Journal Article Annotations
2019, 1st Quarter
Transplant Psychiatry
Paula Zimbrean, MD
March 2019
- Psychosocial consequences of living kidney donation: a prospective multicentre
study on health-related quality of life, donor-recipient relationships and
regret.
- Liver Transplant Recipients Older Than 60 Years Show Executive and Memory
Function Improvement Comparable to Younger Recipients.
PUBLICATION #1 — Transplant Psychiatry
Psychosocial consequences of living kidney donation: a prospective multicentre
study on health-related quality of life, donor-recipient relationships and
regret.
Wirken L(1)(2), van Middendorp H(1)(2), Hooghof CW(3), Sanders JF(4), Dam RE(5),
van der Pant KAMI(6), Wierdsma JM(7), Wellink H(8), van Duijnhoven EM(9), Hoitsma
AJ(3), Hilbrands LB(3), Evers AWM(1)(2)(10).
Background: Previous studies have indicated decreased health-related quality of life (HRQoL) shortly after kidney donation, returning to baseline in the longer term. However, a subgroup of donors experiences persistent HRQoL problems. To identify which HRQoL aspects are impacted most by the donation and to identify at-risk donors, more specific insight into psychosocial donation consequences is needed.
Methods: The current study examined the HRQoL course, donor-perceived consequences of donation for donors, recipients and donor-recipient relationships, and regret up to 12 months post-donation in donors from seven Dutch transplantation centres. Kidney donor candidates (n = 588) completed self-report questionnaires early in the screening procedure, of which 361 (61%) donated their kidney.
Results: Data for 230 donors (64%) with complete assessments before donation and 6 and 12 months post-donation were analysed. Results indicated that donor physical HRQoL was comparable at all time points, except for an increase in fatigue that lasted up to 12 months post-donation. Mental HRQoL decreased at 6 months post-donation, but returned to baseline at 12 months. Donors reported large improvements in recipient’s functioning and a smaller influence of the recipient’s kidney disease or transplantation on the donor’s life over time. A subgroup experienced negative donation consequences with 14% experiencing regret 12 months post-donation. Predictors of regret were more negative health perceptions and worse social functioning 6 months post-donation. The strongest baseline predictors of higher fatigue levels after donation were more pre-donation fatigue, worse general physical functioning and a younger age.
Conclusions: Future research should examine predictors of HRQoL after donation to
improve screening and to provide potential interventions in at-risk donors.
DOI: 10.1093/ndt/gfy307
PMID: 30544241
On PubMed: Nephrol Dial Transplant. 2019 Jun 1;34(6):1045-1055. doi: 10.1093/ndt/gfy307.
Annotation
Type of study: (http://ebm.bmj.com/content/early/2016/06/23/ebmed-2016-110401): cohort, prosepctive
The finding: Clinically relevant improvements of psychological functioning were found in 13–20% of donors, and a clinically relevant worsening was found in 11–27% of donors. There were no changes in the donor’s mental health functioning over time after surgery. Donor’s life was less influenced by the recipient’s kidney disease after transplantation (P < 0.001) compared to pre-transplantation, with 59% of donors experiencing moderate–much influence pre-donation, and 29–33% 6 and 12 months post-donation. Donors also felt less responsible for their recipient’s wellbeing than before transplantation.
Fourteen percent of the donors expressed regret of the donation. Higher levels of regret were associated with different pre-donation factors: worse emotional functioning of the recipient, more donor feelings of responsibility about the recipient , higher expectations about donor benefits, more anxiety, lower age,. Among the post-donation factors that influenced regret were: more influence of the recipient’s transplantation on the donor’s life, worse health perceptions, worse social functioning and worse surgery recovery.
Strength and weaknesses: This was a prospective study of the psychological status of kidney donors, who assessed quality of life , health perceptions and regret after donation in 230 kidney donors at 6 and 12 months after surgery. The study provides important information about factors associated with regret of the donation. The main limitations of this study consists in the non specific evaluation of the psychological well being (assessed by the SF 36 scale), as well as lack of analysis of other factors that may impact the quality of life, such as social support or perceived stress.
Relevance: the study provides important infomraiton about factors associated with regret of the donation in living kidney donors.
PUBLICATION #2 — Transplant Psychiatry
Liver Transplant Recipients Older Than 60 Years Show Executive and Memory
Function Improvement Comparable to Younger Recipients.
Ferman TJ(1), Keaveny AP(2), Schneekloth T(3), Heckman MG(4), Vargas E(5),
Vasquez A(1), Rummans T(6), Taner CB(2), Niazi SK(7).
Objective: We sought to determine whether age or clinical morbidities were associated with pre- and post-transplant executive and memory performance using the Brief Test of Adult Cognition by Telephone (BTACT).
Methods: Participants included 36 recipients with n = 20 in the older group (>60y) and n = 16 in the younger group (≤60 years). The BTACT was administered an average of 3 months before transplant, and at follow-up post-transplant intervals of 3, 6, and 9 months. BTACT composite scores for memory and executive function with age and education norms were obtained.
Results: Older recipients were more likely to have hepatocellular carcinoma, a lower biological MELD score at transplant, less cellular rejection, and fewer post-operative hospital days. Older and younger recipients showed comparable pre-transplant executive and memory function and comparable post-transplant improvement. Both older and younger patients showed statistically significant improvement in executive function scores at 3 months post-transplant and maintained improvement at 6 and 9 months. Memory function improved significantly in older patients by 6 months post-transplant but did not improve significantly in the younger group.
Conclusion: Older liver transplant recipients were more likely to have hepatocellular carcinoma and a lower biological MELD score than younger recipients, but both age groups showed comparable pre-transplant cognitive performance and post-transplant cognitive improvement. Additionally, a normed telephone test can be used to effectively screen and track executive and memory function post-transplant.
Copyright © 2019 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.
DOI: 10.1016/j.psym.2019.01.008
PMID: 30772017
On PubMed: Psychosomatics. 2019 Jan 23. pii: S0033-3182(19)30023-4. doi: 10.1016/j.psym.2019.01.008. [Epub ahead of print]
Annotation
Type of study:(http://ebm.bmj.com/content/early/2016/06/23/ebmed-2016-110401): prospective cohort
The finding: the study found that elderly patients who received a liver transplant showed cognitive improvement after surgery comparable with young liver transplant recipients.
Strength and weaknesses: it is important to note the assessments were collected prospectively so the change in cognitive function could be properly assessed. The cognitive assessments evaluated various aspects of cognitive function, including language and executive function. The limitations of this study consists in low numbers of subjects which did not allow a complete analysis of other factors that may have contributed to the change in cognitive function in this group. In addition, there is no information about potential liver candidates of similar age who received a transplant but opted out of the study.
Relevance: the findings of this study are important when decisions are being made on using age as a criteria for listing for transplantation. There is a tendency in the practice of transplantation to offer transplantation at a more advanced age, to patients who in the past used ot be excluded from listing as considered to be “too old”. This study shows that selected patients can improve cognitively post transplantation.
