Fear of graft rejection and its relationship to psychological general well-being: a longitudinal five-year follow-up after heart transplantation
J Granstrom, I Haugen Lofman, M Dalvindt, A Lennerling, M Melin, C Hage, A ForsbergAbstract
Background
Heart transplantation is the gold standard treatment for advanced heart failure prolonging life and improving quality of life. However, the immunosuppressive treatment involves challenges such as side-effects and symptom distress. The risk of graft rejection and graft failure is always present and can be perceived as a serious threat by the heart recipient which might have an impact on psychological well-being.
Purpose
To explore perceived threat of graft rejection from a longitudinal perspective, evaluate changes over time and the relationship with psychological general well-being.
Methods
In a nationwide, multi-center longitudinal cohort study heart recipient were followed from pre-transplant to 5 years post-transplantation. Data was collected at out-patient clinics by transplant nurses at 3 and 6 months and 1, 2, 3, 4 and 5 years. Fear of graft rejection and psychological well-being was explored by two instruments: The Perceived Threat of the risk of Graft Rejection (PTGR) consisting of three different domains: graft related threat, intrusive anxiety and lack of control, and The Psychological General Well-Being (PGWB).
Results
In total 73 heart recipients, 57 men and 16 women, with a mean age 52 ±13 years were followed until 5 years (Table). Median values for each domain varied between 4 to 8 during the follow-up period, indicating low concern regarding graft rejection (Figure). Self-reported rejections are reported in the Table. The proportion of heart recipients reporting a perceived serious threat of graft rejection varied between 11.5 to 24.5% at each measuring point, with the highest proportion after 3 years. No significant changes were observed over time. Intrusive anxiety was overall low with 8.2 % experiencing severe intrusive anxiety after 3 months followed by a significant decrease from 6 months to 1 year. Low of control regarding graft rejection was reported by 10.6 to 21.9% during the 5 years follow-up. Heart recipients with poor psychological well-being reported significantly stronger intrusive anxiety compared to those with good psychological well-being. Intrusive anxiety explained over 85% of the psychological well-being four years post-transplant. They also reported less control at several measuring points and more graft related threat after 5 years. Intrusive anxiety was an issue also among those reporting good psychological well-being and explained 70 % of the psychological well-being after three years.
Conclusion(s)
Fear of graft rejection is not a prominent problem the first five years after heart transplantation. However, for those affected by the fear the problem must be approached, specifically among those with poor psychological well-being.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.