Baseline Quality-of-Life of Caregivers of Patients With Heart Failure Prior to Advanced Therapies: Findings From the Sustaining Quality of Life of the Aged: Transplant or Mechanical Support (SUSTAIN-IT) Study.

BACKGROUND: We compared health-related quality of life (HRQOL), depressive symptoms, anxiety, and burden in caregivers of older patients with heart failure based on the intended therapy goal of the patient: awaiting heart transplantation (HT) with or without mechanical circulatory support (MCS) or prior to long-term MCS; and we identified factors associated with HRQOL. METHODS: Caregivers (n = 281) recruited from 13 HT and MCS programs in the United States completed measures of HRQOL (EQ-5D-3L), depressive symptoms (PHQ-8), anxiety (STAI-state), and burden (Oberst Caregiving Burden Scale). Analyses included ANOVA, Kruskal-Wallis tests, χ2 tests, and linear regression. RESULTS: The majority of caregivers were female, white spouses with ≤ 2 comorbidities, median [Q1,Q3] age = 62 [57.8, 67.0] years. Caregivers (HT with MCS = 87, HT without MCS = 98, long-term MCS = 96) reported similarly high baseline HRQOL (EQ-5D-3L visual analog scale median score = 90; P = 0.67 for all groups) and low levels of depressive symptoms. STAI-state median scores were higher in the long-term MCS group vs the HT groups with and without MCS, (38 vs 32 vs 31; P < 0.001), respectively. Burden (task: time spent/difficulty) differed significantly among groups. Caregiver factors (number of comorbidities, diabetes and higher anxiety levels) were significantly associated with worse caregiver HRQOL, R2 = 26%. CONCLUSIONS: Recognizing caregiver-specific factors, including comorbidities and anxiety, associated with the HRQOL of caregivers of these older patients with advanced HF may guide support strategies.

Abdominal complications after lung transplantation.

BACKGROUND: Serious abdominal complications after heart and heart-lung transplantation have been a well-documented source of morbidity and mortality in this patient population. This report reviews the incidence and spectrum of abdominal complications occurring in lung transplant recipients at a single institution. METHOD: Between January 1988 and July 1993, 75 patients underwent lung transplantation (58 single lung, 16 bilateral single lung, and 1 double lung) at the University of Minnesota. RESULTS: Twelve patients (16%) sustained 20 abdominal complications. There were 11 early abdominal complications (< or = 30 days after transplantation) including prolonged adynamic ileus (4), diaphragmatic hernia after omental wrap (3), ischemic bowel (2), colitis with hemorrhage (1), and splenic injury after colonoscopy (1). There were nine late abdominal complications (range, 32 days to 28 months after transplantation) including colonic perforation (4), cholelithiasis/choledocholithiasis (2), development of a mesenteric pseudoaneurysm (1), fungal hepatic abscess (1), and intraabdominal hemorrhage (1). Twenty-six procedures were performed for management of the abdominal complications including: colonoscopy (7), colectomy (5), repair of diaphragmatic hernia (3), colostomy takedown (4), small-bowel resection (2), open cholecystectomy with common bile duct exploration (1), open cholecystectomy (1), splenectomy (1), mesenteric arterial pseudoaneurysm embolization (1), and percutaneous liver biopsy (1). Four patients died of causes attributable to their abdominal complications. CONCLUSIONS: In each case in which a death occurred, there was a delay between the onset of symptoms and diagnosis and intervention of more than 6 days. Abdominal complications accounted for 22% of all deaths in our lung transplantation group. A high index of suspicion and early recognition and intervention will decrease the morbidity and mortality caused by abdominal complications in lung transplant patients.

Liberalization of donor criteria in lung and heart-lung transplantation.

Since March 1986, we have performed 26 heart-lung transplantations, 42 single-lung transplantations, 9 bilateral single-lung transplantations, and 1 double-lung transplantation. The original lung donor requirements were as follows: age less than 40 years, no smoking history; no gram-negative rods or fungus on sputum Gram stain; arterial oxygen tension greater than 140 mm Hg on an inspired oxygen fraction of 0.40; no infiltrate or pneumothorax on the chest radiograph; and donor height within 15 cm (6 inches) of recipient height. As the number of potential recipients increased, so did the waiting time. To counter this delay, during the past year we have liberalized our donor criteria. We now accept lung donors up to age 60 years. Any kind of smoking history is acceptable unless there is chronic obstructive pulmonary disease or pulmonary fibrosis on the chest radiograph. Sputum must be free from fungus, but gram-negative rods are treated with appropriate antibiotics. The arterial oxygen tension on an inspired oxygen fraction of 0.40 should be greater than 100 mm Hg, and a small pulmonary infiltrate is not worrisome. This liberalization of the donor pool for lung and heart-lung transplantation has not adversely affected early outcome.