Slominska Anita Marie, Kinsella Elizabeth Anne, El-Wazze Saly, Gaudio Kathleen, Shamseddin M Khaled, Bugeja Ann, Fortin Marie-Chantal, Farkouh Mireille, Vinson Amanda, Ho Julie, Sandal Shaifali
MEDIC, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
Kidney Int Rep. 2024 Jul 17;9(10):2937-2945. doi: 10.1016/j.ekir.2024.07.011. eCollection 2024 Oct.
Kidney transplant recipients with graft failure are a growing cohort of patients who experience high morbidity and mortality. Limited evidence guides their care delivery and patient perspective to improve care processes is lacking. We conducted an in-depth exploration of how individuals experience graft failure, and the specific research question was: "What impact does the loss of an allograft have on their lives?"
We adopted an interpretive descriptive methodological design. Semistructured in-depth narrative interviews were conducted with adult recipients who had a history of ≥1 graft failure. Data were collected until data saturation was achieved and analyzed using an inductive and thematic approach.
Our study included 23 participants from 6 provinces of Canada. The majority were on dialysis and not waitlisted for retransplantation (60.9%). Our thematic analysis identified that the lives of participants were impacted by a range of tangible and experiential losses that go beyond the loss of the transplant itself. The themes identified include loss of control, loss of coherence, loss of certainty, loss of hope, loss of quality of life, and loss of the transplant team. Although many perceived that graft failure was inevitable, the majority were unprepared. The confusion about eligibility for retransplantation appears to contribute to these experiences.
Individuals with graft failure experience complex mental and emotional challenges which may contribute to poor outcomes. The number of patients with graft failure globally is increasing and our findings can help guide practices aimed at supporting and guiding them toward self-management and adaptive coping.
移植肾失功的肾移植受者群体不断壮大，这些患者的发病率和死亡率都很高。指导其护理的证据有限，且缺乏从患者角度改善护理流程的相关研究。我们深入探究了个体如何经历移植肾失功，具体研究问题为：“同种异体移植肾的丧失对他们的生活有何影响？”
我们采用了解释性描述性方法设计。对有≥1次移植肾失功病史的成年受者进行了半结构化深度叙事访谈。持续收集数据直至数据饱和，并采用归纳和主题分析方法进行分析。
我们的研究纳入了来自加拿大6个省份的23名参与者。大多数人正在接受透析，且未被列入再次移植的等候名单（60.9%）。我们的主题分析发现，参与者的生活受到一系列切实和体验性损失的影响，这些损失超出了移植肾本身丧失的范畴。确定的主题包括失去控制、失去连贯性、失去确定性、失去希望、生活质量下降以及失去移植团队。尽管许多人认为移植肾失功不可避免，但大多数人并未做好准备。关于再次移植资格的困惑似乎导致了这些体验。
移植肾失功的个体经历着复杂的心理和情感挑战，这可能导致不良后果。全球移植肾失功患者的数量在增加，我们的研究结果有助于指导旨在支持和引导他们进行自我管理及适应性应对的实践。
