Prospective study of objective physical activity and quality of life in living donor liver transplant recipients

''Two People in One Body": Qualitative Study on the Family Perceptions of Recipients with a Family Member as Their Donor Using a Projective Method

The aim was to examine the family perceptions of recipients with a family member as their donor using a projective method. In this qualitative study, an arts-based narrative method was employed. The study was completed with 16 recipients through the drawing test, observation, and interviews. The recorded data for each participant were analysed projectively by creating a coding list related to family perception. Each participant's drawings were analysed in alignment with data obtained from other data collection tools and the categories were identified. And then categories were evaluated thematically, main themes identified. There were numerous inconsistencies between the recipients' consciously expressed statements and their unconscious projections. The significant changes in the life of another family member after organ transplantation have placed a dual responsibility on the recipient, both for their own life and for the donor's sacrifice, alongside feelings of gratitude. Another finding is the sorrow of lost time within family roles due to illness and its associated treatment processes. Organ transplant recipients tend to view themselves as different from others in society, experience guilt, and engage in self-directed negative attributions. The findings provide transplant and mental health nurses with a new perspective on assessing the psychosocial difficulties of transplant recipients and understanding family dynamics.

Associations Between Social Support, Health Literacy and Psychological Resilience to Self-Management Behaviours in Liver Transplant Recipients-A Structural Equation Model

AIMS

This study aimed to develop a structural model to elucidate the contributions of social support, health literacy and psychological resilience to self-management behaviours in liver transplant recipients after surgery.

DESIGN

Cross-sectional study.

METHODS

This study included 215 Chinese patients who returned to the outpatient department after liver transplantation between June 2023 and March 2024. Data were collected via a general demographic questionnaire, a self-management questionnaire for liver transplant recipients, a chronic disease resource questionnaire, the Connor-Davidson resilience scale and the health literacy scale for chronic patients. Correlation analysis and structural equation modelling were utilised to analyse the relationships among social support, health literacy, psychological resilience and self-management ability.

RESULTS

The final model showed good fit (χ2/df = 1.690, GFI = 0.919, IFI = 0.951, TLI = 0.938, CFI = 0.950 and RMSEA = 0.057). The direct effect coefficient of social support on self-management ability is 0.293. The indirect effect value of health literacy on the relationship between social support and self-management ability was 0.312, whereas the indirect effect value of psychological resilience in this context was 0.096. Furthermore, the chain-mediating effect involving both health literacy and psychological resilience between social support and self-management ability was 0.109.

CONCLUSION

The revised model, grounded in social cognitive theory, demonstrated a strong fit for predicting self-management behaviours among liver transplant recipients. Furthermore, social support, health literacy and psychological resilience exerted both direct and indirect influences on the self-management behaviours of these recipients.

REPORTING METHOD

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

PATIENT OR PUBLIC CONTRIBUTION

In public or patient involvement in this study.

Depression and Quality of Life in Transplant Recipients During the COVID-19 Pandemic

INTRODUCTION

Depression prevention is crucial for maintaining both physical and mental health and enhancing individuals' quality of life (QOL) post-transplantation. Despite the heightened susceptibility of post-transplant patients to COVID-19 infection, the relationship between depression and QOL during the pandemic remains unclear. This study aimed to (1) identify depression and QOL during the pandemic in kidney and liver transplant patients, and (2) explore the relationship between QOL and depression.

DESIGN

This cross-sectional study involved patients aged 20 years or older who were at least 6 months post-transplantation. Depression and QOL were assessed using the Patient Health Questionnaire-9 and the 8-item Short-Form Health Survey, respectively. Logistic regression analysis was conducted to examine the relationship between QOL and depression. The study included 204 participants comprising 68 postkidney transplant and 136 postliver transplant patients.

RESULTS

Among all participants, depressive symptoms were present 30% of the time, with 8.3% experiencing moderate or severe depression. Logistic regression analysis revealed that depression (mental component summary; OR = 2.419, P < .001, 95% CI: 1.862-2.915) and postoperative period (physical component summary; OR = 1.397, P = .008, 95% CI: 1.094-1.733) significantly influenced QOL.

CONCLUSION

This study suggests that the prevention of depression in emerging infectious disease pandemics may contribute to maintaining the mental QOL of transplant recipients.

Validation of the LPA-SQUASH in post-liver-transplant patients

AIM

This study aimed to validate the revised Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH) to measure sedentary activity in post-liver-transplant patients. The proposed scale could be useful for transplantation nurses to assess and modify sedentary lifestyles and increase physical activity.

METHODS

The SQUASH was modified to include items on sitting time and light-intensity physical activity (LPA-SQUASH). A pilot study was conducted with 20 liver transplant patients, and an expert panel validated the scale contents. Then, post-liver-transplant outpatients at a Japanese university hospital participated in the main study (September-October 2020), in which questionnaires were mailed twice to assess test-retest reliability, and accelerometers used to establish criterion validity. Intra-class correlation coefficients (ICC) were calculated for test-retest reliability. Spearman correlations and Bland-Altman plots were used to assess validity and measurement error.

RESULTS

In total, 173 participants returned the questionnaires, and 106 and 71 completed the reliability and validation studies, respectively. The range of LPA-SQUASH correlation coefficients for test-retest was .49-.58. ICCs ranged from .72 to .80 for items other than leisure. Accelerometer data and the LPA-SQUASH total physical activity amount and light-intensity physical activity correlated moderately.

CONCLUSION

We modified the SQUASH, which was developed to measure physical activity in healthy adults, to assess light-intensity physical activity in post-liver-transplant patients. The LPA-SQUASH showed acceptable validity and reliability. The questionnaire may be used by transplantation nurses to examine light-intensity physical activity content/duration, deliver patient education considering patients' sedentary lifestyle, and facilitate goal setting for physical activity interventions to prevent metabolic syndrome.

Post-liver transplantation patient experience

Given improvements in post-transplant patient and graft survival, there is a growing need to focus on patient experience and health-related quality of life (HRQOL). Though liver transplantation can be life-saving, it can also be associated with significant morbidity and complications. Patient HRQOL improves after transplantation, but it may not improve to that of age-matched cohorts. Understanding patient experience and the factors that contribute to it, including physical and psychological health, immunosuppression and medication adherence, return to employment or school, financial burden, and expectations, helps when thinking creatively about potential interventions to improve HRQOL.

Mediating Role of Hope Between Social Support and Self-Management Among Chinese Liver Transplant Recipients: A Multi-Center Cross-Sectional Study

This study aimed to investigate the common status of self-management in liver transplant recipients and to explore the mediating role of hope in the relationship between social support and self-management. Two hundred and ten liver transplant recipients from two tertiary hospitals were included. Questionnaires were used for general demographic information, the Perceived Social Support Scale, the Herth Hope Index, and the Self-Management Questionnaire for Liver Transplantation Recipients. Lifestyle management of liver transplant recipients was good, while the communication with physicians, cognitive symptom management, and exercise dimensions were less than satisfactory. Minimal assurance of family and education levels were significantly associated with self-management. Social support was positively correlated with self-management and hope (r = .31, p < .01; r = .40, p < .01). Hope was positively correlated with self-management (r = .39, p < .01). Additionally, the effect of social support on self-management was partially mediated (β = .17, p < .01) by hope. The proportion of mediation of hope was 40.09%. Therefore, well-designed interventions that boost both social support and hope may help improve self-management behavior in liver transplant recipients.

A bibliometric analysis of infectious diseases in patients with liver transplantation in the last decade

BACKGROUND

A bibliometric analysis was performed to reveal the current status of investigations in infectious diseases in patients with liver transplantation (LT) and to prioritize future research needs.

METHODS

The present study comprehensively retrieved publications relevant to infectious diseases in LT recipients published between 2010 and 2020. The search was conducted on the Web of Science (WoS) database. A bibliometric analysis was conducted through machine learning and visualization tools, including VOSviewer, Bibliographic Item Co-Occurrence Matrix Builder, and Graphical Clustering Toolkit. Research hotspots and trends in the field were assessed, while the contributions and collaborations of countries, institutions, and authors were documented.

RESULTS

A total of 691 publications were analyzed. Research output sharply increased in 2015, with a fast drop afterward. "Liver transplantation" was the most frequent keyword, with strong links to "hepatitis C virus" and "infection". Study areas included risk factors of infectious diseases in LT recipients, pathogens causing post-transplantation infections, antibacterial therapy and prophylaxis for peritransplant infection complications, living donor LT, and pediatric LT. The efficacy and safety of direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection among liver transplant recipients has attracted recent research interest. Didier Samuel was the most productive author, while Xavier Forns was the top-cited author. Shanghai Jiao Tong University was the most productive contributor, and Gilead Sciences was the most cited organization. Moreover, the USA was the greatest contributor. Gastroenterology was the most cited journal, while Liver Transplantation was the most prolific journal.

CONCLUSIONS

This bibliometric analysis will better understand the research status of infectious complications in LT recipients and forecast future research trends. Priority should be given to identifying risk factors for peritransplantation infections and effective treatments against infectious complications in the coming years.