Quality Of Life In Recipients Research Articles

Portable markerless hand motion capture system for determining the grasps performed in activities of daily living

ABSTRACT Upper-limb prostheses are either too expensive for many consumers or have a greatly simplified choice of actions. This research aims to enable an improvement to the quality of life for recipients of these devices by providing an understanding of how we use our hands in modern everyday life. To achieve this a taxonomy of grasps used in activities of daily living has been created. A portable motion capture system was developed to collect data. Thirteen participants’ hand movements were recorded (totalling 62 hours and 10 minutes of data). From these data, 38 and 22 grasps were observed from the left and right hands, respectively. The portable system effectively captured natural hand motions, which formed an updated taxonomy of grasps.

An Exploration of Quality of Life Perceptions of Cochlear Implant Recipients and Their Frequent Communication Partners

Purpose: Quality of life (QoL) after cochlear implantation has been investigated using a variety of QoL questionnaires. However, few studies have examined the perceived QoL of cochlear implant (CI) recipients compared between the recipient and a frequent communication partner (FCP) using both hearing-related (hearing-specific) and health-general (health-general) measures. Method: For this multiple case study, five participant pairs were recruited, consisting of five adult recipients who were implanted at least 6 months prior to the time of evaluation and five adult FCPs who lived with the recipient at the time of evaluation. All 10 participants (five pairs) completed a health-general questionnaire (Medical Outcome Study Short-Form Survey 12-Item [SF-12]), and eight participants (four pairs) completed a disease specific questionnaire (Nijmegen Cochlear Implant Questionnaire [NCIQ]). Results: Both recipients and partners tended to score similarly to each other on both measures. However, both groups scored higher on the SF-12 than the NCIQ. Results also revealed a better interrater agreement between pairs on the SF-12 compared to the NCIQ. Conclusions: Overall, scores for recipients and partners were higher for the health-general SF-12 compared to the hearing-related NCIQ. Additionally, rater agreement was better for the SF-12 compared to the NCIQ, suggesting that differences in QoL perceptions exist for more hearing-specific challenges. These results highlight potential differences in perception of recipient QoL postimplantation as illustrated through the use of multiple QoL measures. Results speak to the importance of open communication between recipients and partners.

Quality of life in recipients after renal transplantation: a single-center experience

Quality of life in recipients after renal transplantation: a single-center experience

Abstract 15126: Hybrid Supervised and Unsupervised Machine Learning Model Improves Prediction of New-Onset Dialysis in Orthotopic Heart Transplant Patients

Introduction: Machine learning (ML) approaches to clinical risk prediction have demonstrated improved performance over traditional statistical approaches. New-onset dialysis following isolated orthotopic heart transplantation (OHT) is an important contributor to mortality risk and quality of life in recipients, yet traditional approaches to predicting its occurrence have performed only modestly. This study sought to develop and evaluate a hybrid supervised and unsupervised ML approach to estimating the risk of new-onset dialysis following OHT. Methods: This was a retrospective study of patients (n = 26,505) with no history of dialysis undergoing primary, isolated OHT between 2000 and 2022 as identified in the United Network for Organ Sharing (UNOS) database. The study cohort was split randomly into training (80%) and validation sets (20%) and under-sampling using K-Nearest Neighbors clustering was used to account for class imbalance. ML models, including a Multilayer Perceptron Classifier, a Support Vector Classifier, and a Logistic Regression Model were developed and compared. Sensitivity, accuracy, precision, and F 1 score were measured, and discriminatory performance was assessed using the area under the receiver-operating-characteristic curve (AUC). Results: The rate of new dialysis was 11.3% following OHT with comparable rates in the training and validation cohorts. In the validation cohort, the support vector classifier had the highest AUC Score (0.774 (95% CI, 0.748 - 0.800), sensitivity (0.74), F 1 Score (0.72), accuracy (0.70), and precision (0.70). All other models yielded poorer performance by every metric. Predictive risk factors that were common across models included congenital heart disease, pre-transplant glomerular filtration rate, and human leukocyte antigen mismatch. Conclusions: This study demonstrates that an ML approach using a support vector model was associated with improved model performance metrics including discriminatory capability compared to other modeling approaches in predicting new-onset dialysis risk after OHT. The use of ML models in OHT may have utility in patient selection, modification of risk factors, and programmatic evaluation.

337.8: The Dynamic of Physical Capacity and Quality of Life in Recipients After Heart Transplantation

Objective: to estimate the dynamic of physical capacity (PC) and quality of life (QoL) in recipients after heart transplantation (HTx). Methods: We analyzed the data collected from January 2010 to December 2019 where 131 heart transplant patients (mean age - 47±13 year-old; 100 – male) were included. Recipients performed cardiopulmonary exercise test (CPET) before, 3 months, 1 and 3 years after HTx. Dynamics of VO2peak and ventilatory efficiency (VE/VCO2slope) were measured. Physical activity (PA) was defined by IPAQ questionnaire. We estimated the dynamic of physical (PCS) and mental component summary (MCS) by SF-36 questionnaire. Results: In 3 months PC significantly increased (VO2peak – 15.6±0.5 ml/min/kg, p<0.001; VO2pred – 53.8±1.7, p<0.001) and VE/VCO2slope decreased (38.2±1.1, p=0.004). Following 1 year after HTx level of PC continue improving (VO2peak – 18.5±0.5 ml/min/kg, p<0.001; VO2pred – 66.3±2.1, p<0.001; VE/VCO2slope – 36.3±0.9, p=0.148) and results remain stable in 3 years (VO2peak – 18.7±0,5, p=0.130; VO2pred – 67.9±1.9, p<0.001; VE/VCO2slope – 36.8±0.9, p=0.017). According to IPAQ results, less than half of patients were physically active (3 months after HTx – 39% (n=45 from 115); 1 year – 46% (n=50 from 109); 3 years – 48% (n=34 from 71), others preferred a sedentary lifestyle. Three months after HTx 58% reached normal values of PC, in 1 year – 68% and in 3 years – 66%. Physically active recipients showed better results of VO2peak than those who had sedentary lifestyle (3 months – 17.0±0.8 vs. 15.2±0.5, p=0.032; 1 year – 19.4±0.8 vs. 16.9±0.4, p<0.001). PCS also increased (3 months – 41.4±1.1, p<0.001; 1 year – 46.6±1.0, p<0.001) and in 3 years remained stable (46.6±1.0, p=0.882). At the same time in 3 months after HTx MCS improved (48.1±0.9, p=0.001) but then started to slowly decrease (1 year – 46.7±0.8, p=0.064; 3 years – 45.4±0.8, p=0.117). We found correlations between age and CPET results (VO2peak - 3 months (r=-0.460, p<0.001), 3 years (r=-0.320, p=0.011); VE/VCO2slope - 3 months (r=0.419, p<0.001), 1 year (r=0.381, p=0.001), 3 years ((r=0.355, p=0.005)) and PCS (3 months – r=-0.391, p<0.001; 1 year – r=-0.341, p<0.001; 1 year – r=-0.363, p=0.002). There were correlations between VO2peak and donors’ age (1 year – r=-0.318, p=0.006; 3 years - r=-0.337, p=0.008) and PA (1 year – r=0.313, p=0.006; 3 years - r=-0.337, p=0.008). The levels of PCS correlated with VO2peak (3 months - r=0.366, p=0.005; 1 year – r=0.397, p<0.001; 3 years – r=0.361, p=0.006) and with VE/VCO2slope (1 year – r=-0.441, p<0.001; 3 years – r=-0.378, p=0.004). Conclusion: All heart transplant recipients improved their physical capacity and quality of life and remained levels of them stable long-term after HTx. Physically active patients showed better results while the older donor and/or recipient’s age are negative factors in reaching normal values of VO2peak.

Health, well-being and quality of life in aged care: Validation of theoretical domains to inform a person-centred outcomes measurement framework.

The constructs of health, well-being and quality of life are not routinely understood or measured for people accessing aged care services. This study aimed to identify and validate theoretical domains of health, well-being and quality of life for recipients of care, their informal carers and staff, and inform the development of a person-centred outcomes measurement framework. First, a rapid review to identify recurrent domains of health, well-being and quality-of-life in aged care, using systematic searches of electronic databases, and review of grey literature, following the PRISMA guidelines. Second, establish content validity of identified domains using (a) Delphi technique with n=134 aged care staff, care recipients and caregivers, and (b) comparability with categories within the International Classification of Functioning, Disability and Health (ICF) and ICF Geriatric Core Set. From 972 records detected in the rapid review, 19 peer-reviewed research articles and 27 grey literature sources were included in the content analysis. Twenty-four domains and 109 concepts were identified, and health, quality of life, security and food and nutrition were ranked as the most important. One domain, cognition, linked to both the Geriatric Core Set and ICF, and 37% of domains and 39% of concepts were evident within the ICF. This study identified and validated 24 important domains of health, well-being and quality of life for the older person receiving care, their informal carers and staff. These domains can be used to guide the selection of outcome measures and facilitate person-centred care and care planning.

The Improvement of Patient's Quality of Life After Kidney Transplantation in Cipto Mangunkusumo Hospital, Indonesia

Kidney transplantation has become the chosen kidney replacement therapy for end stage chronic kidney disease. In Indonesia, no study about quality of life (QoL) in kidney transplantation recipient after surgery has been done. This study aims to determine whether there is a significant difference in the recipient's QoL before and after kidney transplantation surgery. This was a prospective study using Kidney Disease QoL-Short Form (KDQoL-SF) questionnaire before and after surgery (first, third, and sixth month). Samples were consecutively taken from January 2016 until May 2016 and followed up to December 2016. KDQoL-SF has been validated in Indonesian language to assess recipient's QoL (Cronbach alfa >0,6). The data were analyzed using SPSS statistical software 21.0 version and repeated analysis of variance with posthoc comparison Bonferroni was used. There were 33 patients included in this study from January through December 2016. The average age was 44.6 ± 12.88 years old, and average body mass index was 23.8 ± 3.74 kg/m2. The most frequent comorbidity was hypertension (32, 97%). Compared to baseline, the QoL in recipients increased at the first, third, and sixth month after their operation. Major changes in the perceived QoL were noted only between the preoperative stage (median, 50%; interquartile range, [IQR]) ±20) and 1 month after operation (median, 90%; IQR, 0). This study showed that there were significant improvements in almost all aspect in recipient's QoL after kidney transplantation.

Challenges Associated with Pancreas and Kidney Retransplantation-A Retrospective Analysis.

Simultaneous pancreas and kidney transplantation (SPK) is an accepted treatment for diabetic patients with renal failure, and is associated with increased survival and quality of life for recipients. There are only a few publications on the outcomes of simultaneous pancreas–kidney retransplantation (Re-SPK) after previous SPK and the loss of function of both grafts. A total of 55 patients with type 1 diabetes mellitus underwent pancreas retransplantation at our center between January 1994 and March 2021. Twenty-four of these patients underwent Re-SPK after a previous SPK. All 24 operations were technically feasible. Patient survival rate after 3 months, 1 year, and 5 years was 79.2%, 75%, and 66.7%, respectively. The causes of death were septic arterial hemorrhage (n = 3), septic multiorgan failure (n = 2), and was unknown in one patient. Pancreas and kidney graft function after 3 months, 1 year, and 5 years were 70.8% and 66.7%, 66.7% and 62.5%, and 45.8% and 54.2%, respectively. Relaparotomy was performed in 13 out of 24 (54.2%) patients. The results of our study show that Re-SPK, after previously performed SPK, is a technical and immunological challenge, associated with a significantly increased mortality and complication rate; therefore, the indication for Re-SPK should be very strict. Careful preoperative diagnosis is indispensable.

Quality of Life of Informal Caregivers of Hematopoietic Cell Transplant Recipients

IntroductionAutologous (auto) and allogeneic (allo) hematopoietic cell transplant (HCT) recipients face a prolonged post-HCT recovery. Given the extent of supportive care needed post-HCT, recipients are required to have an informal caregiver (IC). ICs are typically spouses, siblings, children or parents of recipients. ICs are critical to post-HCT care, providing emotional support, medication management, assistance with activities of daily living and other vital care that spans months to years of recipient recovery. Given the commitment and responsibility that caregiving requires, it follows that ICs may be burdened. To date, small studies have found that HCT ICs may experience significant levels of distress and burden, as well as poor quality of life (QoL) after HCT. Here we report a large cross-sectional evaluation of HCT IC QoL.MethodsFrom July 2015-June 2016, a survey for ICs was included with a yearly QoL survey that is sent to HCT recipients. Recipients were to give the IC survey to the appropriate person. Both recipient and IC surveys included the SF-36 QoL instrument. SF-36 scores were standardized to the general population (mean 50, standard deviation of 10). Multivariate analyses using forward stepwise logistic regression were used to examine determinants of IC QoL. The two summary scores of the SF-36, the physical component score (PCS) and the mental component score (MCS), were used as endpoints. PCS and MCS summary score >45 (representing QoL scores similar to the general population) were used as the endpoints for all analyses.ResultsSurveys were sent to 4446 recipients. In total, 849 recipient/IC pairs responded (19%), 1170 recipients responded without a corresponding IC response (26%), 43 ICs responded without a corresponding recipient response (1%) and 2384 (54%) recipient/IC pairs did not respond. Most ICs were spouses of the recipient, were caregivers during the first 100 days post-HCT, were still living with the recipient and indicated that they were still providing care to the recipient. The median ages of ICs and recipients were 63 and 62 respectively. One third of recipients received auto-HCT. Recipients were a median of 6 years post-HCT.Median IC QoL measures were at or above population norms across the SF-36 domains. IC QoL measures were significantly higher than those of recipients, apart from the mental health subscale and the MCS which were similarly at or above population norms in both groups (table 1). With respect to the PCS and MCS summary scores; 42.7% and 51.2% of ICs, respectively, scored ≥55 while 18.4% and 21.4% respectively scored ≤45. Results of multivariate analysis are reported in table 2. ICs of allo-HCT recipients were more likely to experience poor QoL (OR 0.68, p=0.05) than ICs of auto-HCT recipients.For auto-HCT ICs, relapse was associated with lower PCS and MCS. Female ICs were associated with a lower MCS while greater time post-transplant was associated with a higher MCS. Higher recipient MCS was significantly associated with higher IC MCS. For allo-HCT ICs, age >60 was associated with lower PCS but higher MCS. Higher IC educational attainment was associated with higher PCS. Higher recipient PCS was associated with higher IC PCS & MCS, while higher recipient MCS was associated with higher IC MCS. Finally, current recipient use of immunosuppressive therapy was associated with lower IC MCS. Notably, for both auto and allo-HCT, IC relationship to recipient, HCT characteristics and most recipient characteristics were not significantly associated with IC QoL.ConclusionsWe report the largest analysis of HCT IC QoL to date. Most ICs in this analysis report QoL at or above general population norms. An understanding of how the HCT experience can enhance QoL, perhaps through post-traumatic growth, might help improve QoL after other distressing events. However, about 20% of ICs in our study reported inferior QoL, with IC age (older associated with worse physical QoL but better mental QoL), IC lower education, IC female gender, lower recipient QoL, current recipient use of immunosuppressive therapy and relapse being significant determinants. Thus, IC characteristics and recipient QoL are more important drivers of IC QoL than recipient and HCT characteristics. With 1 in 5 ICs experiencing poor QoL even several years after HCT, further studies should focus on methods to counteract the adverse effects of HCT on the recipient's support network. [Display omitted] DisclosuresFlowers:Pharmacyclics: Consultancy. Lee:Mallinckrodt: Honoraria; Amgen: Other: One-time advisory board member; Bristol-Myers-Squibb: Other: One-time advisory board member; Kadmon: Other: One-time advisory board member.

The effect of a performing arts intervention on caregivers of people with mild to moderately severe dementia

Objectives This study aimed to determine the feasibility and acceptability of a multi-modal performing arts intervention (MPAI) for caregivers of people with mild to moderately severe dementia. The secondary objective was to examine how MPAI might change caregiver burden, caregiver resiliency, and perceived quality of life (QoL) for care recipients. Method The study features a mixed-methods design. Caregivers (N = 32) completed the Zarit Burden Interview (caregiver burden) Brief Resilience Scale (resiliency) and Quality of Life-Alzheimer’s disease measure (care recipient QoL) at five study timepoints. Semi-structured interviews (N = 15) documented the intervention’s acceptability and caregivers’ subjective experiences. Feasibility was indexed through withdrawal and attendance analysis. Braun and Clarke (2006) thematic analysis guided the qualitative analysis. Results Caregiver burden significantly declined from baseline through final follow-up. Caregiver resiliency and care recipient QoL were not significantly changed but trended up during the intervention until it dropped at the end of the program. Qualitative data suggests the reversal in resiliency and QoL may be explained by caregivers’ increased anxiety as the program ended. Acceptability data indicated caregivers were unanimously highly satisfied with the intervention, desiring to continue participation. Feasibility findings provide recommendations for intervention improvements. Conclusion MPAI could reduce caregiver burden and increase resilience for informal caregivers of a person with dementia. Effects drop off quickly at the end of the program, indicating the need for ongoing interventions that provide social support, a respite from the pressures of care recipients’ dependency, and the relief that caregivers experience when they perceive benefits to their care recipient’s well-being.

The Role of Telemedicine in Kidney Transplantation: Opportunities and Challenges.

Kidney transplantation is the treatment of choice for patients with advanced kidney disease who are medically and surgically fit to undergo the procedure and have reasonable life expectancy. It provides improved survival and quality of life for recipients and overall cost savings to the health care system (1,2). The process of undergoing kidney transplantation involves several phases of care including pretransplant referral and evaluation, waitlist management, and follow-up. In all phases of care, transplant centers interface with candidates and recipients who live across a wide geographic range, with many patients traveling significant distances to a transplant center (3). In the United States, 41,077 candidates were added to the waiting list in 2019 and 23,401 received a transplant. There are approximately 220,000 prevalent kidney transplant recipients and 250 centers actively performing kidney transplants (4). With this continually growing patient population and a limited number of transplant providers, transplant centers are in need of innovative models of health care delivery that ( 1 ) allow them to reach and monitor candidates and recipients, particularly those that live far away; and ( 2 ) improve utilization of transplant center resources. Telemedicine, the practice of medicine using technology to deliver care at a distance, represents an opportunity to do both. The technology used may include telehealth videoconferencing (TVC), the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communication (5). Although telemedicine has been successfully used by numerous specialties, its utilization in the field of kidney transplantation has been lagging. Telemedicine has the potential to affect and improve the delivery of kidney transplant care through the following: ( 1 ) replacing or supplementing in-person visits with virtual visits through TVC, ( 2 ) electronic consultation, and ( 3 ) remote monitoring and provision of education through mobile technology (6). Here we focus on TVC and highlight opportunities for its use …

The Long Term Impact of Cytomegalovirus (CMV) Viremia on Quality of Life in Allogeneic Haematopoietic Cell Transplant Recipients (HCT)

Introduction There is an emerging interest on the indirect effects of cytomegalovirus (CMV) infection following allogeneic haematopoietic cell transplantation (HCT). The long term impact of CMV infection on overall patient quality of life, fatigue and ability to return to work has not previously been described. Objectives We evaluated quality of life measures in recipients of allogeneic HSCT who did and did not experience post-transplant CMV viremia. Methods All adults undergoing allogeneic HCT are invited to attend the Long Term Follow Up (LTFU) clinic at 2 years following their transplantation. For inclusion into the study, we selected any allogeneic HCT recipient who first attended LTFU clinic within the first 2-4 years following HCT between January 2014 to July 2018. At these visits patients completed the EORTC QLQ-C30, FACT BMT0148 and BMTS0-40 quality of life questionnaires. CMV viremia was determined by quantitative CMV plasma viral load testing. Clinically significant CMV viremia (csCMV) was defined as viremia requiring treatment with an anti-CMV agent such as valganciclovir, ganciclovir, foscarnet or cidofovir. Exclusion criteria included any patient undergoing transplantation at another institution or if the QOL questionnaires were not completed at the visit. Results A total of 140 patients with a median age of 52 years (IQR 40-59) were included in the study. AML (45%) and ALL (11%) were the most common reasons for undergoing HSCT. Of the CMV seropositive recipients 94% (n=79), experienced post-HSCT CMV viremia of which 66% had csCMV and were treated with an anti-CMV agent. In patients who were Conclusion There is a significant impact on the long-term quality of life in recipients of allogeneic HCT who received treatment for CMV infection in the areas of fatigue and social functioning. Further studies are warranted to understand, prevent and manage these long-term quality of life effects for patients following HCT.

Exploration of symptom experience in kidney transplant recipients based on symptoms experience model.

Kidney transplant recipients suffer from a variety of symptoms, and symptom management is crucial in improving their quality of life (QOL). Accordingly, this study aims to identify the symptoms experienced by kidney transplant recipients and examine the relationship amongst antecedents, symptom experience and QOL of recipients in China. A total of 300 kidney transplant recipients were investigated in one of the most first-rate hospitals in China by asking them to fill out a self-designed general questionnaire, the Symptom Experience Scale, the Sense of Coherence Scale (Chinese version), the Revised Life Orientation Test (Chinese version) and the 36-item Short Form Health Survey (Chinese version). Kidney transplant recipients experienced multiple symptoms that were frequent, severe and bothersome. The final model showed significant consistency with the data. In the QOL model, post-transplant time, complications, immunosuppressive agents and sense of coherence explained 30.7% of the variance of symptom experience. Moreover, habitual residence, economic burden, post-transplant time, kidney function, optimism and symptom experience accounted for 70.6% of the variance on QOL. We can explain the relationship between antecedents, symptom experience and QOL amongst Chinese kidney transplant recipients by using Symptoms Experience Model. Clinicians and caregivers can manage the recipient's symptoms during follow-up from psychological, physical and medication management perspectives. Improving sense of coherence, maintaining optimism and managing symptoms are essential for enhancing QOL.

WHAT FAMILY CAREGIVERS THINK AND FEEL WHEN PROXY ASSESSING FROM DIFFERENT PERSPECTIVES

Dementia family caregivers are routinely enlisted as proxy assessors of care recipient quality of life (QOL). Proxy assessment is not ideal because proxy assessments differ systematically from self-assessments and the assessment process can elicit negative affect from family caregivers. Prompting adoption of the care recipient’s perspective can enhance assessment congruence and may improve the emotional experience for assessors. This study explored family caregivers’ cognitive and affective experiences during QOL proxy assessments made from both their own and care recipients’ perspectives. Thirty-six dementia family caregivers were recruited from senior service agencies. Subjects completed the Quality of Life-Alzheimer Disease (QOL-AD), Caregiver Version using standard instructions to assess QOL across thirteen domains of their care recipient’s life without specifying the perspective to be used. Subjects were next asked to repeat the QOL-AD with instructions to adopt the perspective of their care recipient, as they imagined it to be. Subjects were then interviewed about what they thought and felt during each proxy assessment experience. Content analysis indicated that spontaneous perspective shifts and response shifts frequently occurred. Most subjects (91.7%) reported changed thinking for one or more QOL-AD domains when they were prompted to switch perspectives. Over half (61.12%) reported changed affect when switching perspectives and 90.9% of those experiencing changed affect reported affective improvement. Little or no affective change was reported by 38.89%. Findings suggest awareness of perspective can enhance clinical interpretation of proxy assessed QOL and can inform clinical response to dementia family caregivers who experience negative emotions while proxy reporting QOL.

Assessing the Quality of Primary Health Services and Its Effect on Quality of Life in Recipients: A Case Study in a Rural Health Center

Assessing the Quality of Primary Health Services and Its Effect on Quality of Life in Recipients: A Case Study in a Rural Health Center

Beyond Survival in Solid Organ Transplantation: A Summary of Expert Presentations from the Sandoz 6th Standalone Transplantation Meeting, 2018.

Beyond Survival in Solid Organ Transplantation: A Summary of Expert Presentations from the Sandoz 6th Standalone Transplantation Meeting, 2018.

Heart transplantation as a radical method of restoring the quality of life in recipients with end-stage heart failure

Aim: the aim of the study was a comparative assessment of the quality of life of recipients with donor heart at the stages before and after heart transplantation. Materials and methods : the study included 150 patients who underwent orthotopic heart transplantation at the «Academician V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs», Ministry of Health of the Russian Federation from January 2009 to March 2018. Results. Analysis of the research results indicates extremely low rates of both physical activity and overall health assessment at the pre-transplantation stage. During the first month after heart transplantation, the role of functioning due to physical condition (p = 0.02), general health (p = 0.001), mental health (p = 0.01) and vital activity (p = 0.01) significantly increase. Tolerance to physical activity increases by 201.26% during the first month after the heart transplantation (p = 0.02). The most complete indicators of quality of life are restored after one year of operation: physical functioning (p = 0.00007), role-based functioning due to physical condition (p = 0.00006), pain threshold (p = 0.04), general health (p = 0.00007), mental health (p = 0.0001), role functioning due to the emotional state (p = 0.01), social functioning (p = 0.0001), vital activity (p = 0.000032). High rates of quality of life are maintained for periods longer than 5 years after transplantation. The best indicators of quality of life in recipients of transplanted heart are observed a year after surgery and manifest a significant increase in all indicators. A comparative analysis of the results obtained in the preoperative period and a year after the operation of orthotopic heart transplantation indicates a significant improvement in the quality of life of patients. Conclusion. The results of the study showed that during the year after heart transplantation in patients with terminal heart failure, there was a significant improvement in all indicators characterizing the quality of life. High levels of physical, mental and social activity achieved by the first year are maintained for at least 5 years, which indicates the high efficiency of orthotopic heart transplantation as a radical method of treating severe heart failure.

The gut microbiota and graft-versus-host disease.

Graft-versus-host disease (GvHD) is a common complication of hematopoietic cell transplantation that negatively impacts quality of life in recipients and can be fatal. Animal experiments and human studies provide compelling evidence that the gut microbiota is associated with risk of GvHD, but the nature of this relationship remains unclear. If the gut microbiota is a driver of GvHD pathogenesis, then manipulation of the gut microbiota offers one promising avenue for preventing or treating this common condition, and antibiotic stewardship efforts in transplantation may help preserve the indigenous microbiota and modulate immune responses to benefit the host.

Peripheral Blood or Bone Marrow Stem Cells? Practical Considerations in Hematopoietic Stem Cell Transplantation.

Although peripheral blood stem cells (PBSC) have worldwide become the predominant source of progenitor cells for hematopoietic stem cell transplantation (HSCT), debate about their role compared with bone marrow (BM) has recently intensified, in large part based on the results of a multicenter Clinical Trials Network study which showed lower incidence of chronic graft-versus-host disease (cGVHD) and improved quality of life in recipients of myeloablative HLA-matched unrelated BM compared with PBSC transplants. However, in certain patient populations, PBSC may lead to improved clinical outcomes due to faster hematologic recovery, a lower risk of graft failure, and possibly a lower probability of relapse. This review will provide a comprehensive summary of studies comparing PBSC with BM as the graft source in terms of acute and chronic GVHD incidence, time to engraftment, and disease-free and overall survival probabilities after HLA-matched related and unrelated donor transplantation and haploidentical donor transplantation. Recommendations based on these studies regarding the use of PBSC versus BM for HSCT are offered.

Dermatologic Conditions of the Early Post-Transplant Period in Hematopoietic Stem Cell Transplant Recipients

Hematopoietic stem cell transplants (HSCTs) are used to treat a variety of conditions, including hematologic malignancies, bone marrow failure syndromes, and immunodeficiencies. Over 60,000 HSCTs are performed annually worldwide, and the numbers continue to increase. Indeed, as new conditioning regimens develop, more and more individuals, including those of older age, will be eligible for transplants. Nevertheless, although HSCTs are clearly a life-saving and necessary treatment for thousands of patients per year, there is still substantial morbidity and mortality associated with the procedure. Of note, skin eruptions in the post-HSCT period are frequent and often significantly reduce quality of life in recipients. Moreover, these cutaneous findings sometimes herald an underlying systemic condition, presenting possible opportunities for timelier intervention. Dermatologists therefore play a vital role in distinguishing life-threatening conditions from benign issues and prompting recognition of critical complications earlier in their course. This article aims to review the major dermatologic conditions occurring in the early post-HSCT period.