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. 2022 Sep;36(9):e14768.
doi: 10.1111/ctr.14768. Epub 2022 Jul 30.

Health-related quality of life and psychological indicators of thriving 15-19 years after heart or lung transplantation

Mary Amanda Dew  1   2   3   4 , Andrea F DiMartini  1   5 , Donna M Posluszny  6   7 , Larissa Myaskovsky  8 , Galen E Switzer  1   4   6 , Chethan Puttarajappa  6 , Gavin W Hickey  6   9 , Pablo G Sanchez  10 , Annette J DeVito Dabbs  3
Affiliations

Health-related quality of life and psychological indicators of thriving 15-19 years after heart or lung transplantation

Mary Amanda Dew et al. Clin Transplant. 2022 Sep.

Abstract

Background: Survival into the second decade after cardiothoracic transplantation (CTX) is no longer uncommon. Few data exist on any health-related quality of life (HRQOL) impairments survivors face, or whether they may even experience positive psychological outcomes indicative of "thriving" (e.g., personal growth). We provide such data in a long-term survivor cohort.

Methods: Among 304 patients prospectively studied across the first 2 years post-CTX, we re-interviewed patients ≥15 years post-CTX. We (a) examined levels of HRQOL and positive psychological outcomes (posttraumatic growth related to CTX, purpose in life, life satisfaction) at follow-up, (b) evaluated change since transplant with mixed-effects models, and (c) identified psychosocial and clinical correlates of study outcomes with multivariable regression.

Results: Of 77 survivors, 64 (83%) were assessed (35 heart, 29 lung recipients; 15-19 years post-CTX). Physical HRQOL was poorer than the general population norm and earlier post-transplant levels (P's < .001). Mental HRQOL exceeded the norm (P < .001), with little temporal change (P = .070). Mean positive psychological outcome scores exceeded scales' midpoints at follow-up. Life satisfaction, assessed longitudinally, declined over time (P < .001) but remained similar to the norm at follow-up. Recent hospitalization and dyspnea increased patients' likelihood of poor physical HRQOL at follow-up (P's ≤ .022). Lower sense of mastery and poorer caregiver support lessened patients' likelihood of positive psychological outcomes (P's ≤ .049). Medical comorbidities and type of CTX were not associated with study outcomes at follow-up.

Conclusions: Despite physical HRQOL impairment, long-term CTX survivors otherwise showed favorable outcomes. Clinical attention to correlates of HRQOL and positive psychological outcomes may help maximize survivors' well-being.

Keywords: health-related quality of life; heart transplantation; lung transplantation; psychological outcomes; psychosocial factors; thriving.

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Conflict of interest statement

CONFLICT OF INTEREST

The Authors declare no conflicts of interest with respect to the completion of this work.

Figures

FIGURE 1
FIGURE 1
HRQOL impairment levels (SF-36 standardized scores) at long-term follow-up and across time post-transplant in 64 cardiothoracic transplantation recipients. (A) *P’s < 0.05 for comparison to the population norm. Actual values were <0.001 for physical function through vitality, 0.222 for social function, 0.047 for role-emotional, 0.026 for mental health, and <0.001 for physical and mental component scores. (B) *Neither group (heart v. lung) nor group X time effects were significant at P < 0.05; see text for more information.
FIGURE 2
FIGURE 2
Life satisfaction across time post-transplant in 64 cardiothoracic transplantation recipients (mean scores and SEs)
See this image and copyright information in PMC

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