Fear of graft rejection after heart transplantation – a nationwide cross-sectional cohort study

Abstract

<jats:sec><jats:title>Background:</jats:title><jats:p> Cellular rejection is most common 3–6 months after heart transplantation while chronic rejection, that is, cardiac allograft vasculopathy and malignancy are the most common causes of death in heart-transplant recipients beyond the third year after transplantation. However, the heart transplantation recipient’s perceived threat of graft rejection has never been explored. </jats:p></jats:sec><jats:sec><jats:title>Aim:</jats:title><jats:p> The aim was to explore perceived threat of the risk of graft rejection and its relationship to psychological wellbeing, fatigue, health literacy, adherence and self-efficacy 1–5 years after heart transplantation. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> In a nationwide, cross-sectional study that constituted part of the Self-management after thoracic transplantation project, 79 heart recipients (68% men and 32% women with a mean age of 52.6 years) were investigated after one year ( n=28), two years ( n=17), three years ( n=11), four years ( n=17) and five years ( n=6). The instruments used were: the Perceived Threat of the Risk of Graft Rejection, the Psychological General Well-being, Self-efficacy for Managing Chronic Disease, the Multidimensional Fatigue Inventory, the Newest Vital Sign and the Basel Assessment of Adherence to Immunosuppressive Medication Scale. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Twenty-eight per cent of the heart transplantation recipients perceived graft rejection as a serious threat. Intrusive anxiety was low and 37% perceived the threat of the risk of graft rejection as being beyond their control. Heart transplant recipients with high level of fatigue and low psychological well-being reported stronger intrusive anxiety and less control. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> A perceived threat of the risk of graft rejection is present in the everyday lives of heart transplantation recipients and is strongly related to overall psychological well-being. </jats:p></jats:sec>

Symptom Distress Before and After Heart Transplantation – A Longitudinal 5‐Year Follow‐Up

“…They also report more fear of graft rejection, which is ever present in the everyday lives of HTRs [7]. Adapting to a changed body after HTx is a time‐consuming and stepwise process involving accepting physical limitations and persistent difficulties with mental fatigue [8]. Despite their different designs (cross‐sectional and qualitative), the above‐mentioned studies have contributed to the understanding of the relationship between symptom distress, self‐efficacy and psychological well‐being.…”

Time for transplant care professionals to face recipients' fear of graft rejection—an opinion paper

“…Intrusive anxiety was low. Thirty-seven percent believed that the threat of graft rejection was beyond their control, and they were unable to protect themselves from it, thereby suggesting a fatalistic approach ( 25 ). Heart recipients with high level of fatigue and low psychological well-being reported stronger intrusive anxiety and less control.…”