Defining Success in Lung Transplantation: From Survival to Quality of Life

Kolaitis, N.A.; Singer, Jonathan P.

doi:10.1055/s-0037-1615801

Cited by 22 publications

(8 citation statements)

References 152 publications

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“…Even though survival is the key outcome, patients' posttransplant quality of life has become an important component of any evaluation of benefits, specifically as survival times increase (22,(49)(50)(51)(52).…”

Section: Psychological Outcomesmentioning

confidence: 99%

“…Also, even though survival is by far the most relevant outcome, it is not the only outcome. In addition to survival and transplant rates, success in lung transplantation should also be defined by patient-centered outcomes such as levels of depression and quality of life (22)(23)(24). For the evaluation of treatment effectiveness quality of life has become a meaningful clinical endpoint (25).…”

Section: Introductionmentioning

confidence: 99%

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The Transplant Evaluation Rating Scale Predicts Clinical Outcomes 1 Year After Lung Transplantation: A Prospective Longitudinal Study

et al. 2021

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Objectives: It has been recommended that all candidates for lung transplantation undergo pre-transplant psychosocial evaluation for risk assessment. However, psychosocial issues are only important if they correlate with outcomes after transplantation.Methods: In this prospective study patients who were referred for lung transplantation from 2016 to 2018 (n = 352) at Hannover Medical School were evaluated using the Transplant Evaluation Rating Scale (TERS). Clinical outcomes included listing, and post-transplant outcomes including mortality, medical aspects such as lung allograft dysfunction, hospitalizations, and renal function, behavioral aspects such as BMI and adherence, and mental issues such as levels of depression, anxiety, and quality of life. TERS scores were divided into tertiles and, in addition, the impact of the two subscale scores—“defiance” and “emotional sensitivity”—was investigated.Results: Of the patients who were transplanted (n = 271) and were still alive (n = 251), 240 had already reached their 1-year assessment at the end of 2020 and were evaluated 1 year after the operation. A subgroup of 143 received an extended mental assessment. BMI, adherence scores, levels of anxiety, depression, and quality of life 1 year post-transplantation differed significantly between TERS tertiles with higher TERS scores predicting less favorable outcomes. The TERS subscale “defiance” was predictive of BMI and adherence whereas the TERS subscale “emotional sensitivity” was predictive of symptoms of anxiety and depression, and quality of life 1 year after transplantation. Patients in the lowest TERS tertile were more likely to having been listed and—as a trend—to having survived the first year after transplantationConclusions: Our findings show that psychosocial factors as measured by TERS score are predictors of behavioral and mental outcomes 1 year after lung transplantation. The TERS allows us to focus on psychosocial risk factors that can be treated or minimized before or after transplantation.

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Section: Psychological Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Transplant Evaluation Rating Scale Predicts Clinical Outcomes 1 Year After Lung Transplantation: A Prospective Longitudinal Study

et al. 2021

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“…For the evaluation of treatment effectiveness in lung transplantation, quality of life (QoL) has become a meaningful clinical endpoint (1, 2). It is recommended that success in lung transplantation should also be defined by patient-centered outcomes such as health-related quality of life (HRQoL) in addition to survival and transplant rates (1). While survival and transplant rates are objective parameters, they give no information regarding the patient’s well-being.…”

Section: Introductionmentioning

confidence: 99%

“…While survival and transplant rates are objective parameters, they give no information regarding the patient’s well-being. It is well known that HRQoL is an important psychosocial parameter which might differ from medical parameters and the clinician’s perspective (1). There are different ways to assess HRQoL.…”

Section: Introductionmentioning

confidence: 99%

“…Even though generic measures allow comparison with other diseases, they are not specific to patients with advanced lung disease. For example, these patients often experience significant physical impairments, e.g., dyspnea, and are frequently dependent on high-volume supplemental oxygen (1). Generic HRQoL scales may not be sensitive enough to capture and quantify these unique effects of lung diseases on QoL (2, 5).…”

Section: Introductionmentioning

confidence: 99%

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Psychometric Properties of the German Version of the Pulmonary-Specific Quality-of-Life Scale in Lung Transplant Patients

et al. 2019

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The Pulmonary-Specific Quality-of-Life Scale (PQLS) is a validated self-report questionnaire assessing health-related quality of life (HRQoL) in patients with end-stage lung disease awaiting lung transplantation. The aim of our study was to evaluate the psychometric properties of the German version of the PQLS. One hundred and forty patients awaiting lung transplantation (55% men) with a median age of 53 years [Interquartile range (IQR) 13] answered the PQLS. A group of the participants ( n = 43) was evaluated again 1 year later after transplantation. A confirmatory factor analysis (CFA) of the PQLS was conducted to test the three-factor structure of the PQLS. We examined the internal consistency of the scales using Cronbach’s α . Convergent validity was explored through correlations with generic measures of HRQoL [Short-Form 8 Health Survey (SF-8), 10-item quality of life (QoL) scale], measures of depression (nine-item Patient Health Questionnaire-Depression Scale), anxiety (Generalized Anxiety Scale), and measures of lung disease severity (supplemental oxygen use, stairway steps). In the group of 43 patients assessed before and after transplantation, sensitivity to change was explored. The CFA confirmed the three-factor model with an acceptable fit. The PQLS total and the three subscale scores “task interference,” “psychological,” and “physical” showed acceptable internal consistency. The PQLS and its subscales showed a significant negative correlation with the 10-item QoL measure and the physical component score of the SF-8, whereas the mental component score of the SF-8 showed a significant negative correlation only with the PQLS subscale “psychological.” Negative correlation was found due to the opposed alignment of the PQLS compared to the 10-item QoL and the SF-8. Symptoms of depression and anxiety were significantly and positively correlated with the subscale “psychological.” Measures of lung disease severity also exhibited a significant positive correlation with the subscales “task interference” and “physical” but not “psychological.” In patients 1 year after a successful transplantation, the PQLS scores were significantly reduced by 50%. The three-factor structure of the PQLS could be replicated using CFA. The results indicate good reliability, validity, and sensitivity to change of the German version of the PQLS.

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