Emotional management and quality of life in mother living versus multi-organ donor renal transplant recipients

The aim of this study was to evaluate psychological differences and quality of life between kidney recipients from living (mother) and multi-organ donor. Overall, 40 patients who had undergone both living (mother) and multi-organ kidney transplantation 3–6months before were asked to complete four self-report instruments: Toronto Alexithymia Scale, Short Form Health Survey, Regulatory Emotional Self-efficacy, and Attachment Style Questionnaire. A greater difficulty in emotional, social, and mental health functioning was found in recipients receiving kidney from mother living donor. Moreover, in these patients, higher levels of avoidant attachment dimensions were associated with a worse quality of lif

A multivariate framework to explore firms’ internationalization patterns: the role of individual heterogeneity

In this paper, we explore the internationalization pattern of firms and its relationship with firms’ heterogeneity. Besides the more traditional exports and Foreign Direct Investments (FDI), we consider various forms of non-equity internationalization. The use of a Multivariate Probit Model allows us to assess the associations among the choices driving the firms’ internationalization strategy as a whole and, at the same time, to avoid a priori assumptions on the internationalization patterns. From the empirical evidence, two main results emerge. At first, we observe that Italian firms jointly adopt various internalization forms, others than exports and FDI, conditionally to characteristics of the firms. The hypothesis reported in literature of a complementary or subsidiary relationship between exports and FDI is then confirmed also for non-equity internationalization forms. Secondly, we find that the heterogeneity of firms, measured by a large range of variables, has an important role in defining the choice of firms on the patterns of internalization. Thus in this context, we endorse the emerging opinion asserting that various dimensions other than productivity are relevan

Predittori psicologici del rigetto d’organo

Il trapianto d’organo è oggi un’efficace terapia in grado di migliorare la qualità di vita di pazienti cronicamente malati, anche se è ancora alto lo squilibrio tra il numero di persone in lista di attesa e gli organi disponibili, il che fa sì che la stessa permanenza in lista sia spesso lunga e fonte di continua tensione. Quanto più l’organo è simbolicamente importante, tanto più è investito di significati psicologicamente rilevanti. Inoltre, la garanzia di continuità nell’aiuto psicologico, dal momento dell’inserimento in lista fino ai follow-up successivi, contribuisce a una buona riuscita dell’intervento stesso, migliorandone la compliance e favorendo un maggiore adattamento e, generalmente, un miglioramento della qualità di vita del paziente

The psychological rejection in kidney and liver transplants

Organ transplantation is an effective therapy to improve the quality of life (QoL) in chronic patients. It is still high the imbalance between the number of the patients in the waiting list and the number of available organs. It causes a long permanence in the waiting lists. For many patients, the organ transplantation is the only way to have a sufficient improvement of the quality of life and sometimes it is the only way to survive. The study of the patient’s personality thus is an important factor in order to avoid that the transplant could cause mental illness. Pre-transplantation relational, cognitive, emotional assessment can help to plan a rehabilitation in order to improve the therapy outcome. Aim of this pilot study is to investigate the possible predicting role of the psychological state (anxiety, introversion-extroversion, psychoticism, antisocial, psychophysiological disorders, fears, depression, obsessions and compulsions) in the organ graft

Psychological risk factors for graft rejection among liver transplant recipients

The purpose of this prospective study was to find psychological risk factors predicting acute, chronic, and psychological rejection in patients undergoing liver transplantation using Cognitive Behavioural Assessment (CBA-2.0). The primary scale included an assessment of fears, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression. We prospectively recruited 44 patients undergoing orthotopic liver transplantation (OLT). Exclusion criteria were: education level below secondary school, unstable clinical situation in an out-patient setting, fulminant hepatitis, psychotic disorders, neurocognitive deficits, dementia, serious mental retardation, current alcohol or drug abuse, recent ideation of or attempted suicide, and non-adherence to therapy. CBA-2.0 primary scale series of questionnaires were handed out to patients immediately after the medical examination, which had been performed to ascertain eligibility for OLT. Rejection (acute and/or chronic) was diagnosed according to clinical and histopathological criteria. Psychological rejection was diagnosed when patients declared, after transplantation, a refusal of the new organ which caused psychiatric symptoms requiring medical treatment and/or psychotherapy. Analysis of variance and logistic regression of psychological variables was performed to detect possible risk factors for each type of rejection. A greater fear of repulsive animals was able a predictor for an acute rejection episode (odds ratio=1.1; P<.05). No other psychological pretransplant predictor was noted for chronic or psychological rejection. In patients undergoing OLT, preoperative emotions of fear could predict an acute graft rejection episode. These findings imply that pre-OLT screening should include psychological factors in addition to traditional medical criteria with intervention in selected cases

Preoperative Psychological Factors Predicting Graft Rejection in Patients Undergoing Kidney Transplant: A Pilot Study

Background. The aim of this study was to investigate whether pretransplant psychological variables included in the CBA 2.0 Primary Scale-fear, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression-could predict graft rejection among patients undergoing kidney transplantation. Methods. After ethical committee approval we enrolled 33 consecutive adult patients undergoing kidney transplantation. The inclusion criteria were a stable clinical situation in an out-of-hospital setting; Italian language literacy; a minimum of secondary school-level education, and written informed consent. We excluded patients with a psychotic disturbance, neurocognitive deficit, dementia, serious mental delay (IQ <50), current alcohol or drug abuse, recent ideation or attempted suicide or nonadherence to the therapeutic protocol. Acute and/or chronic graft rejection was diagnosed according to clinical and histopathologic criteria. CBA-2,0 "Primary Scale" series of questionnaires were handed out to patients at the time of the examinations to discrem eligibility for transplantation. Analyses of variance were performed to compare psychological scores among patients with versus without graft rejection. Logistic regression analyses of psychological variables were performed to detect possible predictors for graft rejection. The results of the analysis showed that higher psychoticism scores were able to predict graft rejection (P < .05). Results. The findings of this study suggest that it is mandatory to preoperatively plan an holistic treatment including psychological intervention mainly focused on psychoticism

Expanding the living donor pool, &quot;Ist Act&quot;: analysis of the causes of exclusion of potential kidney donors.

Abstract BACKGROUND: The evaluation of a potential living kidney donor (LKD) leads to exclusion of at least 50% of candidates. The aim of this study was to analyze the reasons for exclusion of potential LKDs referred to our center. METHODS: We retrospectively analyzed historic and clinical data of all potential LKDs who were evaluated over 7 years from January 2005 to March 2012. Data were obtained by review of an electronic database. RESULTS: Among 79 (50 female, 29 male) candidates, 24 (30.3%) successfully donated, comprising 22 related and 2 unrelated donors. We excluded 45 (56.9%), and 10 (12.6%) are actively undergoing evaluation. Reasons for exclusion were medical (n = 14; 31%), nonmedical (n = 18; 40%), positive cross-match (n = l7.7%), pregnancy (n = 2; 4.4%), and other reasons (n = 3; 6.6%). Of the 14 donors excluded for medical reasons, 75.8% were due to diabetes, cardiovascular disease, hypertension, or obesity and 21.5% to inadequate renal function, malignancy, or liver disease. Of the 18 (40%) excluded for nonmedical reasons, 6 (33.3%) were because the intended recipient received a deceased-donor transplantation before the evaluation could be completed, 5 (27.7%) because the recipient was no longer a candidate for transplantation, 5 (27.7%) because of donor withdrawal, and 2 (11.1%) for other reasons. CONCLUSIONS: Positive cross-match and deceased-donor transplantation during the evaluation process were the 2 most common reasons for LKD exclusion. Evaluation of potential LKDs is time consuming, requiring a remarkable amount of human and material resources. A dedicated pathway for the diagnostic work-up of LKDs may speed- the evaluation process and improve its efficiency, use of ABO-incompatible or paired-exchange donations may increase the yield of donor organs