Transplantation
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In an effort to understand the diminished quality of life (QoL) exhibited by patients with end-stage liver disease (ESLD), we studied the association of frailty and severity of liver disease with quality of life in this patient population. ⋯ In ESLD patient referred for liver transplant, diminished QoL appears to be significantly negatively associated with frailty and not with severity of liver disease as measured MELD. With further study, if frailty is shown to be a remediable condition, targeted programs may help decrease frailty and improve quality of life in ESLD patients.
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Enhanced recovery protocols align with the current advantages of laparoscopic donor nephrectomy and may continue to decrease disincentives to donation. ⋯ Implementation of an ERP for living kidney donors was associated with reduced LOS and decreased narcotic use after donor nephrectomy. This study suggests that ERPs may offer a framework for decreasing disincentives for donation and optimize patient satisfaction.
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Nonadherence to immunosuppressive medication after kidney transplantation is a behavioral issue and as such it is important to understand the psychological factors that influence this behavior. The aim of this study was to investigate the extent to which goal cognitions, illness perceptions, and treatment beliefs were related to changes in self-reported immunosuppressive medication adherence up to 18 months after transplantation. ⋯ Illness perceptions can be described as functional and supportive of adherence which is inconsistent with the pervasive and increasing nonadherence observed. There appears therefore to be a discrepancy between beliefs about adherence and actual behavior. Promoting (intrinsic) motivation for adherence goals and exploring the relative importance in comparison to other personal goals is a potential target for interventions.
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Editorial Biography Historical Article
Introduction of David H. Sachs, MD, recipient of the 2014 Medawar Prize.
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Bilateral lung transplantation (BLTx) is an established treatment for end-stage pulmonary hypertension (PH). Ventilator weaning failure and death are more common as in BLTx for other indications. We hypothesized that left ventricular (LV) dysfunction is the main cause of early postoperative morbidity or mortality and investigated a weaning strategy using awake venoarterial extracorporeal membrane oxygenation (ECMO). ⋯ Early after BLTx for severe PH, the LV may be unable to handle normalized LV preload. This can be effectively bridged with awake venoarterial ECMO.