The context framing the changes in health-related quality of life and working competence before and after lung transplantation: one-year follow-up in Taiwan

Elements of Post-Transplant Recovery in Lung Transplant Recipients: A Scoping Review

To clarify and refine the specific elements of post-transplant recovery in lung transplant recipients, we explored the four dimensions of recovery: physiological, psychological, social, and habitual. This study is a scoping review. Two authors conducted a comprehensive electronic literature search to identify studies published from the establishment of the database to August 2022. Deductive coding was utilized to identify and categorize elements using a predefined list of the four components (physiological, psychological, social, and habitual recovery) based on the framework of post-transplant recovery proposed by Lundmark et al. Inductive coding was applied for concepts requiring further classification. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline. Systematic searching identified 8,616 potential records, of which 51 studies met the inclusion criteria. Ten subdimensions and their corresponding elements were identified and categorized into four dimensions of recovery following lung transplantation. The subdimensions included physiological recovery (including symptom experience, complications, physical function, and energy reserve), psychological recovery (encompassing affective distress, psychological adaptation, and transition from illness to health), social recovery (involving family adaptation and social adaptation), and habit recovery (focusing on health behavior).

Employment after lung transplantation--a single-center cross-sectional study

BACKGROUND

359 lung transplantations were performed in Germany in 2013. The main goals of lung transplantation are to prolong survival and improve the quality of life. Both of these goals can be reflected in a return to employment. We report the first study of employment after lung transplantation in Germany.

METHODS

We evaluated the findings of a single-center, questionnaire-based cross-sectional investigation of the social and economic situation of 531 patients (September 2009 to March 2010) and obtained 5-year follow-up data in December 2014.

RESULTS

38% of the patients were employed after lung transplantation. They took a mean of ten sick days off from work each year; they did not have infections or organ rejection any more frequently than other patients. The fiveyear follow-up data showed no difference in the overall survival rate of employed and unemployed patients. Employment was associated with a better quality of life (80% [interquartiles: 70%, 95%]) versus 75% [interquartiles: 50%, 85%], p = 0.001). Factors associated with a return to employment included a higher educational level (odds ratio [OR] 2.6, 95%confidence interval [CI] 1.7-4, p = 0.001) and better physical fitness (OR 2, 95%CI 1.3-3.2, p = 0.001).

CONCLUSION

The rate of return to work after lung transplantation in Germany is similar to the rates observed in other countries. The findings of this study imply that employment improves the quality of life and does not endanger health. Thus, patients who have received lung transplants should be advised to return to work if possible.

A thematic analysis of quality of life in lung transplant: the existing evidence and implications for future directions

Health-related quality of life (HRQL) has been assessed in various lung transplantation (LT) investigations but never analyzed systematically across multiple studies. We addressed this knowledge gap through a systematic literature review. We searched the PubMed, CINAHL and PsychInfo databases for publications from January 1, 1983 to December 31, 2011. We performed a thematic analysis of published studies of HRQL in LT. Using a comparative, consensus-based approach, we identified themes that consistently emerged from the data, classifying each study according to primary and secondary thematic categories as well as by study design. Of 749 publications initially identified, 73 remained after exclusions. Seven core themes emerged: (1) Determinants of HRQL; (2) Psychosocial factors in HRQL; (3) Pre- and posttransplant HRQL comparisons; (4) Long-term longitudinal HRQL studies; (5) HRQL effects of therapies and interventions; (6) HRQL instrument validation and methodology; (7) HRQL prediction of clinical outcomes. Overall, LT significantly and substantially improves HRQL, predominantly in domains related to physical health and functioning. The existing literature demonstrates substantial heterogeneity in methodology and approach; relatively few studies assessed HRQL longitudinally within the same persons. Opportunity for future study lies in validating existing and potential novel HRQL instruments and further elucidating the determinants of HRQL through longitudinal multidimensional investigation.

Return to work and social participation: does type of organ transplantation matter?

BACKGROUND

Return to work and social participation are objective parameters to evaluate the success of transplantation. Existing reports never compared return to work rates between different organ transplant groups, few European studies were published, and information on patients having a volunteer job or being an active club member is scarce. These outcomes have never been compared with the general population.

METHODS

In a cross-sectional sample of 281 kidney, heart, liver, and lung transplant patients, we assessed self-reported return to work (i.e., having a paid job) and social participation (i.e., having a volunteer job or being an active member of a club). These data were compared with the general population. We also explored possible correlates of return to work (multivariable regression analysis).

RESULTS

Kidney transplant patients had the highest employment rate (58.6%), followed by heart (43.6%), liver (37.5%), and lung transplant patients (28.1%). Except for kidney patients, these numbers are lower than the 62% population's employment rate. Return to work was more likely if the transplanted organ was other than lung, with younger age at time of transplantation, being male, being married, having a positive perception of one's capability to work, and having worked until at least 1 year before transplant. Volunteer work was similar to the general population (17.4% vs. 21.5%), although less patients were an active club member (28.5% vs. 61%).

CONCLUSION

Obtaining a paid or voluntary job posttransplantation is possible and should be strongly recommended by transplant professionals as a meaningful way to contribute to the society.

Does lung transplantation improve health-related quality of life? The University of Florida experience

BACKGROUND

Health-related quality of life (HRQoL) is an important clinical end-point in evaluating the overall success of lung transplantation. The primary purpose of this study, therefore, was to document the degree of change in HRQoL in a sample of patients evaluated before and after lung transplantation.

METHODS

Sixty-six adults who underwent single or bilateral lung transplantation at the University of Florida between March 1994 and May 2001 completed assessments of HRQoL (SF-36 Health Survey, Transplant Symptom Frequency Questionnaire), both before and after transplant. Pre- and post-transplant assessments of forced expiratory volume in 1 second (FEV1) percent predicted and 6-minute walk test performance were also obtained.

RESULTS

HRQoL before transplant was significantly lower than in normative samples of chronic obstructive pulmonary disease (COPD) patients and adults in the general population. However, repeated measures analyses of co-variance showed significant improvements on 7 of 8 SF-36 sub-scales, as well as the physical component summary and the mental component summary. Improvements in FEV1 percent predicted and 6-minute walk test performance were also found. Patients with longer time since transplantation reported more frequent and problematic symptoms commonly associated with immunosuppression, including depression, headaches and changes in physical appearance, among others.

CONCLUSIONS

Lung transplantation appears to yield significant HRQoL benefits for patients. Many patients do, however, experience frequent symptoms associated with immunosuppression that may limit the full benefit of transplantation, and some of these symptoms appear to worsen over time. Future research efforts should focus on the development, implementation and evaluation of clinical interventions designed to optimize HRQoL both before and after lung transplantation.