Hope, mood states and quality of life in female heart transplant recipients.

BACKGROUND: The role of hope on mood states and quality of life (QOL) in heart transplant recipients has not been examined previously. This exploratory study was done to describe levels of hope, mood states and QOL; examine relationships between these variables and demographic characteristics; and identify predictors of QOL in female heart transplant recipients. METHODS: Fifty women from a single heart transplant clinic were asked to complete the Herth Hope Index (HHI), Multiple Affect Adjective Checklist (MAACL) and SF-12 (which produces a physical component summary [PCS] and a mental component summary [MCS]). Descriptive statistics, Pearson correlations, and stepwise multiple regression were used to analyze the data. The level of statistical significance was set at 0.05. RESULTS: Patients on average were 54.7 +/- 13.0 years of age and had undergone heart transplantation 5.2 +/- 4.4 years prior to study participation. Patients reported experiencing moderately low hope, and moderately high anxiety, depression and hostility. They also exhibited low levels of QOL as reflected in their low PCS and MCS scores. There was a strong positive association between hope, mood states and MCS (p = 0.001). In a multiple regression model, age, hope and depression accounted for 69% of the variance in the MCS. CONCLUSIONS: The study supports the strong association between hope, mood states and the MCS of QOL in female heart transplant recipients. Hope was an independent predictor of mood states and QOL. This finding suggests that interventions directed at fostering hope among heart transplant recipients may be the key to improving their QOL.

Sudden, unexpected death in cardiac transplant recipients: an autopsy study.

BACKGROUND: Clinical studies indicate that sudden death (SD) is common after heart transplantation. Autopsy reports of such patients are sparse. METHODS: We performed a retrospective study of clinical and pathologic findings on all autopsied patients who underwent heart transplantation at our institution from January 1984 to July 2002. RESULTS: There were 74 patients who survived >2 months. Of these, 28 (37.8%) died suddenly. The major causes of sudden death (SD) included acute cellular rejection (ACR) (n = 11, 39.3%) and graft coronary artery disease (GCAD) (n = 11, 39.3%). In 9 patients (32.1%), there was no anatomic cause of death. These deaths, assumed to be primary arrhythmic death (PAD), occurred 5 to 36 months post-transplantation. Pre-transplant diagnosis of idiopathic dilated cardiomyopathy (IDCM) was more common in SD (13 of 28, 46.4% vs 9 of 46, 19.6%; p = 0.014). Hypertrophy was not statistically different in SD vs non-SD (79.4% vs 88.4%; p = 0.38). Coronary thrombosis was also not statistically different in sudden GCAD deaths vs non-sudden GCAD deaths (3 of 11, 27.3% vs 8 of 13, 61.5%; p = 0.09). ACR SD patients had fewer episodes of ACR in biopsies than ACR non-SD patients (93 of 190, 48.9% vs 99 of 159, 63.3%; p = 0.01). Biopsies with Quilty lesions (QL) were more frequent in patients with SD (206 of 461, 44.7% vs 243 of 710, 34.2%; p < 0.001). QL were more common in patients with GCAD (44.4%) and ACR (39.6%) than in patients who died of infection (25.7%; P < 0.001 and p < 0.01, respectively). CONCLUSIONS: SD after cardiac transplantation is common (37.8% of all deaths). ACR, in the first year, and GCAD, afterwards, are associated with SD. PAD occurred in 32.1% of SD cases, 5 to 36 months after transplantation. Pre-transplant diagnoses of IDCM and QL are more common in SD. Surprisingly, cardiac hypertrophy is not increased and coronary thrombosis is not more frequent in patients who died suddenly.