5 research outputs found
Psychosocial functioning in pediatric heart transplant recipients and their families
Across pediatric organ transplant populations, patient and family psychosocial functioning is associated with important healthârelated outcomes. Research has suggested that pediatric heart transplant recipients and their families are at increased risk for adverse psychosocial outcomes; however, recent investigation of psychosocial functioning in this population is lacking. This study aimed to provide a contemporary characterization of psychosocial functioning in pediatric heart transplant recipients and their families. Associations between psychosocial function, demographic variables, and transplantârelated variables were investigated. Fiftyâsix parents/guardians of pediatric heart transplant recipients completed a comprehensive psychosocial screening measure during transplant followâup clinic visits. Descriptive statistics, correlational analyses, and independent samples t tests were performed. Forty percent of pediatric heart transplant recipients and their families endorsed clinically meaningful levels of total psychosocial risk. Oneâthird of patients presented with clinically significant psychological problems per parent report. Psychosocial risk was unassociated with demographic or transplantârelated factors. Despite notable improvements in the survival of pediatric heart transplant recipients over the past decade, patients and families present with sustained psychosocial risks well beyond the immediate postâtransplant period, necessitating mental health intervention to mitigate adverse impact on healthârelated outcomes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142422/1/petr13110.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142422/2/petr13110_am.pd
Generalized and specific anxiety in adolescents following heart transplant
Mental health concerns are associated with worse outcomes after adult heart transplant. Illnessâspecific anxiety is associated with worsened psychological wellâbeing after other solid organ transplants but has never been characterized after pediatric heart transplant. This singleâcenter crossâsectional study aimed to evaluate illnessâspecific and generalized anxiety after heart transplantation in adolescents. A novel 12âitem PHTF, GADâ7, and the PedsQL were administered. Univariate associations of demographics, clinical features, and medication adherence as measured by immunosuppression standard deviation with the PHTF and GADâ7 scores were evaluated. Internal consistency and validity of the PHTF were examined. In total, 30 patients participated. The most common illnessâspecific fears were retransplantation, rejection, and more generally postâtransplant complications. The PHTF had good internal consistency (Cronbach α = .88). Construct validity was demonstrated between PHTF and GADâ7 (r = .62) and PedsQL (r = â.54 to â.62). 23% endorsed moderate to severe generalized anxiety symptoms. More severe symptoms were associated with older age at survey (P = .03), older age at listing (P = .01) and having postâtransplant complications (P = .004). Patients with moderate or severe symptoms were more likely to report late immunosuppression doses (P = .004). Illnessâspecific and generalized anxiety may be prevalent after pediatric heart transplant. Screening for anxiety in adolescents postâtransplant may identify those at risk for adverse outcomes including nonâadherence. The PHTF is a brief, valid, and reliable instrument identifying illnessâspecific anxiety in this population.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153669/1/petr13647.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153669/2/petr13647_am.pd
Association of Pediatric Heart Transplant Coronary Vasculopathy with Abnormal Hemodynamic Measures
Objective.â Transplant coronary artery disease (TCAD) is the limiting factor to longâterm cardiac allograft survival; however, presymptomatic diagnosis remains challenging. To that concern, we evaluated the association of abnormal catheterâderived filling pressures with TCAD in pediatric heart transplant (HTx) recipients.Design, Patients, Outcome Measures.â Data from 52 presymptomatic pediatric HTx patients were analyzed. Catheterâderived right ventricular endâdiastolic pressure (RVEDP) and pulmonary capillary wedge pressure (PCWP) were recorded. Biopsies were collected to verify the absence of rejection.Results.â TCAD was diagnosed an average of 8.3 years postâHTx in 20 (38%) patients, six of whom died and four of whom underwent retransplantation. Catheterâderived pressure measurements showed that RVEDP was elevated in TCAD compared with nonâTCAD patients (9.5 ± 6.0 vs. 5.4 ± 4.7; P= .005), as was the PCWP (12.9 ± 5.7 vs. 9.1 ± 5.7; P= .012). Results from logistic regression analysis showed RVEDP > 10âmmâHg or PCWP > 12âmmâHg was associated with TCAD (OR = 5.2; P= .010).Conclusions.â In this series, elevated ventricular filling pressures measured during routine surveillance catheterizations were associated with angiographic TCAD. Recognizing the association between elevated RVEDP/PCWP and TCAD may prompt earlier diagnosis and treatment of this potentially lethal process.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111940/1/j.1747-0803.2010.00470.x.pd