that extend beyond patients to their caregivers.     

A Randomized Evaluation of Quality-of-Life Therapy with Patients Awaiting Lung Transplantation

Research shows that patients wait-listed for lung transplantation have very poor quality of life (QOL). This study evaluated the effectiveness of Quality-of-Life Therapy (QOLT) in improving QOL, mood disturbance and social intimacy in adults awaiting lung transplantation. Thirty-five adults were randomized to QOLT (n = 17) or supportive therapy (ST; n = 18) and received individual, telephone-based treatment sessions. QOL, mood and social intimacy assessments were conducted at baseline and at 1 and 3 months after treatment. Repeated measures analyses of variance showed significant Condition x Time interaction effects for all three primary outcome measures. Subsequent post hoc analyses showed that the two groups did not differ significantly at baseline, but did differ significantly at the 1- and 3-month follow-up assessments. When compared to ST patients, QOLT patients had significantly higher QOL scores at the 1- and 3-month assessments, lower mood disturbance scores at the 3-month assessment, and higher social intimacy scores at the 1-month assessment. Results indicate that a patient's QOL, mood state and relationship with the primary caregiver can be positively impacted by a brief psychological intervention prior to lung transplantation.     

Thoracic muscle cross‐sectional area is associated with hospital length of stay post lung transplantation: a retrospective cohort study

Low muscle mass is common in lung transplant (LTx) candidates; however, the clinical implications have not been well described. The study aims were to compare skeletal muscle mass in LTx candidates with controls using thoracic muscle cross‐sectional area (CSA) from computed tomography and assess the association with pre‐ and post‐transplant clinical outcomes. This was a retrospective, single‐center cohort study of 527 LTx candidates [median age: 55 IQR (42–62) years; 54% male]. Thoracic muscle CSA was compared to an age‐ and sex‐matched control group. Associations between muscle CSA and pre‐transplant six‐minute walk distance (6MWD), health‐related quality of life (HRQL), delisting/mortality, and post‐transplant hospital outcomes and one‐year mortality were evaluated using multivariable regression analysis. Muscle CSA for LTx candidates was about 10% lower than controls (n = 38). Muscle CSA was associated with pre‐transplant 6MWD, but not HRQL, delisting or pre‐ or post‐transplant mortality. Muscle CSA (per 10 cm² difference) was associated with shorter hospital stay [0.7 median days 95% CI (0.2–1.3)], independent of 6MWD. In conclusion, thoracic muscle CSA is a simple, readily available estimate of skeletal muscle mass predictive of hospital length of stay, but further study is needed to evaluate the relative contribution of muscle mass versus functional deficits in LTx candidates.     

Impact of CLAD Phenotype on Survival After Lung Retransplantation: A Multicenter Study

Chronic lung allograft dysfunction (CLAD) remains a major problem after lung transplantation with no definitive treatment except redo lung transplantation (re‐LTx) in selected candidates. However, CLAD is not a homogeneous entity and different phenotypes exist. Therefore, we aimed to evaluate the effect of CLAD phenotypes on survival after re‐LTx for CLAD. Patients who underwent re‐LTx for respiratory failure secondary to CLAD in four LTx centers between 2003 and 2013 were included in this retrospective analysis. Bronchiolitis obliterans syndrome (BOS) and restrictive CLAD (rCLAD) were distinguished using pulmonary function, radiology and explant lung histopathology. Patient variables pre‐ and post‐re‐LTx were collected and analyzed. A total of 143 patients underwent re‐LTx for CLAD resulting in 94 BOS (66%) and 49 rCLAD (34%) patients. Unadjusted and adjusted survival after re‐LTx for rCLAD was worse compared to BOS (HR = 2.60, 1.59–4.24; p < 0.0001 and HR = 2.61, 1.51–4.51; p = 0.0006, respectively). Patients waiting at home prior to re‐LTx experienced better survival compared to hospitalized patients (HR 0.40; 0.23–0.72; p = 0.0022). Patients with rCLAD redeveloped CLAD earlier and were more likely to redevelop rCLAD. Survival after re‐LTx for rCLAD is worse compared to BOS. Consequently, re‐LTx for rCLAD should be critically discussed, particularly when additional peri‐operative risk factors are present.     

Factors related to caregiving for individuals with spinal cord injury compared to caregiving for individuals with other neurologic conditions

Abstract

Context/objective

To compare outcomes among caregivers of adults with spinal cord injuries (SCIs) to caregivers of adults with other neurological conditions, and determine if caregiving for SCI is associated with poor health status and chronic conditions.

Design

Secondary data analysis of 2009/2010 Behavioral Risk Factor Surveillance System survey.

Participants

Informal caregivers of adults with neurological conditions.

Outcome measures

Sociodemographics, caregiving factors (e.g. role, emotional support, life satisfaction), lifestyle behaviors, chronic conditions, and health status.

Results

Demographics and lifestyle behaviors did not differ in caregivers of adults with SCI vs. caregivers of adults with other neurological conditions (except younger age of SCI caregivers). Greater proportions of caregivers of adults with SCI had coronary heart disease (CHD) (12% vs. 6%, P = 0.06) and were obese (43% vs. 28%, P = 0.03). Frequent physical distress was reported by 20% of caregivers of persons with SCI (vs. 12% of other caregivers, P = 0.09), but mental health did not differ between caregiver groups. A greater proportion of caregivers of adults with SCI experienced insufficient sleep (47% vs. 30%, P = 0.008) and more days without enough sleep (13 vs. 9 days, P = 0.008). Odds of being younger, caregiver of a spouse, having CHD, and being obese were associated with being a caregiver of an adult with SCI.

Conclusion

Caregivers of adults with SCI report similar mental health status, but more poor sleep, and have increased odds of CHD and obesity. Interventions to address physical distress, improve sleep, and address CHD and obesity are needed in this cohort.     

The relationship between neurobehavioural problems of severe traumatic brain injury (TBI), family functioning and the psychological well-being of the spouse/caregiver: path model analysis

This study used a modern theory of stress as a framework to strengthen the understanding of the relationship between neurobehavioural problems of TBI, family functioning and psychological distress in spouse/caregivers. The research was an ex post facto design utilising a cross-sectional methodology. Path analysis was used to determine the structural effect of neurobehavioural problems on family functioning and psychological distress. Forty-seven female and 17 male spouse/caregivers of partners with severe TBI were recruited. Spouse/caregivers who reported partners with TBI as having high levels of behavioural and cognitive problems experienced high levels of unhealthy family functioning. High levels of unhealthy family functioning were related to high levels of distress in spouse/caregivers, as family functioning had a moderate influence on psychological distress. Furthermore, indirect effects of behavioural and cognitive problems operating through family functioning intensified the level of psychological distress experienced by spouse/caregivers. Additionally, spouse/caregivers who reported high levels of behavioural, communication and social problems in their partners also experienced high levels of psychological distress. This study was significant because the impact of TBI on the spouse/caregiver from a multidimensional perspective is an important and under-researched area in the brain injury and disability field.     

Neutropenia in kidney and liver transplant recipients: Risk factors and outcomes

No studies have directly compared the key characteristics and outcomes of kidney (KTx) and liver transplantation (LTx) recipients with neutropenia. In this single‐center, retrospective, cohort study, we enrolled all adult patients who received a KTx or LTx between 2000 and 2011. Neutropenia was defined as 2 consecutive absolute neutrophil count (ANC) values <1500/mm³ in patients without preexisting neutropenia. The first neutropenia episode occurring during the first year post‐transplantation was analyzed. A total of 663 patients with KTx and 354 patients with LTx met the inclusion criteria. Incidence of neutropenia was 20% in KTx and 38% in LTx, respectively. High‐risk CMV status and valganciclovir (VGCV) use were significant predictors of neutropenia for KTx recipients, but only VGCV use vs nonuse in LTx recipients. Neutropenia was associated with worse survival in KTx recipients (adjusted HR 1.95, 95% CI 1.18‐3.22, P<.01), but not in LTx recipients (adjusted HR 0.75, 95% CI 0.52‐1.10, P=.15). Sixteen acute rejection episodes were associated with preceding neutropenia in KTx recipients (HR 1.77, 95% CI 1.16‐2.68, P=.007) and 24 acute rejection episodes in LTx recipients (HR 1.41, 95% CI 0.97‐2.04, P=.07). Incidence of infection was similar in patients with and without neutropenia among KTx and LTx recipients.     

A cross-sectional study of fatigue and sleep quality before and after kidney transplantation

Fatigue and sleep disturbances are common problems for adults with chronic kidney disease or end-stage renal disease. However, these issues have not been examined much in the context of kidney transplantation (KTx). This study characterizes these outcomes in the KTx population and examines their association with psychological functioning and quality of life (QOL). A cross-sectional cohort of 100 wait-listed pre-KTx and 100 post-KTx patients at one transplant center in the United States completed validated fatigue, sleep, mood, and QOL questionnaires, and their medical records were reviewed. Pre-KTx patients had higher levels of fatigue frequency, fatigue severity, and fatigue disruptiveness than post-KTx patients. Also, pre-KTx patients had more difficulty with sleep quality, latency, duration, efficiency, and disturbance and were more likely to have "poor" sleep quality compared with post-KTx patients. Multivariate predictors of high fatigue severity for both pre- and post-KTx patients were high body mass index (BMI), poor sleep quality, and mood disturbance, while poor sleep quality was predicted by high BMI and mood disturbance. Most sociodemographic and clinical parameters were not associated with fatigue severity or sleep disturbance. Fatigue and sleep disturbances are common before and after KTx, and study findings have important implications for their assessment and management.     

An internet-based intervention to improve psychosocial outcomes in heart transplant recipients and family caregivers: development and evaluation.

BACKGROUND: Although quality of life (QOL) is generally improved by heart transplantation, medical noncompliance and mental health and QOL limitations often emerge and persist. Transplant teams' ability to address these issues is hampered because many patients reside long distances from the transplant program. We therefore conducted the first empirical evaluation of an internet-based psychosocial intervention for heart recipients and their families. METHODS: Based on focus group work and previous research, a multifaceted web-based intervention was developed with stress and medical regimen management workshops; monitored discussion groups; access to electronic communication with the transplant team; and information on transplant-related health issues. Intervention effectiveness was evaluated with 20 patients and family caregivers who used the website for 4 months (plus usual clinical care). Pre- and post-intervention assessments of mental health, QOL and medical compliance were performed. Comparison groups of 40 patients and their caregivers who received only usual care were similarly assessed. RESULTS: Relative to the comparison groups, intervention patients' depressive and anxiety symptoms, and caregivers' anxiety and hostility symptoms declined significantly (P < 0.05). QOL in social functioning significantly improved. Mental health and QOL benefits were greater among more frequent users of the website. Overall, intervention patients' medical compliance did not change. However, the sub-group using the website's medical regimen workshop showed significantly better compliance at follow-up than all other patients in attending clinic appointments, completing blood work and following diet. CONCLUSIONS: These preliminary findings suggest that a web-based intervention could have a vital role in follow-up care and in patients' and families' adjustment to heart transplantation.     

Hypogammaglobulinemia in the early period after liver transplantation in children

Data, on the kinetic and serum levels of immunoglobulins in the immediate post‐liver transplantation (LTx) period, are sparse with existing studies limited to adults or case reports of children. The aim of this study is to describe the phenomenon of hypogammaglobulinemia (HGG) in the immediate post‐transplantation period among children undergoing LTx. A retrospective 10‐yr chart review was conducted of all children who underwent LTx at a fourth‐level pediatric medical center. Fifty‐seven, of the 76 children who underwent LTx, were included in the study. Seventeen (29.8%) (mean age, 6.8 ± 5.2 yr) had HGG (11‐IgG, 1‐IgG+IgA, 1‐IgG+IgM, 4‐IgG+IgA+IgM), detected at 2 to 25 d after transplantation. Abdominal fluid was drained for 5 to 42 d; the amount drained until detection of HGG measured 27–668 mL/kg. HGG was associated with increased infection rate 0.9 episodes/patient vs. 0.17 episodes/patient (p < 0.01) in children without detected HGG. In conclusion, HGG is not rare in the immediate post‐LTx period in children, and it may place patients at increased risk of infection. Further studies are needed to delineate the rate of occurrence, risk factors, and clinical implications of hypogammaglobulinemia in this patient population.     

Donor pretreatment with nebulized complement C3a receptor antagonist mitigates brain‐death induced immunological injury post–lung transplant

Donor brain death (BD) is an inherent part of lung transplantation (LTx) and a key contributor to ischemia‐reperfusion injury (IRI). Complement activation occurs as a consequence of BD in other solid organ Tx and exacerbates IRI, but the role of complement in LTx has not been investigated. Here, we investigate the utility of delivering nebulized C3a receptor antagonist (C3aRA) pretransplant to BD donor lungs in order to reduce post‐LTx IRI. BD was induced in Balb/c donors, and lungs nebulized with C3aRA or vehicle 30 minutes prior to lung procurement. Lungs were then cold stored for 18 hours before transplantation into C57Bl/6 recipients. Donor lungs from living donors (LD) were removed and similarly stored. At 6 hours and 5 days post‐LTx, recipients of BD donor lungs had exacerbated IRI and acute rejection (AR), respectively, compared to recipients receiving LD lungs, as determined by increased histopathological injury, immune cells, and cytokine levels. A single pretransplant nebulized dose of C3aRA to the donor significantly reduced IRI as compared to vehicle‐treated BD donors, and returned IRI and AR grades to that seen following LD LTx. These data demonstrate a role for complement inhibition in the amelioration of IRI post‐LTx in the context of donor BD.     

Couples After Renal Transplantation: Impact of Sex and Relationship Quality on Adherence in a Prospective Study

BackgroundIn patients after kidney transplantation, nonadherence to immunosuppressant medication is a common problem. Identifying factors that influence adherence could optimize medical care and prevent nonadherence. Kidney transplantation is a stressful situation for the patient and also for the relatives. The recipients of renal transplants as well as the family system have to be taken into account as potential impact factors.MethodsFifty-six couples with a renal transplant recipient were investigated regarding adherence, relationship satisfaction, social support, and quality of life. Moreover, sex and role differences (patient vs partner) as well as differences within the couple were analyzed. Impact factors on adherence were identified.ResultsFemale recipients of renal transplant reported higher relationship satisfaction than male recipients, female spouses, and male spouses. Physical quality of life was lower in renal transplant recipients compared with caregivers. For male renal transplant recipients, significant predictors of adherence, such as social support, relationship quality, and quality of life emerged, whereas for female renal transplant recipients mental quality of life and education level were found to influence adherence.ConclusionsThe study reveals the importance of relationship functioning of couples after kidney transplantation, as well as considering sex and role differences. There is a need to examine the posttransplantation nonadherence risk profile of women and men separately.     

Quality of life in long-term survivors after liver transplantation: impact of recurrent viral hepatitis C virus hepatitis

Post liver transplant recurrence of infection with hepatitis C virus (HCV) occurs in approximately 50% of patients transplanted because of HCV-related liver disease. The aim of this study was to assess long-term quality of life, psychologic distress, and coping in patients with recurrent HCV after liver transplantation in comparison to patients transplanted for other etiologies of underlying liver disease. All liver transplant recipients transplanted at a University affiliated Veterans Affairs Medical Center who had greater than 6 months follow-up were sent a questionnaire investigating quality of life (assessed by Medical Outcomes study health survey SF-36), depression (assessed by Beck Depression Inventory), total mood disturbance (assessed by Profile of Mood States scale), coping (assessed by Billing and Moos Inventory of coping with illnesses), and employment status. Lower Beck Depression Inventory score (p = 0.001), lower mood disturbance score (p = 0.0001), overall satisfaction with present work (p = 0.0001), and lesser use of avoidant coping (p = 0.06) were predictors of better quality of life in long-term survivors of liver transplantation. At a mean follow-up of 4 yr after liver transplantation, patients with histopathologically diagnosed recurrent viral HCV hepatitis had significantly lower global quality of life score (mean score of 76.4 versus 86.2, p = 0.011) and physical functioning score (mean score 20 versus 25, p = 0.015), as compared to all other patients. In summary, quality of life and physical functioning were significantly impaired in liver transplant recipients with histopathologically diagnosed recurrent HCV hepatitis, as compared to those whose HCV hepatitis had not recurred or those transplanted for other reasons.     

Factors related to caregiving for individuals with spinal cord injury compared to caregiving for individuals with other neurologic conditions

Context/objective

To compare outcomes among caregivers of adults with spinal cord injuries (SCIs) to caregivers of adults with other neurological conditions, and determine if caregiving for SCI is associated with poor health status and chronic conditions.

Design

Secondary data analysis of 2009/2010 Behavioral Risk Factor Surveillance System survey.

Participants

Informal caregivers of adults with neurological conditions.

Outcome measures

Sociodemographics, caregiving factors (e.g. role, emotional support, life satisfaction), lifestyle behaviors, chronic conditions, and health status.

Results

Demographics and lifestyle behaviors did not differ in caregivers of adults with SCI vs. caregivers of adults with other neurological conditions (except younger age of SCI caregivers). Greater proportions of caregivers of adults with SCI had coronary heart disease (CHD) (12% vs. 6%, P = 0.06) and were obese (43% vs. 28%, P = 0.03). Frequent physical distress was reported by 20% of caregivers of persons with SCI (vs. 12% of other caregivers, P = 0.09), but mental health did not differ between caregiver groups. A greater proportion of caregivers of adults with SCI experienced insufficient sleep (47% vs. 30%, P = 0.008) and more days without enough sleep (13 vs. 9 days, P = 0.008). Odds of being younger, caregiver of a spouse, having CHD, and being obese were associated with being a caregiver of an adult with SCI.

Conclusion

Caregivers of adults with SCI report similar mental health status, but more poor sleep, and have increased odds of CHD and obesity. Interventions to address physical distress, improve sleep, and address CHD and obesity are needed in this cohort.     

Quality of life and patient satisfaction with outpatient care after heart transplantation in adult and pediatric patients – room for improvement?

Reduced adherence after heart transplantation increases the risk for acute rejection. Therefore, the aim of this study was to evaluate the patient’s satisfaction with outpatient care and quality of life (QOL) after pediatric and adult heart transplantation. Observational study after pediatric (n = 22) and adult (n = 65) heart transplantation and the parents of the pediatric patients (n = 22) to evaluate the patients’ satisfaction with outpatient care and QOL. Established standardized questionnaires were used for patient satisfaction (ZAP survey) and QOL (SF36); the latter was compared with the cohort of the BGS98 survey (BGS98 cohort). ZAP score: excellent results with almost all values >80. QOL: pediatric cohort showed significantly higher values in physical functioning (P = 0.041) and role physical (P = 0.003) but significantly lower values in the sub-scale general health (P = 0.02) compared to adult cohort. In comparison with BGS98 cohort, children showed almost similar results, whereas adult cohort showed worse values in physical and emotional functioning, but higher values regarding general health. The QOL of patients after pediatric heart transplantation is comparable to a standardized reference population in Germany, whereas adult patients show reduced physical and emotional functioning, but better values regarding general health. The patients’ satisfaction with the outpatient care is very high.     

Predictors and Outcomes of Health‐Related Quality of Life in Caregivers of Cardiothoracic Transplant Recipients

Cardiothoracic transplant programs generally require that transplant recipients have family caregivers to assist them posttransplant. The burden of caregiving on the family members remains poorly understood. If caregivers’ well‐being is compromised by caregiving, it may bode poorly for transplant recipients’ own health in the long‐term posttransplant. We examined caregiver health‐related quality of life (HRQOL) during the first year after their family member's transplant, its predictors and its relationship to subsequent patient survival. Adult (aged 18+) caregivers of 242 cardiothoracic transplant recipients (lung = 134; heart = 108) completed assessments of demographics, psychosocial characteristics and caregiver burden at 2 months posttransplant, and HRQOL at 2, 7 and 12 months posttransplant. Recipients’ survival time was obtained from medical records. Caregiver HRQOL was generally high across the first‐year posttransplant in emotional and social functioning; caregiver physical functioning significantly worsened. There were no differences by type of recipient transplant. Greater caregiver burden predicted poorer caregiver HRQOL in several physical domains at 12 months posttransplant. Transplant recipients whose caregivers had lower perceived general health at 12 months posttransplant showed poorer survival rates during the subsequent 7 years of follow up. Transplant teams should identify those caregivers at risk for poorer general health posttransplant to maximize positive outcomes for the entire family.     

Predictors of employment after successful kidney transplantation - a population-based study

Abstract: Introduction: Kidney transplantation is currently the treatment of choice for end‐stage renal disease. As the successful transplantation improves the physical and mental quality of life, it is expected that the transplant recipient should play a productive role in the society. The present study evaluates the occurrence and predictors of employment after kidney transplantation. Methods: Population‐based cross‐sectional study in which 272 adult kidney recipients assisted in a Brazilian Southern state were evaluated. Results: At the moment of the interview, 29% of the patients were employed. After analysis with logistic regression, the predictors of employment were male sex (OR 4.04; 95% CI 1.99–8.23), pre‐transplant employment for non‐diabetic (OR 4.35; 95% CI 3.79–4.99), diabetes for individuals who worked while on dialysis (OR 0.06; 95% CI 0.008–0.5), high educational level for individuals with mental quality of life scores above the 25th percentile (OR 3.06; 95% CI 2.98–3.14 for 50th percentile of mental quality of life). The Hosmer–Lemeshow test was of 3.33 (p = 0.91). Conclusion: The participation of the kidney transplant recipients with functioning graft into the work force in the Brazilian state of Rio Grande do Sul is low, being predicted mainly by sociodemographic factors. It was not detected any influence of patient perception of his/her physical conditions or other clinical variables, except for the presence of diabetes.