Evaluation of psychological symptoms in patients before and after simultaneous pancreas-kidney transplantation: a single-center cross-sectional study

Purpose: Simultaneous pancreas-kidney transplantation (SPKT) brings several benefits for insulin-dependent type-1 diabetic patients associated with end-stage renal disease (ESRD). However, data on psychological outcomes for the waiting list and the transplanted patients are still lacking. Methods: Using the psychological Beck inventories of anxiety (BAI) and depression (BDI), 39 patients on the waiting list were compared to 88 post-transplanted patients who had undergone SPKT. Results: Significant differences were found regarding depression (p = 0.003) but not anxiety (p = 0.161), being the pretransplant patients more vulnerable to psychological disorders. Remarkable differences were observed relative to the feeling of punishment (p < 0.001) and suicidal thoughts (p = 0.008) between the groups. It was observed that patients who waited a longer period for the transplant showed more post-transplant anxiety symptoms due to the long treatment burden (p = 0.002). Conclusions: These results demonstrated the positive impact of SPKT on psychological aspects related to depression when comparing the groups. The high number of stressors in the pretransplant stage impacts more severely the psychosocial condition of the patient.

Pancreas Transplantation from Donors after Circulatory Death: an Irrational Reluctance?

PURPOSE OF REVIEW: Beta-cell replacement is the best therapeutic option for patients with type 1 diabetes. Because of donor scarcity, more extended criteria donors are used for transplantation. Donation after circulatory death donors (DCD) are not commonly used for pancreas transplantation, because of the supposed higher risk of complications. This review gives an overview on the pathophysiology, risk factors, and outcome in DCD transplantation and discusses different preservation methods. RECENT FINDINGS: Studies on outcomes of DCD pancreata show similar results compared with those of donation after brain death (DBD), when accumulation of other risk factors is avoided. Hypothermic machine perfusion is shown to be a safe method to improve graft viability in experimental settings. DCD should not be the sole reason to decline a pancreas for transplantation. Adequate donor selection and improved preservation techniques can lead to enhanced pancreas utilization and outcome.

Past Cardiovascular Episodes Deteriorate Quality of Life of Patients With Type 1 Diabetes and End-stage Kidney Disease After Kidney or Simultaneous Pancreas and Kidney Transplantation.

BACKGROUND: The beneficial influence of kidney (KTx) or simultaneous pancreas and kidney transplantation (SPK) on quality of life (QOL) in patients with end-stage kidney disease caused by type 1 diabetes mellitus was confirmed in many studies. The aim of this study was to identify factors that influence QOL of patients in long-term follow-up after SPK or KTx. METHODS: Twenty-seven SPK and 26 KTx patients with good function of transplanted organs at least 1 year after transplantation were enrolled into the analysis. To estimate QOL of the recipients the Kidney Disease and Quality of Life Short Form was applied. RESULTS: Within the whole analyzed group, the necessity of exogenous insulin administration correlated (P < .05) with symptom/problem list (γ = -0.35), effects of kidney disease (-0.38), cognitive function (-0.47), sleep (-0.42), overall health (-0.47), physical functioning (-0.61), role-physical (-0.32), pain (-0.50), general health (-0.32), emotional well-being (-0.31), role-emotional (-0.36), social function (-0.33), energy/fatigue (-0.44), and the SF-12 physical composite (-0.44). History of cardiovascular episode correlated (P < .05) with symptom/problem list (γ = -0.59), effects of kidney disease (-0.46), burden of kidney disease (-0.56), sleep (-0.54), social support (-0.51), physical functioning (-0.55), role-physical (-0.70), pain (-0.60), general health (-0.57), emotional well-being (-0.45), role-emotional (-0.95), social function (-0.58), energy/fatigue (-0.59), SF-12 physical composite (-0.45), and SF-12 mental composite (-0.83). CONCLUSIONS: Exogenous insulin administration and history of cardiovascular episode are the most important factors influencing QOL in patients after SPK or KTx, particularly worsening its physical components.

Trasplante aislado de páncreas en diabetes tipo 1 de control lábil: A propósito de 3 casos / Isolated pancreas transplantation in patients with brittle type 1 diabetes: A report of 3 cases

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Health-related quality of life of patients awaiting kidney and simultaneous pancreas-kidney transplants.

AIM: Patients undergoing kidney and simultaneous pancreas-kidney (SPK) transplants are younger and fitter than the general dialysis population. Intuitively these patients might have better quality of life (QOL) than the general dialysis population, but their QOL scores are not well characterized. The aim of this study was to compare QOL of patients about to undergo kidney or SPK transplants with Australian dialysis outcomes and practice patterns (DOPPS) data and multiple comorbidity and age-adjusted general population data. METHODS: Patients attending Westmead Hospital for transplants from August 2009 to December 2011 were invited to complete the Kidney Disease QOL-SF(™) 1.3 (KDQOL-SF(™) 1.3) questionnaire regarding their immediate pretransplant QOL. This QOL instrument is predictive of hospitalizations and mortality. The questionnaire was completed within 4 weeks of transplantation. RESULTS: Of 180 patients seen within 4 weeks of transplantation 95 (53%) responded, with no differences from non-responders in age, sex, comorbidities or perioperative complications. Compared with DOPPS, these patients had better physical function and less pain, but significantly lower scores for role physical (CI: -19 to -4, P=0.004) and role emotional (CI: -17 to -2, P=0.018). Patients undergoing SPK transplants reported even poorer general health, energy, social support and function. Patients had lower emotional and social function than people with multiple comorbidities, with whom they shared poor general and mental health and vitality. Scores were markedly lower than the general population except for bodily pain (female). CONCLUSION: Younger, fitter patients are more vulnerable to effects of their illness on social, emotional and physical interactions and may benefit from targeted support.

If I were a rich man could I sell a pancreas? A study in the locus of oppression.

Dan Brock argues that since the unexploitable rich could sell their kidneys too, exploitation could not be an essential feature of organ vending. This paper takes his claim as the point of departure for a discussion on the locus of organ vending-associated oppression. While it accepts Brock's conclusion, it explores the possibility that such oppression is invariably found rather outside the sphere of exchange. It then analyses the implications of this possibility for the discourse surrounding the ethics of organ vending.

Patient-reported outcomes following islet cell or pancreas transplantation (alone or after kidney) in Type 1 diabetes: a systematic review.

AIMS: For selected individuals with complex Type 1 diabetes, pancreatic islet transplantation (IT) offers the potential of excellent glycaemic control without significant hypoglycaemia, balanced by the need for ongoing systemic immunosuppression. Increasingly, patient-reported outcomes (PROs) are considered alongside biomedical outcomes as a measure of transplant success. PROs in IT have not previously been compared directly with the closest alternate treatment option, pancreas transplant alone (PTA) or pancreas after kidney (PAK). METHODS: We used a Population, Intervention, Comparisons, Outcomes (PICO) strategy to search Scopus and screened 314 references for inclusion. RESULTS: Twelve studies [including PRO assessment of PAK, PTA, islet-after kidney (IAK) and islet transplant alone (ITA); n = 7-205] used a total of nine specified and two unspecified PRO measures. Results were mixed but identified some benefits which remained apparent up to 36 months post-transplant, including improvements in fear of hypoglycaemia, as well as some aspects of diabetes-specific quality of life (QoL) and general health status. Negative outcomes included short-term pain associated with the procedure, immunosuppressant side effects and depressed mood associated with loss of graft function. CONCLUSIONS: The mixed results may be attributable to limited sample sizes. Also, some PRO measures may lack sensitivity to detect actual changes, as they exclude issues and domains of life likely to be important for QoL post-transplantation and when patients may no longer perceive themselves to have diabetes. Thus, the full impact of islet/pancreas transplantation (alone or after kidney) on QoL is unknown. Furthermore, no studies have assessed patient satisfaction, which may highlight further advantages and disadvantages of transplantation.

Impact of pancreas transplantation on the quality of life of diabetic renal transplant recipients.

UNLABELLED: Simultaneous pancreas and kidney transplantation (SPKT) is considered to be the best method of treatment for patients with chronic renal failure (CRF) resulting from insulin-dependent diabetes mellitus (IDDM). The aim of the study was to compare the quality of life (QOL) of patients with IDDM and CRF subjected to SPK or kidney transplantation alone (KTA). MATERIALS AND METHODS: We analyzed 21 patients after SPKT with good function of both grafts. The results were compared with 17 patients with functioning kidney grafts. Minimal observation time was 6 months. QOL was evaluated using Kidney Disease and Quality of Life Short Form (KDQOL-SF), which was sent to recipients by post. Results were presented as medians and interquartile ranges of calculated scored KDQOL-SF points. RESULTS: Observation time was 30 months (range, 6-85). Analyzed groups did not differ as regards patient age at transplantation or duration of diabetes and dialysis treatment before transplantation. After SPKT patients reported higher QOL compared with KTA as regards symptom/problem list, 90.91 (86.36-95.46) versus 84.09 (75.00-90.91; P = .04), effects of kidney disease, 90.63 (84.38-93.75) versus 81.25 (68.75-82.14; P = .001); cognitive function, 93.33 (86.67-100.00) versus 80.00 (73.33-93.33; P = .03); overall health, 80.00 (70.00-90.00) versus 50.00 (50.00-70.00; P = .001); physical functioning, 90.00 (75.00-100.00) versus 80.00 (55.00-85.00; P = .03); and pain, 100.00 (90.00-100.00) versus 67.50 (45.00-90.00; P = .005), respectively. CONCLUSION: SPKT had a positive impact on selected parameters of QOL among patients with IDDM and CRF compared to KTA.

Qualidade de vida dos pacientes diabéticos tipo 1 submetidos a transplante / Quality of life of type 1 diabetic patients following transplantation

A qualidade de vida é um desfecho importante quando analisamos os resultados de qualquer tipo de tratamento. No que tange ao diabetes tipo 1, este desfecho torna-se de especial relevância. Os tratamentos mais eficazes para controlar esta enfermidade podem modificar ignificativamente a qualidade de vida dos pacientes. Nos casos de diabetes com complicações crônicas em estágios avançados, o transplante de órgãos passou a ser indicado de forma mais liberal, visando a melhorar a qualidade de vida deste subgrupo de enfermos. Este artigo tem como objetivo revisar as publicações que avaliaram as modificações na qualidade de vida dos pacientes diabéticos tipo 1 submetidos às diferentes modalidades de transplante de órgãos (transplante isolado de rim, transplante simultâneo de pâncreas e rim e transplante isolado de pâncreas).

Quality of life is an important outcome when the results of any type of treatment are analyzed. Concerning diabetes type 1, this outcome becomes especially relevant. The most effective treatments to control this disease may significantly affect the quality of life of the patients. In the cases of diabetes with chronic complications at advanced stages, organ transplantation came to be indicated more frequently, as a measure to improve the quality of life of this subgroup of patients. This article aimed at reviewing the published studies evaluating changes to the quality of life of type 1 diabetic patients following different types of organ transplantation (kidney transplant, simultaneous pancreas-kidney transplant, and pancreas transplant.).

Sexuality, an important component of the quality of life of the kidney transplant recipient.

People who receive a kidney transplant experience overall better quality of life (QOL) than those on dialysis. However, one area of QOL that does not seem to improve after transplant is sexuality. The purposes of this review were to evaluate the literature specific to sexuality after kidney and kidney/pancreas transplant, identify gaps in the literature, and suggest directions for future research. Sources for this review included studies published in nursing and medical journals as well as studies from the related fields of social work and psychology. This literature review revealed several factors that may affect posttransplant sexuality and sexual functioning including chronic illnesses, pretransplant dialysis, and medication side effects. In addition, numerous studies have shown that problems with sexual functioning are prevalent in the transplant population affecting up to 50% of kidney transplant recipients. These problems have a strong negative association with QOL and life satisfaction. Future research should focus on identifying the specific sexual concerns of kidney transplant recipients and on the development and testing of interventions to help alleviate these concerns.

Developing new ways to address learning needs of adult abdominal organ transplant recipients.

CONTEXT: The degree to which patients are knowledgeable about posttransplant care can affect outcomes and patients' satisfaction. Transplant team members must identify knowledge gaps, contributory factors, and innovative methods to address learning needs. OBJECTIVE: To identify patients' perceptions of their knowledge gaps and identify ways to improve current approaches to patient education. DESIGN: Nonexperimental. SETTING: Midwestern teaching hospital. PATIENTS: 726 adult abdominal organ transplant recipients. INTERVENTION(S): A patient education survey was mailed out to solid-organ transplant recipients who met study criteria. A modified version of the Patient Learning Needs Scale (PLNS) was used to identify the recipients' learning needs. Additional questions on the survey addressed factors that we hypothesized would influence responses to the PLNS and asked patients which methods would help them learn during various phases of the transplant process. MAIN OUTCOME MEASURE(S): Statistical analysis was conducted on survey responses. RESULTS: Overall, PLNS scores were satisfactory in all 4 categories. Analysis of PLNS subscales revealed significantly lower scores in the quality of life/psychosocial subscale compared with the other 3 subscales. Significantly lower scores in the medications and follow-up categories of the PLNS items were found among the group whose length of stay was between 15 to 30 days compared with patients with shorter and longer stays. A variety of different methods are desired by patients in order to get information, especially before transplant.

Evaluation of quality of life after simultaneous pancreas and kidney transplantation from living donors using short form 36.

We performed the first case of simultaneous pancreas and kidney transplantation from a living donor (LDSPK) in 2004. We examined the quality of life (QOL) of performed 6 recipients and 5 donors among 8 LDSPK from 2004 to 2007 at our institution using Short Form 36. All recipients achieved insulin and hemodialysis independence after LDSPK with positive serum C-peptide levels. Before LDSPK, all scores of the 8 specific domains of the recipients were low (28.2 +/- 10.6), indicating extremely poor QOL. Both the Physical and the Mental Component Summary Scores (PCS/MCS) quickly increased after LDSPK. PCS at 6, 12, and 24 months after LDSPK were significantly higher than the pretransplantation level. MCS were also significantly higher than the pretransplantation level. LDSPK showed prominent QOL improvement for the recipient. Complications were not observed in any donor. Although PCS decreased at 6 months after the operation, it recovered at 12 and at 24 months after the operation. MCS was maintained at more than 50 from 6 to 24 months after the operation. QOL was well preserved in the LDSPK donors despite the major surgery. In conclusion, LDSPK was confirmed to be a potent tool for treatment of type 1 diabetes mellitus patients with end-stage renal disease (ESRD) by complete normalization of glucose metabolism and renal function. In addition to these medical advantages, both their physical and mental QOL were improved by LDSPK.

Relationships between sex, race, and social class and social support networks in kidney, liver, and pancreas transplant recipients.

CONTEXT: The contribution of social support networks to the recovery of transplant recipients is an important assessment in measuring improved physical and psychosocial well-being. Social support networks are described by structure, type, and function. OBJECTIVES: (1) To describe the levels of structure (size, formal and informal support), type (concrete, emotional, and informational), and function (criticalness, direction, closeness, frequency, and duration) of the social support network and (2) to examine the relationships between individual characteristics of sex, race, and social class and social support networks. METHODS: This exploratory-descriptive study was done in a Mid-south transplant center. A total of 258 kidney, liver, and pancreas transplant recipients participated, 61% of whom were less than 50-years-old. Instruments included a demographic questionnaire, the social support network pie chart, and the social support network grid. Descriptive statistics and analysis of variance were used with a .05 significance level. RESULTS: The social support network comprised extended family (67%), with a mean of 13.68 members. Emotional support was the most prevalent type of support reported. The mean (SD) duration of support was 7.9 (4.9) years. Sex, race, and social class had no main relationships with structure and type of support. However, women had a main effect with closeness (F = 4.98, P < .03) and African Americans had significantly higher levels of frequency of support (F = 7.51, P < .01) and longer duration of support (F = 9.07, P < .01) than did whites. Social and nursing intervention may improve the network closeness in males and may also augment support frequency and duration for whites.

The concept of quality of life in organ transplantation.

The goal of organ transplantation is not only to ensure the survival of individuals with end-stage heart, lung, liver, kidney, pancreas, and small bowel diseases, but also to offer patients the health they enjoyed before the disease, achieving a good balance between the functional efficacy of the graft and the patient's psychological and physical integrity. Quality of life (QoL) assessments are used to evaluate the physical, psychological, and social domains of health, seen as distinct areas that are influenced by a person's experiences, beliefs, expectations, and perceptions, and QoL is emerging as a new medical indicator in transplantation medicine too.

Quality of life after simultaneous pancreas-kidney transplantation.

Even recipients with satisfactory function of transplanted pancreas and kidney may show physical and/or social disability due to diabetic complications. Our aims were to evaluate diabetic complications influencing recipient quality of life and to assess patients' psychosociological status. Nineteen patients with functioning grafts who consented to take part in the study, underwent clinical evaluation and answered questions regarding their quality of life. Results showed excellent endocrine pancreatic function in 17 patients. In most recipients, insulin activity and C-peptide levels were elevated owing to systemic venous drainage. Opthalmological examination revealed blindness in 7 patients (in 4 cases with onset following SPKTx) and retinopathy in 13 patients (in 5 cases it appeared after SPKTx). Assessment of the cardiovascular system revealed satisfactory cardiac function in 16 of 19 patients; 4 patients underwent amputation of a lower limb following SPKTx. All 19 recipients admitted to a great benefit of transplantation; most patients declared ability to organize their life activity and social functions and 4 had regular employment. Conversely, most patients were afraid of graft loss, and half were often sad and even depressed.

[How do patients experience their body after simultaneous pancreas-kidney transplantation? ]. / Wie reden Patienten nach einer simultanen Pankreas-Nieren-Transplantation über ihren Körper?

UNLABELLED: Simultaneous transplantation of pancreas and kidney (SPK) has become a standard procedure for type 1 diabetics with terminal kidney failure. Patients often experience SPK as a dramatic event which mobilizes a complexity of affects such as anxiety, hope, and gratitude. Patients often have fantasies regarding their bodies after transplantation which are linked to massive affects. METHODS: We investigated 8 non-selected patients in the first year after SPK by narrative interviews to study their experiences of transplantation. The interviews were audiotaped, transcribed and analysed according to Grounded Theory and ideal type analysis. RESULTS: Our patients had many different private theories and fantasies regarding transplantation. Patients' experiences were centred around themes of adoption of the transplanted organs and the protection of identity and self, and could be grouped into five ideal type sets. CONCLUSIONS: Bodily fantasies of our patients can be interpreted as specific adaptations to coping requirements after transplantation.