Predictors of post-traumatic psychological growth in the late years after lung transplantation.

Background: Although lung transplantation improves quality of life, most psychosocial research focuses on adverse psychological and social functioning outcomes. Positive effects, particularly in the late-term years as physical morbidities increase, have received little attention. We provide the first data on a psychological benefit - post-traumatic growth (PTG) - and we focused on long-term (>5 yr) survivors.

Onset and risk factors for anxiety and depression during the first 2 years after lung transplantation.

Objective: Anxiety disorders are prominent in chronic lung disease; lung transplant recipients may therefore also be at high risk for these disorders. We sought to provide the first prospective data on rates and risk factors for anxiety disorders as well as depressive disorders during the first 2 years after transplantation.

Method: A total of 178 lung recipients and a comparison group (126 heart recipients) received psychosocial and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition assessments at 2, 7, 12, 18 and 24 months posttransplant.

Obese patients and mechanical circulatory support: weight loss, adverse events, and outcomes.

Background: Obesity and heart failure are increasingly common, but the outcomes, weight changes, and adverse events of patients with advanced heart failure and obesity on mechanical support is not well described.

Methods: We retrospectively reviewed all non-underweight patients with durable mechanical support at a single institution from January 2000 until December 2008 and compared outcomes, weight change, and Interagency Registry for Mechanically Assisted Circulatory Support-defined adverse events between obese and nonobese patients.

Results: A total of 169 patients were included; 113 (67%) nonobese and 56 (33%) obese.

Impact of renal function before mechanical circulatory support on posttransplant renal outcomes.

Background: Renal dysfunction is common before mechanical circulatory support (MCS). Mechanical circulatory support frequently improves renal function, but the impact of pre-MCS renal dysfunction on renal function after cardiac transplantation (CTX) is unknown.

Methods: Patients with MCS from January 1995 until April 2008 at a single center were included if their MCS duration was at least 60 days and they underwent successful CTX.

Long-term effects on renal function of dose-reduced calcineurin inhibitor and sirolimus in cardiac transplant patients.

Unlabelled: Calcineurin inhibitor (CNI)-associated renal insufficiency is common after cardiac transplantation (CTX); however, the addition of sirolimus allows for CNI dose reduction and this strategy may limit CNI renal toxicity. This study examines the long-term effects of such a strategy.

Methods: Patients from a single center who had CTX from 1990 to 2007 and who were converted to sirolimus and a dose-reduced CNI were compared to group-matched controls maintained on CNI and an antiproliferative agent.

Aggressive steroid weaning after cardiac transplantation is possible without the additional risk of significant rejection.

Background: Chronic steroid use after cardiac transplantation (CTX) is accompanied by co-morbidities that are dependent on length of exposure.

Methods: A retrospective review of all CTX without induction therapy from 1999-2004. After 2001, an aggressive strategy of steroid weaning was introduced.

Adherence to the medical regimen during the first two years after lung transplantation.

Background: Despite the importance of adherence to the medical regimen for maximizing health after lung transplantation, no prospective studies report on rates or risk factors for nonadherence in this patient population. Whether adherence levels differ in lung versus other types of transplant recipients is unknown.

Methods: A total of 178 lung recipients and a comparison group of 126 heart recipients were enrolled.

Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation.

Background: Despite the impact of medical regimen nonadherence on health outcomes after organ transplantation, there is mixed and conflicting evidence regarding the prevalence and predictors of posttransplant nonadherence. Clinicians require precise information on nonadherence rates in order to evaluate patients' risks for this problem.

Methods: A total of 147 studies of kidney, heart, liver, pancreas/kidney-pancreas, or lung/heart-lung recipients published between 1981 and 2005 were included in a meta-analysis.

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.