Progress in Transplantation

To evaluate the literature on the stress, coping, and quality of life of organ transplant candidates and recipients, and to place previous research within a theoretical context.

CINAHL database, Proquest database, Google Scholar; references from articles were also reviewed to identify additional data.

Qualitative and quantitative research studies and meta-analyses pertinent to the stress, coping, and quality of life of transplant candidates and recipients were selected.

Stressors associated with the transplantation process, coping strategies of transplant patients, and quality of life or transplant patients have been well researched for many years. Patients typically use problem-focused coping strategies in response to various stressors. Transplant recipients typically report a higher quality of life than do transplant candidates; however, posttransplant quality of life does not typically equal the quality of life of healthy nonpatients.

The relationship between stress, coping, and quality of life of transplant patients has not yet been systematically investigated from a theoretical perspective. Recommendations for further research are provided.

The emergence and subsequent integration of new technologies precipitate changes in roles and work lives of nurses. The nurses' work with home monitoring technologies within a spirometry-based program that transmits pulmonary function data after lung transplantation has characteristics that are distinct from other types of direct patient care. Nurses' changing roles in such programs after transplantation have not been well described.

To describe a time-motion study of 2 research nurses in the context of a home-spirometry study to monitor patients' pulmonary status after lung transplantation.

A detailed list of research nurses' 67 routine work-related activities was developed and validated to monitor and record activities of research home monitoring nurses. Two weeks of observations were completed; recordings of a second observer established reliability of observations.

In 48.8 hours of observation, 610 tasks related to monitoring of 45 patients were recorded. Task time ranged from brief seconds (eg, data review) to 39 minutes (eg, clinic visits). Between-observer intraclass correlation (r=0.96) reflected high agreement in observations of the duration of activities. Agreement for category of activity was strong (κ = 0.82), with high levels of agreement (96%). Computer tasks were the most frequent (118 tasks/week) and most time-intensive activities. Nurses' face-to-face interactions with health professionals were equally time intensive (both 267 minutes/week), but not as frequent. Data review tasks were the second most frequent (49/week), although less time-intensive (47 minutes/week).

Findings reveal patterns of effort and time expenditure in nurses' evolving roles in home monitoring of the health status of patients after lung transplantation. These findings highlight the centrality and importance of well-developed data management, computer skills, and interprofessional communication skills of nurses who perform responsibilities in this emerging role in transplantation. Efforts to streamline computerized information access, as through integrated information systems, and methods to enhance efficiency in connecting with patients in the clinic may free up time for nurses to engage in other activities of direct benefit to patients. Strategies to supplement face-to-face meetings among professionals with electronic modalities may reduce the time spent meeting, while maintaining or enhancing communication.

Social support appears to be an important component in lung transplantation. However, the relationship between social support, psychological distress, and listing status has not been evaluated in lung transplant candidates.

To evaluate the relationships between depression, anxiety, and social support in patients with end-stage lung disease being evaluated for transplantation and determine (1) relationships between social support, depression, anxiety, and coping via seeking emotional and instrumental support; (2) whether social support explains a significant proportion of the variance in depression and anxiety; and (3) whether these factors were associated with whether a patient was listed for transplant.

For this observational study, patients completed self-report questionnaires after their pretransplant evaluations. Listing status was subsequently obtained from medical records.

Participants were patients with end-stage lung disease evaluated for transplantation at a major hospital.

Medical Outcomes Study Social Support Survey, COPE Inventory, Beck Depression Inventory, and State-Trait Anxiety Inventory.

Social support was associated with depression, anxiety, and seeking support (P values < .01). When other factors related to these variables were controlled for, social support explained a significant proportion of the variance in depression (9%), state anxiety (8%), and trait anxiety (7%; all P values < .001). Patients who were listed for transplant reported seeking more emotional and instrumental support than did patients who were not listed (all P values < .05). Whether a patient was listed for transplant was not associated with depression, state anxiety, trait anxiety, or availability of social support. Results highlight the important role that coping via seeking support plays in transplant candidacy.

The Model for End-Stage Liver Disease (MELD) is used to predict short-term mortality of patients on the liver transplant waiting list and to allocate deceased donor livers for transplantation.

To examine the relationship between MELD score before transplant and quality of life and other functional status indicators after transplant.

Two-hundred sixty-five adults from 2 transplant programs completed quality-of-life measures 1 year after transplantation. A subcohort (n = 115) also completed quality-of-life assessments before transplant. Clinical parameters at the time of transplantation were collected from their medical records.

Short Form-36 Health Survey, version 2; Transplant Symptom Frequency Questionnaire.

Patients with MELD scores greater than 25 at transplantation had significantly higher scores on the Short Form-36 general health (P = .004) and physical component summary (P = .02) than did patients with MELD scores of 25 or less. However, scores on the Transplant Symptom Frequency Questionnaire did not vary significantly by MELD score. Child-Turcotte-Pugh (CTP) score, a measure of disease severity, was significantly associated with total symptom frequency after transplant (P = .03) but was not correlated with any domains on the Short Form-36. In the subcohort of 115 patients, a MELD score greater than 25 at the time of transplantation was associated with greater improvement in physical functioning (11.3 vs 4.8, P = .02), role functioning-physical (10.7 vs 4.7, P = .04), general health (11.9 vs 5.5, P = .03), vitality (10.4 vs 5.2, P = .02), and physical component summary (12.3 vs 5.4, P = .01) relative to patients with MELD scores of 15 to 25.

The relationship between disease severity before transplant and quality of life after transplant is different depending on the index of disease severity used (MELD vs CTP) and whether the assessment of quality of life is general or specific to transplant-related symptoms.

Intraoperative transfusion can affect the chance of graft survival in liver transplantation, a complicated operation with massive blood loss. Verification of factors that are predictive of intraoperative blood loss and transfusion increases the quality of anesthesia management.

To assess use of blood and blood products between 2002 and 2008 and to evaluate factors associated with blood loss and requirement for blood products in adult patients undergoing orthotopic liver transplantation via piggyback technique.

Medical charts and anesthesia records from 261 eligible adult recipients of an orthotopic liver transplant between March 2002 and May 2008 were reviewed.

Shiraz Liver Transplantation Center, the only active liver transplantation center in Iran.

Potential influencing factors in blood loss and transfusion, including sex, preoperative hemoglobin level, international normalized ratio, primary diagnosis, platelet count, creatinine level, Model for End-Stage Liver Disease (MELD) score, central venous pressure, and total anesthesia time, were measured and subjected to multivariable analysis.

Mean blood loss was 54.2 (SD, 47.9) mL/kg, the mean (SD) for amounts of blood products transfused was 25.3 (19.5) mL/kg for packed red blood cells, 2.6 (3.3) units for fresh frozen plasma, and 1.7 (3.1) units for platelets. Seven recipients (2.7%) underwent transplantation without intraoperative transfusion of red blood cells, whereas 25 patients (9.6%) received more than 10 units of red blood cells intraoperatively. Multivariable analysis showed that no preoperative factor was a predictor of blood loss or requirement for intraoperative transfusion. Transfusion of fresh frozen plasma and packed red blood cells was significantly lower in 2005, 2006, 2007, and 2008 than in 2003 to 2004 (P< .001).

Liver transplantation has become the treatment of choice for patients with end-stage liver disease. Most studies show a positive effect on quality of life after liver transplantation, but most studies are based on data from Western countries and little is known about quality of life in liver transplant recipients in Turkey or other developing countries.

To investigate liver transplant recipients' quality of life and factors affecting it, before and 3 months after transplantation in western Turkey.

Descriptive and comparative, with data collected prospectively.

Two medical centers in Western Turkey.

Sixty-five adult recipients of a liver transplant between May 15 and December 31, 2007.

Quality of life was measured by using the Nottingham Health Profile Turkish version, and sociodemographic and clinical data were collected from patients' records.

Scores on all subscales of the Nottingham Health Profile differed significantly from before to after liver transplantation. The differences between the mean scores for quality of life before and after transplantation varied significantly with the patients' sex and disease severity.