Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada.
Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
Transplant Rev (Orlando). 2023 Apr;37(2):100761. doi: 10.1016/j.trre.2023.100761. Epub 2023 Apr 13.
Kidney transplant recipients with graft failure are a rapidly rising cohort of patients who experience high morbidity, mortality, and fragmented transitions of care between transplant and dialysis teams. Current approaches to improving care focus on medical and surgical interventions, increasing re-transplantation, and improving coordination between treating teams with little understanding of patient needs and perspectives.
We undertook a systematic literature review of personal experiences of patients with graft failure. Six electronic and five grey literature databases were searched systematically. Of 4664 records screened 43 met the inclusion criteria. Six empirical qualitative studies and case studies were included in the final analysis. Thematic synthesis was used to combine data that included the perspectives of 31 patients with graft failure and 9 caregivers.
Using the Transition Model, we isolated three interconnected phases as patients transition through graft failure: shattering of lifestyle and plans associated with a successful transplant; physical and psychological turbulence; and re-alignment by learning adaptive strategies to move forward. Critical factors affecting coping included multi-disciplinary healthcare approaches, social support, and individual-level factors. While clinical transplant care was evaluated positively, participants identified gaps in the provision of information and psychosocial support related to graft failure. Graft failure had a profound impact on caregivers especially when they were living donors.
Our review reports patient-identified priorities for improving care and can help inform research and guideline development that strives to improve the care of patients with graft failure.
移植肾功能丧失的肾移植受者是一个快速增长的患者群体，他们经历着高发病率、高死亡率，以及在移植和透析团队之间医疗护理的碎片化转移。目前改善护理的方法主要集中在医疗和手术干预、增加再移植，以及提高治疗团队之间的协调性上，但对患者的需求和观点缺乏了解。
我们对移植肾功能丧失患者的个人经历进行了系统的文献回顾。系统地检索了六个电子数据库和五个灰色文献数据库。在筛选出的 4664 条记录中，有 43 条符合纳入标准。最终分析纳入了 6 项实证定性研究和病例研究。使用主题合成方法将包括 31 名移植肾功能丧失患者和 9 名照顾者观点的数据进行了组合。
我们使用过渡模型，确定了患者在移植肾功能丧失过程中经历的三个相互关联的阶段：与成功移植相关的生活方式和计划的破灭；身体和心理的动荡；通过学习适应性策略重新调整前进方向。影响应对的关键因素包括多学科医疗保健方法、社会支持和个体因素。虽然临床移植护理得到了积极评价，但参与者指出，在与移植肾功能丧失相关的信息和心理社会支持方面存在差距。移植肾功能丧失对照顾者，特别是对活体供者，产生了深远的影响。
我们的综述报告了患者确定的改善护理的优先事项，有助于为改善移植肾功能丧失患者护理的研究和指南制定提供信息。
