Letter to the Editor
Lung transplant: Complications and quality of life
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Melo, C. Ribeiro, A. Sanches, A. Oliveira" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R.C." "apellidos" => "Melo" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Ribeiro" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Sanches" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Oliveira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511515000639?idApp=UINPBA00004E" "url" => "/21735115/0000002100000004/v1_201507020213/S2173511515000639/v1_201507020213/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173511515000652" "issn" => "21735115" "doi" => "10.1016/j.rppnen.2015.02.007" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "1051" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "cor" "cita" => "Rev Port Pneumol. 2015;21:218-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1706 "formatos" => array:3 [ "EPUB" => 218 "HTML" => 965 "PDF" => 523 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Prognostic value of plasma D-dimer level in adults with community-acquired pneumonia: A prospective study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "218" "paginaFinal" => "219" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1703 "Ancho" => 1500 "Tamanyo" => 109694 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curves for CURB-65 (dotted spaced line: AUC, 0,669; 95%CI, 0,53 to 0,81), CURB-65 and D-dimer levels (continue line: AUC: 0,689; 95%CI, 0,55 to 0,83), d-dimer level (dashed line: AUC, 0,513; 95% CI, 0,39 to 0,64) and for PSI (dotted line: AUC 0,548; 95% CI 0,38 to 0,71).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Joana Clemente Duarte, Ana Tavares e Castro, Raquel Silva, Lurdes Correia, Adélia Simão, Armando Carvalho" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Joana Clemente" "apellidos" => "Duarte" ] 1 => array:2 [ "nombre" => "Ana Tavares e" "apellidos" => "Castro" ] 2 => array:2 [ "nombre" => "Raquel" "apellidos" => "Silva" ] 3 => array:2 [ "nombre" => "Lurdes" "apellidos" => "Correia" ] 4 => array:2 [ "nombre" => "Adélia" "apellidos" => "Simão" ] 5 => array:2 [ "nombre" => "Armando" "apellidos" => "Carvalho" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511515000652?idApp=UINPBA00004E" "url" => "/21735115/0000002100000004/v1_201507020213/S2173511515000652/v1_201507020213/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Lung transplant: Complications and quality of life" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "219" "paginaFinal" => "220" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A.V. Cardoso, H.N. Bastos, C. Damas" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A.V." "apellidos" => "Cardoso" "email" => array:1 [ 0 => "car_veronica@sapo.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "H.N." "apellidos" => "Bastos" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Damas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "ICVS/3B's – PT Government Associate Laboratory, Braga/Guimarães, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1612 "Ancho" => 1595 "Tamanyo" => 150419 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Quality of life of candidates and lung transplant recipients. Asterisk (<span class="elsevierStyleInlineFigure"><elsevierMultimedia class="elsevierStyleLink" ident="fx1"></elsevierMultimedia></span>)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 in comparison between candidates and patients with <1.5 years after lung transplant.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The aim of lung transplant (LT) is not only to extend the survival rate of recipients but also to improve their quality of life (QoL).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Several studies have been conducted to compare QoL before and after LT.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2–4</span></a> However, fewer reports evaluated the long term QoL, specifically the period when some late complications tend to appear.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> These include chronic allograft rejection or bronchiolitis obliterans syndrome (BOS), which are the major cause for decreased patient life expectancy.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> In order to prevent or stabilize these complications, LT recipients maintain a high level of immunosuppressants for life. In turn, the immunosuppressive drugs induce different disorders, like arterial hypertension, chronic kidney failure, diabetes, hyperlipidemia, osteoporosis, and infections (which are the second cause of mortality after BOS), and increase the risk of malignancies, mainly skin cancers, post-transplant lymphoproliferative disorders and Kaposi's sarcoma.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The authors here describe the data about complications related to LT and QoL of patients followed in LT outpatient clinic of Centro Hospitalar São João. Of the 83 patients, 37 (30 LT recipients and 7 LT candidates) completed the Medical Outcomes Study Short Form-36 (MOS SF-36), the London Chest Activity of Daily Living (LCADL) questionnaire and the Hospital Anxiety and Depression Scale (HADS). The lung transplant recipients (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>30) were grouped according to the time of transplant [<1.5 years post-LT (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5); 1.5–3 years post-LT (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6); >3 years post-LT (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19)]. The parameters assessed in the questionnaires were compared between the groups pre- and post-transplant.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Among all patients, COPD (27%), silicosis (19%), hypersensitivity pneumonitis (19%) and alfa-1 antitrypsin deficiency (16%) were the most common underlying diagnoses. Of the 30 LT recipients, the most frequent complications were: osteoporosis (46.7%), CMV infection (40%), renal dysfunction (33%), hyperlipidemia (33%), arterial hypertension (30%), and acute rejection (30%); only one patient had BOS. We observed a positive correlation between the complications frequency and the physical limitation in the self-care domain of LCADL (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.45; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Compared with candidates, recipients had better QoL assessed by the MOS SF-36 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). However, only the patients with less than 1.5 years of transplant reported statistically significant differences in QoL relative to candidates, particularly in the physical function dimension (84.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17.1% vs. 29.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>22.4%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01), physical role difficulty dimension (90.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>22.3% vs. 21.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>39.3%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.04) and emotional role difficulty dimension (93.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14.7 vs. 28.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>40.5%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.04). No statistically significant difference was found among recipients grouped by time since their transplant, but there is a downward trend in QoL over the years (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Levels of depression are significantly lower in transplant recipients than in candidates (moderate–severe depression: 12% in recipients vs. 100% in candidates, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), with no differences among the three groups after transplantation. No statistically significant difference was found in levels of anxiety.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Therefore, the improvement of the QoL of LT recipients is highest early after transplantation, with a slight but not significant decrease over the years. This may reflect the accumulation of complications with time after LT, which affect physical activity.</p><p id="par0035" class="elsevierStylePara elsevierViewall">This analysis had two essential limitations: (1) the small sample size and (2) it is not a longitudinal pre- and post-transplant evaluation of patients QoL.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Santana, et al. described the effects of QoL measures in the management of LT patients, namely in lung allocation decisions, and advised their use in clinical routine.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> In addition, improving QoL appears as the primary goal of the LT for diseases such COPD (the major common indication to LT), where a survival advantage has not yet been proven.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> Therefore, we highlight the importance of including QoL measures in assessing the outcomes in LT.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1612 "Ancho" => 1595 "Tamanyo" => 150419 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Quality of life of candidates and lung transplant recipients. Asterisk (<span class="elsevierStyleInlineFigure"><elsevierMultimedia class="elsevierStyleLink" ident="fx1"></elsevierMultimedia></span>)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 in comparison between candidates and patients with <1.5 years after lung transplant.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A thematic analysis of quality of life in lung transplant: the existing evidence and implications for future directions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. 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Estenne" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pneumo.2010.08.002" "Revista" => array:7 [ "tituloSerie" => "Rev Pneumol Clin" "fecha" => "2010" "volumen" => "67" "numero" => "1" "paginaInicial" => "28" "paginaFinal" => "49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21353971" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of diagnosis on survival benefit of lung transplantation for end-stage lung disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.D. Hosenpud" 1 => "L.E. Bennett" 2 => "B.M. Keck" 3 => "E.B. Edwards" 4 => "R.J. Novick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(97)06405-2" "Revista" => array:7 [ "tituloSerie" => "Lancet" "fecha" => "1998" "volumen" => "351" "numero" => "9095" "paginaInicial" => "24" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9433425" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735115/0000002100000004/v1_201507020213/S2173511515000640/v1_201507020213/en/main.assets" "Apartado" => array:4 [ "identificador" => "20584" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735115/0000002100000004/v1_201507020213/S2173511515000640/v1_201507020213/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511515000640?idApp=UINPBA00004E" ]
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| 2024 July | 43 | 25 | 68 |
| 2024 June | 42 | 27 | 69 |
| 2024 May | 43 | 45 | 88 |
| 2024 April | 46 | 34 | 80 |
| 2024 March | 27 | 18 | 45 |
| 2024 February | 27 | 22 | 49 |
| 2024 January | 22 | 21 | 43 |
| 2023 December | 19 | 26 | 45 |
| 2023 November | 33 | 40 | 73 |
| 2023 October | 26 | 39 | 65 |
| 2023 September | 23 | 34 | 57 |
| 2023 August | 20 | 16 | 36 |
| 2023 July | 26 | 27 | 53 |
| 2023 June | 34 | 10 | 44 |
| 2023 May | 33 | 23 | 56 |
| 2023 April | 16 | 10 | 26 |
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