| 41. |
|
|
| 42. |
- Esmaily, Sorosh, et al.
(författare)
-
Patient Outcomes after Heart Transplantation in Sweden between 1988 and 2017: Continuous Improvement in Survival.
- 2020
-
Ingår i: The Journal of heart and lung transplantation. 39 (4), S284. - : Elsevier BV. - 1557-3117 .- 1053-2498.
-
Konferensbidrag (refereegranskat)abstract
- To investigate the survival of heart transplant (HTx) recipients during different time periods in Sweden. We hypothesized that the survival for HTx recipients has improved following advancements in the management of these patients.Data was obtained through the database of the organ exchange organization Scandiatransplant. All patients who underwent HTx in Sweden between Jan 1988 and Dec 2017 were included. Patients were divided into five cohorts of six-year periods each.A total of 1137 HTx recipients were included. Main causes of transplantation were dilated cardiomyopathy (44 %) and ischemic heart disease (18 %). Retransplantation constituted a small portion of the overall total (2 %). The cohorts were similar in terms of age and gender, while later cohorts had higher BMI, lower GFR and longer ischemia time (Tab. 1). The later cohorts received organs from older donors (Tab. 1). The amount of heart transplantations performed in Sweden has increased with time (Tab. 1). Log-rank test comparing the survival curves was able to show improved survival during later eras (Fig. 1).Survival among HTx recipients has significantly improved in Sweden over time, despite less favorable recipients and donor characteristics. This was related to both reduced postoperative mortality and also improved long-time survival.
|
|
| 43. |
|
|
| 44. |
|
|
| 45. |
|
|
| 46. |
|
|
| 47. |
- Forsberg, A., et al.
(författare)
-
Fatigue One to Five Years after Lung Transplantation
- 2020
-
Ingår i: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. - : Elsevier BV. - 1557-3117. ; 39:4, s. 209-210
-
Konferensbidrag (refereegranskat)abstract
- PURPOSE: The knowledge is scarce regarding how recovery and well-being after lung transplantation is affected by various symptoms. Thus, little is known about self-management support for these recipients. Since fatigue is a symptom that severely impair well-being, the aim of this study was to explore associations between fatigue and influencing factors as perceived self-efficacy, social and psychological well-being, and recovery. METHODS: Cross-sectional, multi-center cohort study. Lung recipients (n=117) due for an annual follow-up one to five years after transplantation were screened with The Multidimensional Fatigue Inventory-20, Self-Efficacy for Managing Chronic Disease scale, Postoperative Recovery Profile questionnaire and the Organ Transplant Symptom and Well-being Instrument. RESULTS: Totally, 56% reported high general fatigue regardless of follow-up time. Regardless of time after transplantation patients reported high levels of fatigue. Lung recipients at the four-year follow-up reported most severe fatigue in all dimensions except for mental fatigue. There was no relationship between lung function (FEV1) and any of the five dimensions of fatigue. There was a weak relationship between mental fatigue and the grade of Bronchiolitis obliterans syndrome (rs-.202*). A strong negative correlation (range -.66- -.73; p<0.001) was found between four out of five dimensions of fatigue (general, physical fatigue, reduced activity and reduced motivation) and self-efficacy. A high level of fatigue was related to impaired self-efficacy. There was a strong relationship between all dimensions of fatigue and both mental and social well-being. Regardless of follow-up time, those reporting being fully or almost fully recovered were significantly less fatigued. CONCLUSION: A high level of fatigue is related to impaired self-efficacy causing a risk of impaired self-management ability and an increased demand for self-management support. Self-perceived recovery might be a matter of the lung recipient's experienced fatigue. Fatigue should be a preferred target of interventions in clinical practice due to its association to self-efficacy and recovery.
|
|
| 48. |
- Forsberg, A., et al.
(författare)
-
Fear of Graft Rejection after Heart Transplantation
- 2020
-
Ingår i: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. - : Elsevier BV. - 1557-3117. ; 39:4, s. 498-499
-
Konferensbidrag (refereegranskat)abstract
- PURPOSE: Perceived Threat of the Risk of Graft Rejection (PTRGR) is prominent in organ transplant recipients' lives. When asked about what they fear most, the commonest response is graft rejection. A reasonable assumption is that this perceived threat is also relevant for heart recipients and involves various psychological reactions, such as efforts to cope with the perceived threat. There are no published data on heart recipients' PTRGR. Therefore, the aim of the present study was to explore the perceived threat of the risk of graft rejection and its relationship to psychological general well-being and self-efficacy one to five years after heart transplantation. METHODS: A total of 79 heart recipients due for their yearly follow-up one to fiveyears after heart transplantation were included. The key instrument used was the Perceived Threat of the Risk of Graft Rejection (PTGR) covering three factors. The meaning of the first factor, graft-related threat (GRT), is a perception that the primary disease will return, leaving one as ill as before the transplantation and facing re-transplantation. The second factor, intrusive anxiety (IA), means being constantly aware of the risk of graft rejection and thinking about it all the time. It also means experiencing great anxiety, which is elevated when taking immunosuppressive medication or undergoing a biopsy. Finally, the third factor, lack of control (LOC), involves perceptions that the threat of the risk of graft rejection is beyond one's control, revealing the degree of belief that one can control and protect oneself from the threat. Additional instruments used were the Psychological General Well-being (PGWB) and Self-efficacy in chronic illness. RESULTS: Heart recipients younger than 50 years reported more graft related threat than those older than 50 years. Further, those who had experienced one or more graft rejection reported less graft related threat. Patients with good psychological well-being reported both less intrusive anxiety and higher control than those with poor psychological well-being. CONCLUSION: Fear of graft rejection, especially intrusive anxiety seems related to psychological general well-being after heart transplantation. Successful experience from graft rejection might reduce the graft related threat.
|
|
| 49. |
- Gjesdal, Grunde, et al.
(författare)
-
Waiting list and post-transplant outcome in Sweden after national centralization of heart transplant surgery
- 2024
-
Ingår i: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. - 1557-3117 .- 1053-2498. ; 43:8, s. 1318-1325
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous studies have demonstrated an association between transplantation rate per center and postoperative mortality after heart transplantation. In 2011, Sweden centralized heart transplants and waiting lists, reducing the number of centers from 3 to 2. We aimed to assess the active waiting time and pre- and post-transplant mortality before and after centralization.METHODS: Heart transplantations performed in Sweden between January 1, 2001 and December 31, 2020 were included. Background and donor organ supply data were collected from Scandiatransplant, the Swedish Thoracic Transplant Registry, and the Swedish Cardiac Surgery Registry. The Fine and Gray methods were applied to visualize cumulative incidence curves and conduct competing risk regressions. A Cox model was used to adjust for factors influencing time to post-transplant death.RESULTS: When comparing the two eras, the median active waiting time increased from 54 to 71 days (p = 0.015). The risk of mortality on the waiting list decreased in the later era (subhazard ratio 0.43; [95% confidence interval {CI} 0.25-0.74]; p = 0.002). The number of heart transplantation procedures (including pediatric patients) increased by 53%. There was a significant difference in organ utilization between eras (p = 0.033; chi-square test). 30-day and 1-year survival post-transplant rates for adults increased from 90.8% to 97.8% (p < 0.001) and from 87.9% to 94.6% (p < 0.001), respectively. 1-year mortality was reduced by 63% (hazard ratio 0.37; 95% CI 0.22-0.61).CONCLUSIONS: This nationwide study examined patients listed for and undergoing heart transplantation before and after the centralization of waiting lists and surgeries in Sweden. Waiting list mortality decreased, and 1-year post-transplantation survival was improved.
|
|
| 50. |
|
|
