Lung transplant: Complications and quality of life
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Cardoso, H.N. Bastos, C. Damas" "autores" => array:3 [ 0 => array:4 [ "Iniciales" => "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" => "affa" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "Iniciales" => "H.N." "apellidos" => "Bastos" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 2 => array:3 [ "Iniciales" => "C." "apellidos" => "Damas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "ICVS/3B's – PT Government Associate Laboratory, Braga/Guimarães, Portugal" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "correspondencia" => "Corresponding author. car_veronica@sapo.pt" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n04-90433953figfx1.jpg" "Alto" => 687 "Ancho" => 700 "Tamanyo" => 17267 ] ] "descripcion" => array:1 [ "en" => " " ] ] ] "textoCompleto" => "<p class="elsevierStylePara">To the Editor,</p><p class="elsevierStylePara">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 href="#bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> Several studies have been conducted to compare QoL before and after LT.<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">, </span><a href="#bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">, </span><a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> However, fewer reports evaluated the long term QoL, specifically the period when some late complications tend to appear.<a href="#bib12" class="elsevierStyleCrossRefs"><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 href="#bib12" class="elsevierStyleCrossRefs"><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 href="#bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a></p><p class="elsevierStylePara">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> = 30) were grouped according to the time of transplant [<1.5 years post-LT (<span class="elsevierStyleItalic">n</span> = 5); 1.5–3 years post-LT (<span class="elsevierStyleItalic">n</span> = 6); >3 years post-LT (<span class="elsevierStyleItalic">n</span> = 19)]. The parameters assessed in the questionnaires were compared between the groups pre- and post-transplant.</p><p class="elsevierStylePara">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> = 0.45; <span class="elsevierStyleItalic">p</span> = 0.01).</p><p class="elsevierStylePara">Compared with candidates, recipients had better QoL assessed by the MOS SF-36 (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 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 ± 17.1% vs. 29.3 ± 22.4%, <span class="elsevierStyleItalic">p</span> = 0.01), physical role difficulty dimension (90.0 ± 22.3% vs. 21.4 ± 39.3%, <span class="elsevierStyleItalic">p</span> = 0.04) and emotional role difficulty dimension (93.4 ± 14.7 vs. 28.6 ± 40.5%, <span class="elsevierStyleItalic">p</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 href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>).</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v21n04-90433953fig1.jpg" alt="Quality of life of candidates and lung transplant recipients. Asterisk (<a name="></img></p><p class="elsevierStylePara"><img src="320v21n04-90433953figfx1.jpg"></img></p><p class="elsevierStylePara"></p>) =  <span class="elsevierStyleItalic">p</span> < 0.05 in comparison between candidates and patients with <1.5 years after lung transplant." /> <p class="elsevierStylePara">Figure 1. Quality of life of candidates and lung transplant recipients. Asterisk (<a name="0" class="elsevierStyleCrossRefs"></a></p><p class="elsevierStylePara"><img src="320v21n04-90433953figfx1.jpg"></img></p><p class="elsevierStylePara"></p>) =  <span class="elsevierStyleItalic">p</span> < 0.05 in comparison between candidates and patients with <1.5 years after lung transplant. <p class="elsevierStylePara">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> < 0.001), with no differences among the three groups after transplantation. No statistically significant difference was found in levels of anxiety.</p><p class="elsevierStylePara">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 class="elsevierStylePara">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 class="elsevierStylePara">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 href="#bib10" class="elsevierStyleCrossRefs"><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 href="#bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> Therefore, we highlight the importance of including QoL measures in assessing the outcomes in LT.</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare.</p><p class="elsevierStylePara">Corresponding author. car_veronica@sapo.pt</p>" "pdfFichero" => "320v21n04a90433953pdf001.pdf" "tienePdf" => true "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n04-90433953figfx1.jpg" "Alto" => 687 "Ancho" => 700 "Tamanyo" => 17267 ] ] "descripcion" => array:1 [ "en" => " " ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n04-90433953fig1.jpg" "Alto" => 1612 "Ancho" => 1595 "Tamanyo" => 281179 ] ] "descripcion" => array:1 [ "en" => "Quality of life of candidates and lung transplant recipients. 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| 2024 June | 65 | 48 | 113 |
| 2024 May | 62 | 30 | 92 |
| 2024 April | 60 | 34 | 94 |
| 2024 March | 44 | 22 | 66 |
| 2024 February | 52 | 24 | 76 |
| 2024 January | 44 | 22 | 66 |
| 2023 December | 31 | 27 | 58 |
| 2023 November | 40 | 30 | 70 |
| 2023 October | 36 | 61 | 97 |
| 2023 September | 46 | 71 | 117 |
| 2023 August | 46 | 43 | 89 |
| 2023 July | 34 | 36 | 70 |
| 2023 June | 36 | 24 | 60 |
| 2023 May | 54 | 29 | 83 |
| 2023 April | 45 | 19 | 64 |
| 2023 March | 50 | 15 | 65 |
| 2023 February | 52 | 18 | 70 |
| 2023 January | 41 | 12 | 53 |
| 2022 December | 69 | 25 | 94 |
| 2022 November | 73 | 41 | 114 |
| 2022 October | 50 | 33 | 83 |
| 2022 September | 63 | 29 | 92 |
| 2022 August | 65 | 41 | 106 |
| 2022 July | 53 | 45 | 98 |
| 2022 June | 35 | 31 | 66 |
| 2022 May | 51 | 36 | 87 |
| 2022 April | 34 | 44 | 78 |
| 2022 March | 48 | 43 | 91 |
| 2022 February | 32 | 39 | 71 |
| 2022 January | 43 | 37 | 80 |
| 2021 December | 32 | 39 | 71 |
| 2021 November | 29 | 31 | 60 |
| 2021 October | 48 | 47 | 95 |
| 2021 September | 36 | 33 | 69 |
| 2021 August | 25 | 27 | 52 |
| 2021 July | 34 | 13 | 47 |
| 2021 June | 32 | 27 | 59 |
| 2021 May | 34 | 35 | 69 |
| 2021 April | 95 | 66 | 161 |
| 2021 March | 40 | 16 | 56 |
| 2021 February | 50 | 24 | 74 |
| 2021 January | 38 | 16 | 54 |
| 2020 December | 38 | 8 | 46 |
| 2020 November | 47 | 22 | 69 |
| 2020 October | 32 | 16 | 48 |
| 2020 September | 66 | 27 | 93 |
| 2020 August | 42 | 19 | 61 |
| 2020 July | 75 | 16 | 91 |
| 2020 June | 69 | 18 | 87 |
| 2020 May | 65 | 14 | 79 |
| 2020 April | 76 | 7 | 83 |
| 2020 March | 63 | 11 | 74 |
| 2020 February | 52 | 29 | 81 |
| 2020 January | 63 | 16 | 79 |
| 2019 December | 58 | 16 | 74 |
| 2019 November | 75 | 23 | 98 |
| 2019 October | 47 | 20 | 67 |
| 2019 September | 39 | 14 | 53 |
| 2019 August | 92 | 12 | 104 |
| 2019 July | 97 | 19 | 116 |
| 2019 June | 91 | 13 | 104 |
| 2019 May | 81 | 9 | 90 |
| 2019 April | 79 | 22 | 101 |
| 2019 March | 89 | 17 | 106 |
| 2019 February | 87 | 11 | 98 |
| 2019 January | 103 | 26 | 129 |
| 2018 December | 65 | 6 | 71 |
| 2018 November | 13 | 0 | 13 |
| 2018 October | 17 | 6 | 23 |
| 2018 September | 13 | 3 | 16 |
| 2018 August | 32 | 21 | 53 |
| 2018 July | 33 | 13 | 46 |
| 2018 June | 25 | 13 | 38 |
| 2018 May | 28 | 11 | 39 |
| 2018 April | 51 | 22 | 73 |
| 2018 March | 63 | 13 | 76 |
| 2018 February | 30 | 8 | 38 |
| 2018 January | 43 | 10 | 53 |
| 2017 December | 55 | 17 | 72 |
| 2017 November | 20 | 13 | 33 |
| 2017 October | 11 | 10 | 21 |
| 2017 September | 13 | 16 | 29 |
| 2017 August | 21 | 22 | 43 |
| 2017 July | 11 | 12 | 23 |
| 2017 June | 16 | 11 | 27 |
| 2017 May | 25 | 14 | 39 |
| 2017 April | 4 | 0 | 4 |
| 2017 March | 5 | 1 | 6 |
| 2017 February | 5 | 4 | 9 |
| 2017 January | 6 | 3 | 9 |
| 2016 December | 4 | 4 | 8 |
| 2016 November | 3 | 3 | 6 |
| 2016 October | 2 | 7 | 9 |
| 2016 September | 1 | 3 | 4 |
| 2016 August | 7 | 3 | 10 |
| 2016 July | 4 | 12 | 16 |
| 2016 June | 0 | 10 | 10 |
| 2016 May | 0 | 6 | 6 |
| 2016 April | 12 | 15 | 27 |
| 2016 March | 28 | 15 | 43 |
| 2016 February | 20 | 27 | 47 |
| 2016 January | 24 | 25 | 49 |
| 2015 December | 35 | 26 | 61 |
| 2015 November | 18 | 25 | 43 |
| 2015 October | 28 | 27 | 55 |
| 2015 September | 69 | 28 | 97 |
| 2015 August | 140 | 90 | 230 |
| 2015 July | 119 | 93 | 212 |
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