Health-Related Quality of Life Evolution in Patients After Heart Transplantation

We analyzed the evolution of the health-related quality of life during the first year after heart transplantation (HT). A prospective, longitudinal study was performed in 13 heart transplant recipients who were assessed at four different stages: at inclusion on the HT waiting list and at 3, 6, and 12 months after receiving the graft. The instruments used were a structured interview and the 36-item Short-Form Health Survey. The results showed that, compared with pre-HT, there was progressive improvement in physical, psychologic, and social areas post-HT and that health-related quality of life was stable 6 months after receipt of the graft.     

肝移植患者家属心理状况与生活质量调查

目的 探讨肝移植患者家属的心理状况及其对生活质量的影响,为改善此类特殊人群生活质量提供依据.方法 采用焦虑、抑郁自评量表和SF-36简明健康量表,对52例肝移植患者家属进行问卷调查,分析其相关性.结果 肝移植患者家属的焦虑、抑郁得分显著高于健康人群(均P＜0.01);肝移植患者家属在生理职能、情感职能、社会功能、精神状态、活力及对健康总评价方面得分显著低于健康人群(P＜0.05,P＜0.01);焦虑、抑郁情绪与肝移植患者家属的情感职能、社会功能、精神状态、活力及健康总评价呈负相关(均P＜0.01),抑郁情绪与患者家属的生理职能呈负相关(P＜0.05).结论 肝移植患者家属存在严重的焦虑、抑郁情绪,并影响了他们的生活质量,有必要采取行之有效的干预措施.     

Quality of Life After Islet Transplantation

This study analyzed quality of life in patients with type 1 diabetes that received islet transplantation. Twenty-three subjects were followed over 3 years. In addition to an interview, patients self-completed two standardized psychometric questionnaires, HSQ 2.0 and DQOL, before and after transplant, and scores were compared. Analysis was also adjusted for potential "confounders" such as graft dysfunction, insulin therapy and adverse events. DQOL: the Impact score significantly improved at all time points of the follow-up; satisfaction and worry scales also significantly improved at selected time points. Longitudinal analysis demonstrated that reintroduction of insulin had a negative effect on all three scales, but significant improvement in Impact scale persisted even after adjusting for this factor. HSQ 2.0: only the Health Perception scale preliminarily showed significant improvement at most time points. Longitudinal analysis showed loss of significance when insulin therapy was considered. Other scores were improved only at selected time points or not affected. Bodily pain scale showed deterioration at selected times. Interview: glucose control stability, not insulin independence, was reported as the main beneficial factor influencing QOL. In conclusion, islet transplantation has a positive influence on patients' QOL, despite chronic immunosuppression side effects. Re-introduction of insulin modifies QOL outcomes.     

Quality of Life and Psychological Well-Being in Children and Adolescents After Renal Transplantation

BackgroundKidney transplantation is the predominant treatment option in patients with end-stage renal disease. The aim of this study was to evaluate the effect of the presence of a psychiatric disorder on the quality of life in children and adolescents after kidney transplantation.MethodsA total of 43 patients aged 6 to 18 years were included in the study. All participants and their parents were asked to complete the Pediatric Quality of Life Inventory (PedsQL), and families only, the Strengths and Challenges Questionnaire. Psychiatric symptoms and disorders of the patients were evaluated according to the Schedule for Mood Disorders and Schizophrenia for School-Age Children/Now and Lifetime Turkish Version. Patients were divided into 2 groups according to psychiatric symptoms and disorders.ResultsThe most common psychiatric disorder was attention deficit and hyperactivity disorder (26%). The questionnaires filled out by the patients revealed a lower Total PedsQL Score (P = .003), PedsQL Physical Functionality Score (P = .019), and PedsQL Social Functioning Score (P = .016) in patients with psychiatric disorders. When the parents filled out the questionnaires, the Total PedsQL Score was similar in both groups. The PedsQL Emotional Functionality Score (P = .001) and PedsQL School Functionality Score (P = .004) were significantly lower in patients with psychiatric disorders. The Strengths and Difficulties Questionnaire revealed significantly higher total (P = .014) and hyperactivity/inattention subscale scores (P = .001) in those with a psychiatric disorder.ConclusionsPsychiatric disorders in kidney transplant patients adversely affect the quality of life.     

综合健康教育对肾移植术后患者生活质量的影响

目的 探讨综合健康教育对肾移植术后患者生活质量的影响.方法 将50例肾移植术后患者按手术先后顺序分为观察组和对照组,各25例.对照组接受常规健康教育,由责任护士发放健康教育手册并按手册内容进行教育;观察组在此基础上接受综合健康教育,内容包括以家庭为单位的集体教育与个别指导相结合、同伴教育和网络教育等.于健康教育开始前、出院后6个月采用生活质量测量问卷对患者的生活质量进行评定.结果 观察组健康教育前后生活质量评分比较,差异有显著性意义(均P＜0.01);教育后观察组生活质量评分显著高于对照组(P＜0.05,P＜0.01).结论 综合健康教育能有效提高肾移植术后患者的生活质量.     

Quality of Life and Cost-Effectiveness 1 Year After Total Hip Arthroplasty

Quality of life index (Quality Of Well-Being [QWB]) was used to calculate the costs per quality of well year (QWY) in total hip arthroplasty (THA) and compare it to other interventions. Ninety-eight primary and/or revision THA were reviewed. Patients had minimum 1-year follow-up. Quality of life index was used to calculate the costs per QWY in primary and revision THA. Preoperative QWB for primary THA was 0.52 ± 0.06 SD; revision was 0.53 ± 0.07 SD. The QWB change at 1 year for primary THA was 0.08 ± 0.13 SD; revision THA was 0.06 ± 0.14 SD. Calculated costs per QWY were $5572 for primary procedures and $10?775 for revision procedures. Cost-effectiveness of THA compares favorably with other surgical and medical interventions such as epilepsy ablation surgery and gastric bypass surgery.     

Sleep Disturbances and Quality of Life in Patients After Living Donor Liver Transplantation

BackgroundFollowing improvements in patient and graft survival after liver transplantation (LT), the recipients' quality of life has become an important focus of patient care. Sleep is closely related to physical and mental health; however, sleep disturbances in LT patients have not yet been evaluated.MethodsWe assessed 59 LT patients (aged ≥18 years) between September 2011 and September 2012. The patients completed the restless legs syndrome (RLS), 36-item short-form health survey (SF-36), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) questionnaires. In addition, laboratory data were obtained and neuropsychological tests (NPT) were performed during study entry.ResultsThirty-eight patients (64%) were included in the poor sleep group (PSQI ≥6 or ESS ≥10). The SF-36 scores were lower in the poor sleep group than in the good sleep group. Eleven patients (18%) had RLS. An NPT score ≥3 indicated minimal hepatic encephalopathy (MHE3). The MHE3 group consisted of 22 patients (43%). The time after LT was shorter; serum albumin, branched chain amino acid/tyrosine molar ratio (BTR), and role limitations due to poor physical health were lower; and serum ammonia levels were higher in the MHE3 group than in the MHE0-2 group. When the poor sleep group was divided into subgroups (control, MHE, RLS, and unknown), MHE patients had high model for end-stage liver disease scores, high ammonia levels, and low BTR, whereas RLS patients showed a short time after LT.ConclusionSixty-four percent of recipients were classified as poor sleepers. SF-36 scores were lower for poor sleepers than good sleepers. RLS and MHE are major diseases that cause sleep disturbances in patients after LT.     

Analysis of Histologic Changes During Early Rejection After Renal Transplantation by Performing Protocol Biopsy at 1 Year After Kidney Transplantation

Background

In this retrospective study, we analyzed histologic changes identified through protocol biopsy (PB) at 1 year after kidney transplantation (KT). We focused on the pathologic changes observed in patients with a history of treatment for graft rejection within 1 year of transplantation.

Methods

Between January 2008 and December 2011, 56 patients underwent KT at our center. We assessed the histologic findings observed at 1 year after renal transplantation using the Banff 2007 classification. At our center, PBs are performed immediately after or at 1 hour after transplantation, and at 1 year after KT. PBs were performed in 39 patients; PBs could not be performed in 17 patients because of various causes. Of the 39 patients, 29 stabilized without clinical rejection and without treatment (the NTx group); 10 patients showed pathologic changes or clinical rejection after steroid pulse therapy within 1 year (the Tx group). We compared these 2 groups with respect to baseline data, renal function, and pathologic scores.

Results

The interstitial fibrosis (“ci”) score, according to the Banff classification, was significantly greater in the NTx group (0.89) than in the Tx group (0.50) at 1 year after transplantation.

Conclusions

The currently applied early steroid withdrawal regimen may be not be ideal for preventing pathologic changes occurring after KT. In addition to the PB performed 1 year after KT, PB should be performed within 1 year of renal transplantation to identify early signs of rejection and to provide access to appropriate treatment regimes.     

Functional Status and Quality of Life in Patients Surviving 10 years After Lung Transplantation

Although many lung allograft recipients achieve long-term survival, there is a lack of published data regarding these patients' functional status and quality of life (QoL). We evaluated all 10-year survivors at our institution and, utilizing the SF-36 questionnaire, compared their QoL to population normative and chronic illness data. Twenty-eight (29%) of 96 patients survived > or =10 years following 11 single, 6 bilateral and 11 heart-lung procedures. At the most recent evaluation, median FEV(1) in single and double lung recipients was predicted to be 54% and 74%, respectively. Five (18%) patients had BOS score 0, 13 (46%) BOS 1, 5 (18%) BOS 2 and 5 (18%) BOS 3 and median time to BOS was 7 years. Four (14%) patients required renal replacement therapy. Three patients (11%) developed symptomatic osteoporosis, 2 (7%) post-transplant lymphoma and 1 (4%) an ischaemic stroke. Scores for physical function, role-physical/emotional and general health, but not mental health and bodily pain, were significantly lower compared to normative and chronic illness data. Energy and social-function scores were significantly lower than normative data alone. Long-term survival after lung transplantation is characterized by an absence or delayed development of BOS, low iatrogenic morbidity and preserved mental, but reduced physical health status.     

Liver Stiffness 1 Year After Transplantation Predicts Clinical Outcomes in Patients With Recurrent Hepatitis C

The value of transient elastography (TE) to assess clinical outcomes in hepatitis C recurrence after liver transplantation (LT) has not been explored so far. We studied 144 hepatitis C–infected and 48 non–hepatitis C virus (HCV)‐infected LT recipients and evaluated the prognostic value of TE 1 year after transplantation to predict clinical decompensations and graft and patient survival. In HCV patients, cumulative probabilities of liver decompensation 5 years after LT were 8% for patients with liver stiffness measurement (LSM) <8.7 kilopascals (kPa) versus 47% for patients with LSM ≥ 8.7 kPa (p < 0.001). Five‐year graft and patient cumulative survival were 90% and 92% in patients with LSM < 8.7 kPa (p < 0.001) and 63% and 64% in patients with LSM ≥ 8.7 kPa, respectively (p < 0.001). Patients with low LSM 1 year after LT had excellent outcomes independently from receiving antiviral treatment or achieving sustained virological response (SVR). In contrast, graft survival significantly improved in patients with LSM ≥ 8.7 kPa who achieved SVR. No association between outcomes and LSM at 12 months was observed in non‐HCV patients. In conclusion, LSM 1 year after LT is a valuable tool to predict hepatitis C‐related outcomes in recurrent hepatitis C and can be used in clinical practice to identify the best candidates for antiviral therapy.     

Sport Activity and Health-Related Quality of Life After Kidney Transplantation

Objective

Considering the importance of sport activity for enhancing quality of life, the aim of this study was to investigate the effects of regular sport activity on quality of life of kidney transplant recipients.

Methods

Health-related quality of life (HRQoL) was assessed with the use of the SF-36 questionnaire on a group of 118 active kidney transplant patients (AKTPs) practicing different sports at low to moderate intensity (5 ± 4 h/wk). Scores were compared with those of 79 sedentary kidney transplant patients (SKTPs) and with 120 active healthy control subjects (AHCs).

Results

AKTPs reported higher scores than SKTPs in the SF-36 scales of Physical Functioning (P < .05), Role Limitations due to Physical Problems (P < .05), General Health (P < .01), Vitality (P < .05), Social Functioning (P < .05), Role Limitations due to Emotional Problems (P < .05), and Mental Health (P < .01). AKTPs obtained higher scores than AHCs on the Mental Health (P < .01) and Social Functioning scales (P < .01) and similar scores (P > .05) on all the other scales. The effect of quantity of sport activity was significant on the General Health (P < .01; η² = 0.05), and Role Physical scales (P = .04; η² = 0.03), with higher sport activity associated with higher HRQoL. The effect of sex was significant for Bodily Pain (P = .05; η² = 0.02), Vitality (P = .08; η² = 0.06), Social Functioning (P = .08; η² = 0.05), and Mental Health (P = .05; η² = 0.02), with male participants scoring higher than female participants.

Conclusions

This study indicates that regular sport activity significantly improves different dimensions of HRQoL among kidney transplant recipients. The benefits of sport activity go beyond its impact on physical health to involve psychologic and social components of quality of life. Spontaneous and low to moderate sport activity may play an important role after kidney transplantation that has been largely underestimated in the literature.     

Quality of Life After Liver Transplantation for Alcoholic Liver Disease

There are few data on predictive factors for alcohol relapse or long-term functional outcome after liver transplantation for alcoholic liver disease (ALD). In all 56 surviving UK patients (47 men, 9 women; mean age: 51 years; range: 33 to 69 years) who underwent transplantation for ALD at King's College Hospital over a 10-year period, alcohol relapse and outcome were assessed by outpatient and case-note review and by postal questionnaire containing (1) the Nottingham Health Profile (NHP), (2) the Short-Form-36 (SF-36) Health Survey, and (3) a drug and alcohol questionnaire. At a median of 2.5 years (range: 0.5 to 10 years), 13 of the 47 respondents (28%) and 2 of the 9 nonrespondents (22%) had evidence of potentially harmful drinking (>3 units daily) at some time posttransplantation. An additional 13 patients admitted to drinking some alcohol at least once, corresponding to an overall relapse rate of 50%. The patients with harmful drinking (1) had started drinking regularly at a younger age (18 v 25 years; P = .01), (2) began drinking heavily at a younger age (30 v 40 years;P = .01), (3) had shorter pretransplantation abstinence periods (10 v 23 months; P = .02), and (4) had a longer time since transplantation (median, 5.7v 1.5 years; P = .0004) than those with no or mild alcohol relapse. They were also more likely to report sleep disturbance (NHP sleep problem score, 45 v 16;P = .01) and use benzodiazepines regularly (7 of 13v 3 of 34 patients; P = .002). Despite these differences, health dimension scores in the SF-36 and NHP posttransplantation were similar between the groups and to those of UK community controls. In the long term, at least 50% of the patients will drink again at some time posttransplantation, although at lower levels of alcohol intake than previously. Those patients with multiple predictive factors for alcohol relapse may be at greatest risk for harmful drinking and be the group that would benefit most from professional counseling. Overall, the quality of life after liver transplantation for ALD is high and broadly similar to the levels expected in the normal population. (Liver Transpl 2000;6:762-768.)     

Unplanned Readmission Within 1 Year After Heart Transplantation in Taiwan

Introduction

Survival in patients with refractory heart failure greatly improves after heart transplantation (HTx).

Objective

To evaluate the rate of unplanned readmission within the first year post-HTx and the causes of such readmission.

Patients and Methods

From January 2005 to June 2008, the 112 patients who underwent HTx were regularly followed up at our hospital. A protocol biopsy was performed every week during the first month, then every 3 months during the first year. Any unplanned readmission was discussed in detail in a transplantation meeting. Data were collected from review of medical records.

Results

The rate of unplanned readmission was 19.3% in 2005, 21.5% in 2006, 22.2% in 2007, and 20.3% in 2008. Infection was the primary cause leading to unplanned readmission in 2005 (51.5%), 2006 (42.9%), and 2008 (30.7%). Rejection was the primary cause leading to readmission in 2007 (40%). Other causes included fluid retention, pericardial effusion, anemia, and systemic diseases.

Conclusion

To reduce unplanned readmissions and to promote quality of life and long-term survival, health professionals must meticulously monitor the adverse effects of treatments including immunosuppression agents and concomitantly used medications.     

Usefulness of Follow-up Biopsies at One Year After ABO-Incompatible Kidney Transplantation

Background

Due to the shortage of deceased donor kidneys, we have expanded the indications for living-donor kidney transplantation (LKT) including ABO-incompatible (ABO-i) donors in Japan. In this study, the utility of protocol biopsies was discussed in ABO-i LKT.

Methods

Protocol biopsies have been performed on kidney graft 1 hour, 3 weeks, and 1 year after LKT in our institution. The relationship between biopsies and clinical courses was considered retrospectively in 38 cases of ABO-i LKT. The immunosuppressive regimen consisted of anti-CD20 antibody, mycophenolate mofetil, prednisolone, calcineurin inhibitor (cyclosporine or tacrolimus), and anti-CD25 antibody. Anti-ABO blood type antibody removal by plasmapheresis was performed before LKT up to 32 times. The post-transplantation regimen consisted of mycophenolate mofetil or mizoribine as an antimetabolite.

Results

Episode biopsies have been performed in 6 cases within 3 weeks post-transplantation. Each pathological diagnosis was as follows: antibody-mediated rejection (AMR; 5 cases) and calcineurin inhibitor (CNI) nephrotoxicity (1 case). Subclinical chronic active AMR was found at 1 year post-transplantation follow-up biopsies in 4 of the 6 cases. Episode biopsies have been done in the other 6 cases from 1 month to 1 year post-transplantation. Each pathological diagnosis was as follows: acute T-cell–mediated rejection (TMR; 1 case), vesicoureteral reflux (VUR; 3 cases), CNI nephrotoxicity (2 cases), and VUR + CNI nephrotoxicity (1 case). AMR was also not found at 1 year post-transplantation follow-up biopsies in them. In all cases episode biopsies were performed based on pathological diagnosis and had no graft dysfunction after that.

Conclusions

Pathological study revealed that acute AMR was found early (ie, within 3 weeks) following transplantation. Although appropriate treatment made AMR go into remission once, chronic active AMR was often found at 1-year follow-up biopsies.     

The Quality of Sex Life Among Patients Before and After Lung Transplantation: A Single-Center Study

BackgroundLung 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.MethodsThe 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).ResultsPatients 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).ConclusionsPatients after LTx show better pulmonary function and quality of sex life than qualified. Preliminary results encourage us to conduct research on a larger group.     

重返工作岗位肾移植患者社会支持与生活质量相关性研究

目的 了解重返工作岗位肾移植患者社会支持与生活质量的关系,探讨提高其生活质量的有效途径.方法 采用社会支持评定量表(SRSS)和生活质量综合评定量表(GQOLI-74)调查重返工作岗位肾移植患者29例(观察组)社会支持及生活质量情况,与未重返工作岗位肾移植患者32例(对照组)进行比较,分析观察组社会支持与生活质量的相关性.结果 两组生活质量总分及各维度得分比较,差异有统计学意义(均P<0.01);两组社会支持总分及各维度得分比较,差异有统计学意义(均P<0.01);观察组除物质功能与社会支持利用度无显著相关外,生活质量其余各维度与社会支持呈正相关(均P<0.05).结论 社会支持与重返工作岗位肾移植患者的生活质量密切相关,全社会应重视社会支持系统对重返工作岗位肾移植患者生活质量的作用,拓宽重返工作岗位肾移植患者现有的社会支持渠道,从而提高生活质量.     

Influence of Activity on Quality of Life Scores After RYGBP

Gastric bypass is one of the medically acceptable interventions for weight loss for the obese. Quality of life greatly improves after surgery. Most improvements in quality of life (QOL) after these surgeries are attributed to the weight loss. Few studies have demonstrated any contribution of other variables to positive outcomes in QOL. The purpose of this study was to suggest variables that improve QOL in this post-surgical population. The Arizona Activity Frequency Questionnaire, the Arizona Food Frequency Questionnaire, and the SF-36 survey were sent to all of the Roux-en-Y gastric bypass procedure (RYGBP) patients who had surgery 1–5 years prior to the study and performed through the same bariatric surgery center (n = 805; respondents = 265; 33%). Analysis was performed through ANOVA testing to determine relationships between selected behaviors and the SF-36 of the respondents. Comparisons of differences in SF-36 scores were analyzed using the variables of hours of activity/day (HOAD) and energy in activity/day (EEAD). Patients with more EEAD and HOAD demonstrated significantly better SF-36 scores in both mental component and physical component scores (p = 0.05) when compared to those with less EEAD or HOAD. Outcomes measured by the SF-36 tool were improved after RYGBP, if the patient expended more energy/day or was active more hours/day. The post-bariatric surgery populations will have improved QOL if the patients expend more energy and are active more hours as demonstrated in activity/day after their surgery.