Estado de salud de pacientes con trasplante hepático por enfermedad relacionada con el consumo de alcohol vs. otras etiologías: estudio de cohortes / Health status of patients with liver transplantation by alcohol-related disease vs another etiology: a cohort study

Objetivo: Estudiar el estado de salud de un grupo de pacientes con trasplante hepático (TH) por enfermedad relacionada con el consumo de alcohol vs. otras etiologías, antes y después del trasplante. Método: Estudio longitudinal de cohortes en pacientes trasplantados hepáticos desde noviembre de 2019 hasta julio de 2022. Se incluyeron pacientes atendidos para un primer TH tanto electivo como urgente en la Unidad de Trasplantes de un hospital. Se excluyeron aquellos pacientes que ya portaban un órgano trasplantado y aquellos que necesitaron un re-TH en el primer mes tras el primer trasplante. Se recogieron variables sociodemográficas y clínicas, Model for End-Stage Liver Disease (MELDNa), índice de fragilidad hepática (LFI), efectos emocionales-conductuales del trasplante, nivel de ansiedad y depresión. En el análisis estadístico se utilizaron las pruebas de X2 de Pearson, t de Student, U de Mann-Whitney y el signo de Wilcoxon. Resultados: La muestra fue n = 67 pacientes trasplantados hepáticos, con una edad promedio de 56,37 años, siendo 67,2% hombres y 39% por enfermedad hepática relacionada con el alcohol (EHRA). De todos los pacientes incluidos, 9% fueron trasplantes urgentes. El consumo de alcohol se asoció con una mayor edad, una alta tasa de fragilidad hepática y una situación laboral no activa. La etiología alcohólica se correlacionó con una mayor preocupación durante los primeros seis meses después del trasplante de hígado. Conclusión: Existen diferencias en el estado de salud de los pacientes trasplantados hepáticos por EHRA vs. otra etiología. Las enfermeras deben considerar la etiología de la enfermedad hepática para orientar los cuidados y las intervenciones durante todo el proceso de trasplante.(AU)

Aim: To study the health status of a group of patients with liver transplantation by alcohol-related disease vs another etiology before and after the transplantation. Method: Longitudinal cohort study of liver transplant patients from November 2019 to July 2022. Adult patients attended in the unit of transplantation of a hospital for a first liver transplant, both elective and urgent, were included. Patients who already had a transplanted organ and those who required liver re-transplantation in the first month after the first transplant were excluded. Sociodemographic and clinical variables, MELDNa, liver frailty index, emotional-behavioral effects of transplantation, level of anxiety and depression were collected. Pearson's chi-square, Student's t, Mann-Whitney U, and Wilcoxon sign tests were used for statistical analysis. Results: The sample was n = 67 liver transplant patients with a mean age of 56.37 years, 67.2% being men and 39% due to alcohol-related liver disease. 9% of all included patients were urgent transplants. Alcohol consumption was associated with older age, a high rate of liver frailty, and a non-active work situation. Alcoholic etiology correlated with increased concern during the first six months after liver transplantation. Conclusion: There are differences in the health status between liver transplant patients for alcohol-related liver disease vs other etiology. Nurses must consider the etiology of liver disease to guide care and interventions throughout the transplant process.(AU)

Matching Hearts.

This short memoir conveys a special relationship between a nurse and her patient, a 13-year-old girl who had a liver transplant.

Relationship of Nurse-Led Education Interventions to Liver Transplant Early Readmission.

INTRODUCTION: Early hospital readmission following liver transplantation is associated with lower survival and worse long-term graft function. Language, cultural practices, and health literacy influence patient understanding of posttransplant care education. Complex medication regimes, changes in metabolism and nutrition absorption, and infection/rejection further complicate the prevention of readmission. PURPOSE: The purpose of this study was to compare the 30-day readmissions of single-organ liver transplant recipients for 1-year prior and 1-year following the implementation of nurse-led education. The study examined the demographics, clinical characteristics, and 30-day readmissions of 35 liver transplant recipients who participated in the newly designed nurse-led education and 51 liver transplant recipients who experienced the prior post-liver transplant education. DESIGN: A single-center, correlational study with a convenience sample was conducted at a Hispanic-serving South Texas hospital. The new education intervention maintained the standard education and added twice-daily mutual patient-focused goal setting between the nurse and the recipient that aligned with readiness for discharge activities/goals, structured education using abbreviated handouts written at a second-grade level available in both English and Spanish, and the use of repetition through multimodal methods. RESULTS: The odds for 30-day readmissions the year prior to the nurse-led patient education intervention were 2.088 times greater than the year following the implementation. Thirty-day readmissions were reduced by 16.3% from the 2017 cohort to the 2018 cohort. DISCUSSION: Understanding unique risk factors facilitates structured patient education which can be individualized to the patient and caregiver including collaborative nurse-patient goals.

Critical Care Management of Living Donor Liver Transplants.

This article represents a review of the postoperative management of donors and recipients after living donor liver transplant, including monitoring, liberation from mechanical ventilation, nutritional support, and pain control. Vascular complications, such as biliary and sepsis, and bleeding are also discussed. Finally, commonly used immunosuppression and antimicrobial prophylaxes are reviewed.

Graft Dysfunction and Management in Liver Transplantation.

Graft dysfunction of the liver allograft manifests across a spectrum in both timing posttransplantation and clinical presentation. This can range from mild transient abnormalities of liver tests to acute liver failure potentially leading to graft failure. The causes of graft dysfunction can be divided into those resulting in early and late graft dysfunction. Although nonspecific, liver biochemistry abnormalities are still the mainstay investigation used in monitoring for dysfunction. This article provides a summary of the main causes and management strategies for liver graft dysfunction in the early through late posttransplant stages.

Perioperative Management of the Liver Transplant Recipient.

Perioperative management of the liver transplant recipient is a team effort that requires close collaboration between intensivist, surgeon, anesthesiologist, hepatologist, nephrologist, other specialists, and hospital staff before and after surgery. Transplant viability must be reassessed regularly and particularly with each donor organ. Regular discussions with patient and family facilitate realistic determinations of goals based on patient aspirations and clinical realities. Early attention to hemodynamics with optimal resuscitation and judicious vasopressor support, respiratory care designed to minimize iatrogenic injury, and early renal support is key. Preoperative and postoperative nutritional support and physical rehabilitation should remain a focus.

Incidencia de la infección nosocomial en pacientes trasplantados hepáticos. Factores de riesgo y rol de las enfermeras / Incidence of cross infection in liver transplant patients. Risk factors and role of nursinge

Objetivo: Conocer la incidencia de infección en pacientes trasplantados hepáticos, en el postrasplante inmediato y los factores de riesgo de infección, durante el ingreso en una unidad de trasplante hepático. Metodología: Estudio descriptivo, prospectivo realizado en la Unidad de trasplante hepático del Hospital Clínic que incluyó a todos los pacientes que fueron trasplantados entre enero de 2012 y agosto de 2015(n=241). Se realizó el análisis de datos con el paquete estadístico R Comander. Las variables cualitativas se compararon con el chi2 y las cuantitativas con la t de Student, considerándose significativa una p≤ 0,05. Resultados: La incidencia de infección fue de 34,8% (n=241). Las bacterianas fueron las más frecuentes (75,3%) y dentro de estas las urinarias (34%) causadas por Escherichia coli y Klebsiella pneumoniae. Realizado el análisis multivariado en las infecciones bacterianas, se observó que el sexo, la edad y los días de estancia en hospital fueron los factores predictivos independientes. Conclusiones: La infección bacteriana en el postrasplante inmediato es común y repercute en la recuperación del paciente, implicando más días de estancia hospitalaria y más procesos invasivos. El personal de enfermería debe conocer los factores de riesgo relacionados con la infección para extremar medidas de prevención. La correcta aplicación de las recomendaciones publicadas en la bibliografía sobre la inserción, mantenimiento y retirada precoz de dispositivos médicos y el cumplimiento de la higiene de manos son fundamentales (AU)

Objective: To determine the incidence and risk factors of infection in liver transplant recipients immediately post-transplant, during admission to a liver transplant unit during the immediate post-transplant admission. Methodology: Descriptive, prospective study performed in the Liver Transplant Unit of Hospital Clínic, Barcelona. All liver transplant recipients between January 2012 and August 2015 (n=241) were included. Statistical analysis was performed with R Commander. Variables were compared with Chi-square and Student's t-test. A value of p≤.05 was considered significant. Results: The incidence of infection was 34.8%. The most frequent infections were bacterial (75.3%), particularly urinary infections (34.6%) caused by Escherichia coli and Klebsiella pneumoniae. Independent risk factors for the development of bacterial infections according to multivariate analysis were sex, age and length of hospital stay. Conclusions: Infections are a significant problem in the early post-transplant period, and are associated with longer hospitalisation periods. The role of nursing in preventing infections, by identifying risk factors, correctly applying nursing protocols in insertion, maintenance and early withdrawal of medical devices and fulfilling hand hygiene, is essential (AU)

Registered nurse intent to promote physical activity for hospitalised liver transplant recipients.

AIM: To describe how registered nurse work motivation, attitudes, subjective norm and perceived behavioural control influence intention to promote physical activity in hospitalised adult liver transplant recipients. DESIGN: Descriptive study of clinical registered nurses caring for recipients of liver transplant at a tertiary medical centre. METHODS: Intent to Mobilise Liver Transplant Recipient Scale, Work Extrinsic and Intrinsic Motivation Scale, and demographics were used to explore registered nurses' work motivation, attitudes, subjective norms, perceived behavioural control and intention to promote physical activity of hospitalised adult liver transplant recipients during the acute postoperative phase. Data analysis included demographics, comparison between scale items and analysis of factors predicting intent to mobilise. RESULTS: Factors predictive of intention to promote physical activity after liver transplant included appropriate knowledge to mobilise patients (R2  = .40) and identification of physical activity as nursing staff priority (R2  = .15) and responsibility (R2  = .03). DISCUSSION/IMPLICATIONS FOR NURSING MANAGEMENT: When implementing an early mobilisation protocol after the liver transplant, education on effects of physical activity in the immediate postoperative period are essential to promote implementation in practice. Nursing care environment and leadership must be supportive to ensure mobility is a registered nurse priority and responsibility. Nursing managers can leverage results to implement a mobility protocol.

Complicações pós-operatórias do transplante hepático: evidências para otimização da assistência de enfermagem / Las complicaciones postoperatorio de trasplante de hígado: evidencias parala optimización de la asistencia de enfermería / Postoperative complications of liver transplant: evidence for the optimization of nursing care

Objetivo: investigar as principais complicações mais frequentes no pós-operatório do transplante hepático e apontar as evidencias para a detecção precoce e otimização da assistência de enfermagem. Método: Trata-se de um estudo com abordagem quantitativa do tipo descritiva. Foram analisados todos os prontuários eletrônicos disponíveis no sistema MvPep no período de janeiro de 2012 a dezembro de 2014. Os dados foram coletados por meio de um formulário esquematizado, e, para a analise, foram transferidos para o Microsoft Office Excel 2007, transcritos em forma de tabelas e transformado em gráficos para melhor visualização dos dados. Resultados: Destacaram-se diversas complicações como as neurológicas, pulmonares, respiratórias, cardíacas, hematológicas, vasculares, biliares, as do próprio enxerto, intestinais, peritoneais, cirúrgicas, infecciosas e renais. Conclusão: Evidenciou-se a necessidade de uma assistência diferenciada e individualizada aos transplantados, com um olhar aguçado e minucioso, sendo o enfermeiro o responsável por planejá-la.

Objective: to investigate the main and most frequent complications in postoperative liver transplantation and to point out the evidence for early detection and optimization of nursing care. Method: This is a study with a quantitative approach of a descriptive type. All electronic records available in MvPep system from January 2012 to December 2014. Were analyzed. The data were collected through a schematic form, and for the analysis, they were transferred to Microsoft Office Excel 2007, transcribed in the form of tables and graphs were made for better visualization of data. Results: Several complications were noteworthy such as neurological, pulmonary, respiratory, cardiac, hematologic, vascular, biliary, the graft itself, intestinal, peritoneal, surgical, infectious and kidney related. Conclusion: The need for a differentiated and individualized assistance to the transplant patient, with a keen and thorough look, was made evident, and the nurse is responsible for planning it.

Objetivo: investigar las principales complicaciones mas frecuentes em el postoperatorio del trasplante hepatico y senalar las pruebas para La deteccion temprana y la optimizacion de los cuidados de enfermeria. Método: Se trata de un estudio con un enfoque cuantitativo descriptivo, se analizaron todos los registros electronicos disponibles en el sistema MvPep desde enero de 2012 hasta diciembre de 2014. Los datos fueron recogidos a traves de una forma esquematica, y para la analisis fueron transferidos a Microsoft Office Excel 2007, transcritos en forma de tablas y graficos fueran realizados para una mejor visualizacion de datos. Resultados: Se destacaron varias complicaciones como neurologica, pulmonar, respiratorias, cardiacas, hematologicas, vasculares, biliares, el propio injerto, intestinal, peritoneal, quirurgica, infecciosas y en el rinon. Conclusión: Se demostro la necesidad de uma atencion diferenciada e individualizada al paciente de trasplante, com una mirada penetrante y profunda, y el enfermero responsable de La planificacion de la misma.

[Risk factors for delirium in intensive care unitin liver transplant patients]. / Fattori di rischio per l'insorgenza di delirium in terapia intensiva nei pazienti sottoposti a trapianto di fegato.

. Risk factors for delirium in intensive care unit in liver transplant patients. INTRODUCTION: Delirium is a disorder of the state of consciousness characterized by acute onset and temporal variability of cognitive abilities. It is frequent in intensive care unit (ICU) and it is associated with worst outcomes. AIM: To identify risk factors for the development of delirium in patients in intensive care unit (ICU) after orthotopic liver transplantation (OLTx). METHODS: Observational retrospective study on all the patients undergoing OLTx between January 2014 and December 2015. The daily assessment for delirium was performed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), by nemed nurses. RESULTS: Of the 123 patients included, 15 (12.2%) developed post-operative delirium. The main risk factor was preoperative hepatic encephalopathy (OR = 8.80, 95% CI 2.70-28.59): the deterioration of the state of consciousness (GCS pre-OLTx score < 15) increased the risk of developing delirium (OR 6.18; IC 95% 1.51 - 25.31). A high Acute Physiologic and Health Evaluation (APACHE II) score (OR=1.29, IC 95%: 1.12-1.47) showed how patients with a more severe clinical situation at ICU admission were more likely to develop delirium. CONCLUSIONS: The risk factors identified predict the development of delirium in ICU. Its prevention with the implementation of pharmacological or other strategies may reduce the onset of delirium and improve the quality of care.

Multi-professional team's perception of nurses' competences in liver transplantations.

Objective describe the multi-professional team's perception of nurses' competences in liver transplantation programs. METHOD: descriptive study with a qualitative approach. Data were collected through a questionnaire. Participants were 12 professionals of the liver transplantation team of a reference hospital. For result interpretation, the thematic analysis technique was employed. RESULTS: the professionals assessed the competences employed by nurses as proactive, autonomous, creative, humanized, capable of teamwork, decision-making and conflict management. CONCLUSION: this study made it possible to demonstrate that members of the multi-professional team perceived nurses as professionals capable of coordinating and integrating the skills "knowing, doing, being and co-existing", enabling quality care for candidates and receivers of liver transplants, as well as for their families and/or caregivers in all perioperative phases.

Multi-professional team's perception of nurses' competences in liver transplantations / Percepción del equipo multiprofesional sobre las competencias del enfermero en el trasplante hepático / Percepção da equipe multiprofissional sobre as competências do enfermeiro no transplante hepático

ABSTRACT Objective describe the multi-professional team's perception of nurses' competences in liver transplantation programs. Method: descriptive study with a qualitative approach. Data were collected through a questionnaire. Participants were 12 professionals of the liver transplantation team of a reference hospital. For result interpretation, the thematic analysis technique was employed. Results: the professionals assessed the competences employed by nurses as proactive, autonomous, creative, humanized, capable of teamwork, decision-making and conflict management. Conclusion: this study made it possible to demonstrate that members of the multi-professional team perceived nurses as professionals capable of coordinating and integrating the skills "knowing, doing, being and co-existing", enabling quality care for candidates and receivers of liver transplants, as well as for their families and/or caregivers in all perioperative phases.

RESUMEN Objetivo: describir la percepción del equipo multiprofesional sobre las competencias del enfermero en el programa de trasplante hepático. Método: estudio descriptivo, con abordaje cualitativo. Datos recolectados mediante cuestionario, con la participación de 12 profesionales del equipo de trasplante hepático de un hospital de referencia. Para la interpretación de resultados, se utilizó técnica de análisis temático. Resultados: los profesionales evaluaron las competencias desarrolladas por el enfermero como proactiva, autónoma, creativa, humanizada, que sabe trabajar en equipo, tomar decisiones y administrar conflictos. Conclusión: este estudio permitió revelar que los miembros del equipo multiprofesional percibían al enfermero como un profesional capaz de articular e integrar los saberes "conocer, hacer, ser y convivir", permitiendo una atención de calidad al candidato y al receptor de trasplante hepático, así como también a sus familiares y/o cuidadores en todas las fases del perioperatorio.

RESUMO Objetivo: descrever a percepção da equipe multiprofissional sobre as competências do enfermeiro no programa de transplante hepático. Método: estudo descritivo com abordagem qualitativa. Os dados foram coletados por meio de questionário com participação de 12 profissionais da equipe do transplante hepático de um hospital de referência. Para interpretação dos resultados, utilizou-se a técnica de análise temática. Resultados: os profissionais avaliaram as competências desenvolvidas pelo enfermeiro como proativa, autônoma, criativa, humanizada, que sabe trabalhar em equipe, tomar decisões e administrar conflitos. Conclusão: este estudo possibilitou revelar que os membros da equipe multiprofissional percebiam o enfermeiro como um profissional capaz de articular e integrar os saberes "conhecer, fazer, ser e conviver", possibilitando uma assistência com qualidade ao candidato e ao receptor de transplante hepático, como também aos seus familiares e/ou cuidadores em todas as fases do perioperatório.

Continuidad asistencial desde atención primaria en un plan de cuidados interniveles para un caso de trasplante hepático pediátrico / Assistance continuity from primary care in an inter-level nursing plan for a case of pediatric liver transplant

España es uno de los países donde más trasplantes de órgano sólido se realizan al año, de los cuales, según datos del 2014, un 2,7% se dan en la edad pediátrica. Dada la complejidad y la gravedad de la patología es necesario establecer un plan de cuidados que abarque tanto el pretrasplante como el postrasplante, con una estrecha colaboración entre los diferentes niveles asistenciales para abordar los variados problemas que se presentan y así asegurar la continuidad asistencial. En el siguiente caso, una adolescente de origen gambiano en riesgo de exclusión social hizo que la colaboración entre la enfermera de asistencia primaria y la enfermera de trasplante de órgano sólido fuera clave para dar continuidad a los cuidados. Se utilizaron múltiples estrategias en el plan de cuidados para garantizar una mejor adherencia y cumplimiento terapéutico. A pesar de ello, se ha de profundizar en el conocimiento de la cultura de origen para establecer planes de cuidados más individualizados y mejorar así los resultados. El plan de cuidados incluyó problemas formulados de acuerdo con la taxonomía NANDA, NOC, NIC

Spain is one of the countries where most solid organ transplants are performed each year, in the year 2014 a 2.7% of them were given in childhood. Given the complexity and severity of this disease it is necessary to establish a care plan that covers both pre-transplant and post-transplant, with close cooperation between different levels of care, to approach the several problems that can appear and assure continuum of care. In the following example, a Gambian teen with risk of social exclusion fostered a collaboration between the primary care nurse and transplant nurse that was the key to continuum care. Multiple strategies were used in the care plan to ensure better adherence and compliance of the treatment. However, the knowledge of the culture of origin must be deepened to establish more individualized care plans and thus improve results. The care plan included problems according to the NANDA, NOC, NIC taxonomy

Assistance continuity from primary care in an inter-level nursing plan for a case of pediatric liver transplant. / Continuidad asistencial desde atención primaria en un plan de cuidados interniveles para un caso de trasplante hepático pediátrico.

Spain is one of the countries where most solid organ transplants are performed each year, in the year 2014 a 2.7% of them were given in childhood. Given the complexity and severity of this disease it is necessary to establish a care plan that covers both pre-transplant and post-transplant, with close cooperation between different levels of care, to approach the several problems that can appear and assure continuum of care. In the following example, a Gambian teen with risk of social exclusion fostered a collaboration between the primary care nurse and transplant nurse that was the key to continuum care. Multiple strategies were used in the care plan to ensure better adherence and compliance of the treatment. However, the knowledge of the culture of origin must be deepened to establish more individualized care plans and thus improve results. The care plan included problems according to the NANDA, NOC, NIC taxonomy.

Cuerpo, cultura y vulnerabilidad en la sociedad contemporánea: estudio de caso de un trasplante hepático / Corpo, cultura e vulnerabilidade na sociedade contemporânea: um estudo de caso de transplante de fígado / Body, culture and vulnerability in contemporary society: a case study of liver transplantation

En el presente artículo se exponen las reflexiones vinculadas al cuerpo y a la vulnerabilidad del ser humano a partir del estudio de caso de un trasplante hepático con donante vivo. La receptora del hígado es la madre del autor del trabajo y el donante el hermano. Todo ello forma parte de un acercamiento metodológico que podemos designar como etnografía familiar. Más allá de una perspectiva biomédica del proceso, ha interesante explorar las dimensiones simbólicas del cuerpos desde el punto de vista de la subjetividad. Se entiende al paciente, no como alguien pasivo sino como alguien que toma decisiones sobre su vida, sobre su cuerpo (AU)

In this article the reflections related to the body and human vulnerability from a case study of living donor liver transplantation are discussed. The receiving liver is the mother of the author of the work and the donor’s brother. This is part of a methodological approach that can be designated as family ethnography. Beyond a biomedical perspective of the process, it has interesting exploring the symbolic dimensions of bodies from the point of view of subjectivity. The patient is understood, not as someone passive but as someone who makes decisions about his life, about his body (AU)

Neste artigo são discutidas as reflexões relacionadas ao corpo e vulnerabilidade humana a partir de um estudo de caso do transplante hepático intervivos. O fígado recebe é a mãe do autor da obra e irmão do doador. Isso faz parte de uma abordagem metodológica que pode ser designado como etnografia família. Além de uma perspectiva biomédica do processo, tem interessante explorar as dimensões simbólicas de corpos a partir do ponto de vista da subjetividade. O paciente é entendida, não como alguém passivo, mas como alguém que toma decisões sobre sua vida, sobre seu corpo (AU)