Monday, August 17, 2009

Palliative Care Referrals After Lung Transplantation

Palliative Care Referrals After Lung Transplantation in Major Transplant Centers in the United States

This article in Medscape Pulmonary Medicine notes that lung transplantation improves survival and quality of life for patients with end-stage lung disease. However, long-term success in achieving these outcomes is limited due to the development of chronic rejection and the adverse effects of the requisite immunosuppression

By 5 years after transplantation, 43% of lung transplant recipients (LTR) develop chronic rejection. Compared with a survival rate of >80% at 4 years in LTR without chronic rejection, the overall mortality rate following the onset of chronic rejection is 40% within 2 years of diagnosis. Even recipients with chronic rejection who opt for retransplant experience higher morbidity and mortality compared with their initial transplant procedure.

The authors also note that from the onset of chronic rejection until death, LTR experience frequent hospitalizations (up to 14 readmissions) and exacerbations (up to 17 visits to the emergency department). In addition, LTR commonly experience higher levels of psychological distress (e.g., anxiety and depression) than other organ recipients, manage an average of 17 physical symptoms and report a low sense of mastery for managing their illness. Although both LTR and their families are typically satisfied with medical care during the early recovery phase after lung transplant, they are critical about the lack of continuity of care as their health condition deteriorates. Family caregivers report high levels of subjective burden, symptoms of depression and anxiety, stress related to tackling organizational difficulties, and financial burdens. They also express the need for more information, better communication, and better access to psychosocial support.

The authors also say that future research should include developing and testing interventions and strategies to integrate palliative care into lung transplant care to better meet the needs of LTR and their families as health declines.

Read the Full article for study methods, results, discussion and the author's conclusions.

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