Journal Article Annotations
2019, 1st Quarter
Paula Zimbrean, MD
Type of study: (http://ebm.bmj.com/content/early/2016/06/23/ebmed-2016-110401): cohort, prosepctive
The finding: Clinically relevant improvements of psychological functioning were found in 13–20% of donors, and a clinically relevant worsening was found in 11–27% of donors. There were no changes in the donor’s mental health functioning over time after surgery. Donor’s life was less influenced by the recipient’s kidney disease after transplantation (P < 0.001) compared to pre-transplantation, with 59% of donors experiencing moderate–much influence pre-donation, and 29–33% 6 and 12 months post-donation. Donors also felt less responsible for their recipient’s wellbeing than before transplantation.
Fourteen percent of the donors expressed regret of the donation. Higher levels of regret were associated with different pre-donation factors: worse emotional functioning of the recipient, more donor feelings of responsibility about the recipient , higher expectations about donor benefits, more anxiety, lower age,. Among the post-donation factors that influenced regret were: more influence of the recipient’s transplantation on the donor’s life, worse health perceptions, worse social functioning and worse surgery recovery.
Strength and weaknesses: This was a prospective study of the psychological status of kidney donors, who assessed quality of life , health perceptions and regret after donation in 230 kidney donors at 6 and 12 months after surgery. The study provides important information about factors associated with regret of the donation. The main limitations of this study consists in the non specific evaluation of the psychological well being (assessed by the SF 36 scale), as well as lack of analysis of other factors that may impact the quality of life, such as social support or perceived stress.
Relevance: the study provides important infomraiton about factors associated with regret of the donation in living kidney donors.
Type of study:(http://ebm.bmj.com/content/early/2016/06/23/ebmed-2016-110401): prospective cohort
The finding: the study found that elderly patients who received a liver transplant showed cognitive improvement after surgery comparable with young liver transplant recipients.
Strength and weaknesses: it is important to note the assessments were collected prospectively so the change in cognitive function could be properly assessed. The cognitive assessments evaluated various aspects of cognitive function, including language and executive function. The limitations of this study consists in low numbers of subjects which did not allow a complete analysis of other factors that may have contributed to the change in cognitive function in this group. In addition, there is no information about potential liver candidates of similar age who received a transplant but opted out of the study.
Relevance: the findings of this study are important when decisions are being made on using age as a criteria for listing for transplantation. There is a tendency in the practice of transplantation to offer transplantation at a more advanced age, to patients who in the past used ot be excluded from listing as considered to be “too old”. This study shows that selected patients can improve cognitively post transplantation.