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177: LVAD Therapy: Impact of Family Caregivers' Stress, Coping, Social Support on Perceived Burden & Quality of Life (QOL)
The Journal of Heart and Lung Transplantation Volume 28, Number 2S
5°C for 12 hours with the same solution. One heart underwent conventional static storage for the same interval. Temperature, flow, and pressure were recorded in perfused hearts. After 12 hours of perfusion, Hearts were removed and weighed. Tissue samples were collected, frozen in liquid nitrogen and later analyzed by proton magnetic resonance spectroscopy (MRS). The lactate/alanine ratio was used to evaluate the metabolic state of stored hearts as previously described. Results: Donor patients ages in this study range from 20-67 years. Perfusate temperature was maintained at 6⫾2°C. Aortic pressures averaged 16⫾2 mmHg. After 12 hour storage, perfused hearts showed no evidence of myocardial edema. Initial heart weights were 429⫾31 g. Final heart weights were 404⫾29 g (p⫽NS). Final LV water content: was 76.8⫾0.9%. Oxidative metabolism was preserved in perfused hearts. LV extract lactate/alanine ratios were 0.68⫾0.22 for perfused hearts. This ratio was 2.55 in the static storage heart. Conclusions: Perfusion preservation supported myocardial metabolism over this extended storage interval without myocardial edema formation. These data suggest that perfusion preservation may be an effective strategy to preserve human hearts for long intervals.
175 Post-Lung Transplant Health-Related Quality of Life: Perception and Reality L.G. Singer1,2, N. Chowdhury2, C. Chaparro1,2, M.A. Hutcheon1,2 1 University of Toronto, Toronto, ON, Canada; 2University Health Network, Toronto, ON, Canada Purpose: Candidates should understand the health-related quality of life (HRQL) benefits of lung transplantation to make an informed decision about this treatment. Our goals were to estimate utility improvements with transplantation, and to determine whether lung transplant candidates can accurately predict post-transplant HRQL (utility)scores. Methods and Materials: In this prospective cohort study, standard gamble (SG) and visual analog scale (VAS) utilities for current health (PreTx) were elicited from transplant candidates. Candidates then completed SG and VAS utilities imagining that they had received a transplant, and were asked to predict utilities without (NoBOS) and with BOS (BOS). After transplantation, the same patients reported actual SG and VAS utilities for current health. We calculated the difference between mean pre-transplant predicted and post-transplant actual uNoBOS and uBOS, for both SG and VAS scores. Matched-pairs signed-ranks tests were used examine associations between predicted and actual utilities, and between actual pre- and post-transplant utilities. Results: 207 patients underwent 347 pre-transplant and 816 post-tx utility assessments. 202 patients provided uNoBOS data and 52 patients provided uBOS data (Highest stage: BOS1-23, BOS2-16, BOS3-13) post-transplant. Actual utility improved significantly with transplant, even with BOS (Mean SG PreTx 0.43 vs. actual NoBOS 0.88 and BOS 0.75; mean VAS 36 PreTx vs. actual NoBOS 77 and BOS 63; p⬍0.00001 for all comparisons). Candidates accurately predicted SG for NoBOS (mean difference diff between predicted and actual scores -0.01, p⫽0.4) but underestimated SG for BOS (diff -0.19, p⫽0.007). Candidates overestimated VAS for NoBOS (diff 9, p⬍0.00001) and underestimated VAS for BOS (diff -13, p⫽0.005). Conclusions: Lung transplantation significantly improves utility, even with BOS. However, lung transplant candidates may not accurately estimate utility after transplantation, and particularly tend to underestimate utility with BOS. Education about post-transplant quality of life may improve patient decision-making.
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176 Health-Related Quality of Life in Long-Term Survivors after Heart and Lung Transplantation: A Comparative Cohort Study C. Kugler1, U. Tegtbur2, J. Gottlieb3, C. Bara1, D. Malehsa1, T. Fuehner3, M. Strueber1, A. Haverich1, A. Simon1 1Hannover Medical School, Hannover, Germany; 2Hannover Medical School, Hannover, Germany; 3Institute of Sportsmedicine, Hannover Medical School, Hannover, Hannover, Germany Purpose: Purpose for this study was to evaluate (1) the development of health-related quality of life (HRQoL) after transplantation, (2) to compare HRQoL for heart (HTx) and lung (LTx) transplant survivors, and (3) to assess potential outcome-related predictors. Methods and Materials: A sample of 171 patients were prospectively followed for five years after HTx (n⫽82) or LTx (n⫽89) including 8 HRQoL assessments (pre-tx, 6, 12, yearly 24-60 months) using the SF-36, global life satisfaction, and the work performance index. The study protocol received IRB approval. Results: Patient groups (HTx vs. LTx) differed with respect to age (57⫾12 vs. 52⫾11; p⬍0.001), gender (male 74% vs. 47%; p⬍0.0001), and high urgency waiting status (30% vs. 54%; p⬍0.0001). Both cohorts showed most significant HRQoL improvements within the first year post-tx (p⬍0.0001), and a steady state in five of eight SF-36 subscales afterwards. Before transplant LTx candidates report lower HRQoL ratings in the physical (p⬍0.03) and psychosocial (p⬍0.01) domain of HRQoL compared to HTx patients. Group comparisons after transplant showed comparable ratings for the medium period (yr 1-3), and significantly lower HRQoL ratings for LTx patients at 4 and 5 yrs post-tx in their physical (p⬍0.005), and psychosocial (p⬍0.04) subscales. 28.4% of HTx and 28.7% of LTx patients returned to work after transplant. Occurrence of rejections (⬎1yr) significantly impacted the psychosocial domain in both groups (HTx p⬍0.05 vs. LTx p⬍0.04). Chronic rejection (TVP 8.7%) did not impact HTx recipients HRQoL perceptions, but showed significantly lower HRQoL in LTx patients (BOS 29.3%; p⬍0.001). Other predictors including cancer (3.6% vs. 3.3%) showed no impact on HRQoL. Conclusions: HTx and LTx patients benefit from the transplant procedure with respect to HRQoL improvements for at least five years post-transplant, however their trajectories differ. Further research on organ-type related predictors of HRQoL is necessary for development of tailored interventions. 177 LVAD Therapy: Impact of Family Caregivers’ Stress, Coping, Social Support on Perceived Burden & Quality of Life (QOL) M. Petty1, K. Savik2 1University of Minnesota Med. Center, Fairview, Minneapolis, MN; 2University of Minnesota, Minneapolis, MN Purpose: No prospective quantitative evaluation of perceived family caregiver burden and QOL and its influencers has been performed in LVAD caregivers. The purpose of this study was to gain a better understanding of their experience over time and to identify point(s) at which the LVAD team can focus support on those caregivers. Methods and Materials: A longitudinal, prospective correlational design was selected for a convenience sample of 22 self-identified family caregivers of BTT and DT LVAD patients from a single Midwestern US center. Subjects completed questionnaires 1 to 5 times over a 6 month period. Items included measures of demographics, caregiver involvement, caregiver distress (CDS), coping (BCS), social support (MOS-SS), depression (CES-D), caregiver burden (CBA) and QOL (SF-12, Cantril ladder). Results: Subjects were predominantly Caucasian (86.4%) female (90.9%) spouses (81.8%) of LVAD patients bridged to transplant
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(77.3%). Caregiver health was generally rated very good (54.5%) or excellent (9.1%). While caregiver involvement with ADLs and IADLs decreased over time, CDS trended up at time 4 in all subscales (p⫽ns). Caregiver burden decreased and leveled off across time points except for subjective demand burden which slightly rebounded late. QOL by Cantril ladder rating trended downward (p⫽0.10) as did the mental composite scale of SF-12 (p⫽0.20). Caregiver distress scales of social impact and personal cost negatively impacted QOL (p⫽0.01, p⫽0.05, respectively). Conclusions: Family caregivers experience increased distress 4 months or more after hospital discharge, with a negative impact on QOL. Future studies should focus on confirming findings and developing intervention strategies to support family caregivers.
The Journal of Heart and Lung Transplantation February 2009
social support 5 to 10 yrs after heart HT (P⬍.05). No significant associations between pts physiologic characteristics and satisfaction with social support were observed at 5 and 10 yrs post HT. Pts with higher degree of stress (P⬍.001), depressive moods (P⬍.0001), mobility limitation (P⬍.01) and symptom (P⬍.001) reported less satisfaction with social support at 5 years, and such negative associations continued to grow and became stronger at 10 years after HT. At 5 and 10 years, perceived satisfaction with social support was a significant (P⬍.001) predictor of QOL post HT after controlling for pts demographic, physiologic, and psychosocial characteristics. Conclusions: Social support was significantly related to long-term QOL outcomes after HT. It is important for researchers to identify pts at risk for poor QOL outcomes and to develop interventions that will facilitate the best QOL possible following heart transplantation.
179 Impact of Donor-Transmitted Coronary Atherosclerosis on Quality of Life and Quality-Adjusted Life Years after Heart Transplantation O. Grauhan1, H. Chang2, W. Albert1, N. Hiemann1, R. Meyer1, H. Lehmkuhl1, M. Dandel1, C. Knosalla1, M. Hubler1, M. Pasic1, R. Hetzer1 1German Heart Institute Berlin, Berlin, Germany; 2 Taipeh Veterans General Hospital, Taipeh, Taiwan
178 The Relationship of Social Support and Quality of Life 5 to 10 Years after Heart Transplantation C. White-Williams1, K.L. Grady2, E.C. Wang2, D.C. Naftel3, B. Rybarczyk4, J.B. Young5, D. Pelegrin5, S. Myers3, J. Kirklin3, J. Czerr5, J. Kobashigawa6, J. Chait6, A. Heroux7, R. Higgins8 1 University of Alabama, Birmingham, AL; 2Northwestern Memorial Hospital, Chicago, IL; 3University of Alabama, Birmingham, AL; 4Virginia Commonwealth University, Richmond, VA; 5The Cleveland Clinic, Cleveland, OH; 6UCLA Medical Center, Los Angeles, CA; 7Loyola University Medical Center, Chicago, IL; 8Rush University Medical Center, Chicago, IL Purpose: Detailed information regarding social support and its relationship with quality of life (QOL) 5 to 10 years (yrs) after heart transplantation (HT) is unknown. The purposes of this longitudinal study were to examine demographic, physiologic, and psychosocial characteristics and their relationship to social support after HT, and identify if perceived satisfaction with social support is a predictor of QOL post HT. Methods and Materials: Data were collected from 555 HT pts (78% male, 88% white, mean age⫽53.8yrs) at 4 U.S. sites using the following instruments: HT Social Support Index, Sickness Impact Profile, HT Symptom Checklist, QOL Index, Cardiac Depression Scale, and chart review. Statistical analyses included Pearson correlations and multiple regressions. Results: There were no associations between age, education, and ethnicity and perception of social support at 5 and 10 yrs after HT. Married pts, however, reported significantly higher satisfaction with
Purpose: Insufficient donor screening result in accidental transmission of significant coronary artery sclerosis (CAS) in 5-10% of heart transplantations. The purpose of this study was to evaluate the impact of donor-transmitted CAS (DCAS) on quality of life (QOL) after HTX and quality-adjusted life years (QALY). Methods and Materials: In 1253 consecutive HTX single-vessel DCAS (⬎49%) was found in 53 patients (DCAS1 group) and double- or triple-vessel DCAS in 26 patients (DCAS2/3 group) by means of angiography and/or autopsy. “Short-Term Inventory 36 Health Survey” (SF-36) scale was used to analyze the HTX patients’ health-related QOL. QALY were calculated by analysis of Kaplan-Meier curves and SF-36 questionnaires. Coronary vessels were screened by angiography and endomyocardial biopsy for macro- and microvasculopathy, respectively. Patients without DCAS, who were matched for sex, age and indication, served as controls (NDCAS). Results: Thirty-day mortality in the NDCAS, DCAS1 and DCAS2/3 groups was 12.2%, 13.2% and 61.5%, respectively. However, beyond the first year the annual decrease in all groups was comparable (5.4%/year, 4.3%/year, and 5.0%/year). The SF-36 questionnaire showed no significant differences between the groups in the longterm survival, despite the fact that more coronary interventions were performed in the DTCA groups than in the NDTCA group. No differences were found in the development of macrovasculopathy; the incidence of microvasculopathy began to differ significantly 2 years after HTX, however without any clinical impact. Qualityadjusted life years were comparable in NDCAS (8.0 QALY) and DCAS1 (8.5 QALY) but worse in DCAS2/3 (2.2 QALY). Conclusions: Donor-transmitted coronary atherosclerosis represents a risk for early graft failure but reduces neither long-term survival thereafter nor quality of life (QOL). On the other hand, donor screening by angiography seems to be a good investment to avoid the loss of about 6 quality-adjusted life years (QALY) by transmitted coronary atherosclerosis.
180 What They Say Versus What We See: ‘Hidden’ Distress and Impaired Quality of Life in Heart Transplant Recipients
5°C for 12 hours with the same solution. One heart underwent conventional static storage for the same interval. Temperature, flow, and pressure were recorded in perfused hearts. After 12 hours of perfusion, Hearts were removed and weighed. Tissue samples were collected, frozen in liquid nitrogen and later analyzed by proton magnetic resonance spectroscopy (MRS). The lactate/alanine ratio was used to evaluate the metabolic state of stored hearts as previously described. Results: Donor patients ages in this study range from 20-67 years. Perfusate temperature was maintained at 6⫾2°C. Aortic pressures averaged 16⫾2 mmHg. After 12 hour storage, perfused hearts showed no evidence of myocardial edema. Initial heart weights were 429⫾31 g. Final heart weights were 404⫾29 g (p⫽NS). Final LV water content: was 76.8⫾0.9%. Oxidative metabolism was preserved in perfused hearts. LV extract lactate/alanine ratios were 0.68⫾0.22 for perfused hearts. This ratio was 2.55 in the static storage heart. Conclusions: Perfusion preservation supported myocardial metabolism over this extended storage interval without myocardial edema formation. These data suggest that perfusion preservation may be an effective strategy to preserve human hearts for long intervals.
175 Post-Lung Transplant Health-Related Quality of Life: Perception and Reality L.G. Singer1,2, N. Chowdhury2, C. Chaparro1,2, M.A. Hutcheon1,2 1 University of Toronto, Toronto, ON, Canada; 2University Health Network, Toronto, ON, Canada Purpose: Candidates should understand the health-related quality of life (HRQL) benefits of lung transplantation to make an informed decision about this treatment. Our goals were to estimate utility improvements with transplantation, and to determine whether lung transplant candidates can accurately predict post-transplant HRQL (utility)scores. Methods and Materials: In this prospective cohort study, standard gamble (SG) and visual analog scale (VAS) utilities for current health (PreTx) were elicited from transplant candidates. Candidates then completed SG and VAS utilities imagining that they had received a transplant, and were asked to predict utilities without (NoBOS) and with BOS (BOS). After transplantation, the same patients reported actual SG and VAS utilities for current health. We calculated the difference between mean pre-transplant predicted and post-transplant actual uNoBOS and uBOS, for both SG and VAS scores. Matched-pairs signed-ranks tests were used examine associations between predicted and actual utilities, and between actual pre- and post-transplant utilities. Results: 207 patients underwent 347 pre-transplant and 816 post-tx utility assessments. 202 patients provided uNoBOS data and 52 patients provided uBOS data (Highest stage: BOS1-23, BOS2-16, BOS3-13) post-transplant. Actual utility improved significantly with transplant, even with BOS (Mean SG PreTx 0.43 vs. actual NoBOS 0.88 and BOS 0.75; mean VAS 36 PreTx vs. actual NoBOS 77 and BOS 63; p⬍0.00001 for all comparisons). Candidates accurately predicted SG for NoBOS (mean difference diff between predicted and actual scores -0.01, p⫽0.4) but underestimated SG for BOS (diff -0.19, p⫽0.007). Candidates overestimated VAS for NoBOS (diff 9, p⬍0.00001) and underestimated VAS for BOS (diff -13, p⫽0.005). Conclusions: Lung transplantation significantly improves utility, even with BOS. However, lung transplant candidates may not accurately estimate utility after transplantation, and particularly tend to underestimate utility with BOS. Education about post-transplant quality of life may improve patient decision-making.
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176 Health-Related Quality of Life in Long-Term Survivors after Heart and Lung Transplantation: A Comparative Cohort Study C. Kugler1, U. Tegtbur2, J. Gottlieb3, C. Bara1, D. Malehsa1, T. Fuehner3, M. Strueber1, A. Haverich1, A. Simon1 1Hannover Medical School, Hannover, Germany; 2Hannover Medical School, Hannover, Germany; 3Institute of Sportsmedicine, Hannover Medical School, Hannover, Hannover, Germany Purpose: Purpose for this study was to evaluate (1) the development of health-related quality of life (HRQoL) after transplantation, (2) to compare HRQoL for heart (HTx) and lung (LTx) transplant survivors, and (3) to assess potential outcome-related predictors. Methods and Materials: A sample of 171 patients were prospectively followed for five years after HTx (n⫽82) or LTx (n⫽89) including 8 HRQoL assessments (pre-tx, 6, 12, yearly 24-60 months) using the SF-36, global life satisfaction, and the work performance index. The study protocol received IRB approval. Results: Patient groups (HTx vs. LTx) differed with respect to age (57⫾12 vs. 52⫾11; p⬍0.001), gender (male 74% vs. 47%; p⬍0.0001), and high urgency waiting status (30% vs. 54%; p⬍0.0001). Both cohorts showed most significant HRQoL improvements within the first year post-tx (p⬍0.0001), and a steady state in five of eight SF-36 subscales afterwards. Before transplant LTx candidates report lower HRQoL ratings in the physical (p⬍0.03) and psychosocial (p⬍0.01) domain of HRQoL compared to HTx patients. Group comparisons after transplant showed comparable ratings for the medium period (yr 1-3), and significantly lower HRQoL ratings for LTx patients at 4 and 5 yrs post-tx in their physical (p⬍0.005), and psychosocial (p⬍0.04) subscales. 28.4% of HTx and 28.7% of LTx patients returned to work after transplant. Occurrence of rejections (⬎1yr) significantly impacted the psychosocial domain in both groups (HTx p⬍0.05 vs. LTx p⬍0.04). Chronic rejection (TVP 8.7%) did not impact HTx recipients HRQoL perceptions, but showed significantly lower HRQoL in LTx patients (BOS 29.3%; p⬍0.001). Other predictors including cancer (3.6% vs. 3.3%) showed no impact on HRQoL. Conclusions: HTx and LTx patients benefit from the transplant procedure with respect to HRQoL improvements for at least five years post-transplant, however their trajectories differ. Further research on organ-type related predictors of HRQoL is necessary for development of tailored interventions. 177 LVAD Therapy: Impact of Family Caregivers’ Stress, Coping, Social Support on Perceived Burden & Quality of Life (QOL) M. Petty1, K. Savik2 1University of Minnesota Med. Center, Fairview, Minneapolis, MN; 2University of Minnesota, Minneapolis, MN Purpose: No prospective quantitative evaluation of perceived family caregiver burden and QOL and its influencers has been performed in LVAD caregivers. The purpose of this study was to gain a better understanding of their experience over time and to identify point(s) at which the LVAD team can focus support on those caregivers. Methods and Materials: A longitudinal, prospective correlational design was selected for a convenience sample of 22 self-identified family caregivers of BTT and DT LVAD patients from a single Midwestern US center. Subjects completed questionnaires 1 to 5 times over a 6 month period. Items included measures of demographics, caregiver involvement, caregiver distress (CDS), coping (BCS), social support (MOS-SS), depression (CES-D), caregiver burden (CBA) and QOL (SF-12, Cantril ladder). Results: Subjects were predominantly Caucasian (86.4%) female (90.9%) spouses (81.8%) of LVAD patients bridged to transplant
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(77.3%). Caregiver health was generally rated very good (54.5%) or excellent (9.1%). While caregiver involvement with ADLs and IADLs decreased over time, CDS trended up at time 4 in all subscales (p⫽ns). Caregiver burden decreased and leveled off across time points except for subjective demand burden which slightly rebounded late. QOL by Cantril ladder rating trended downward (p⫽0.10) as did the mental composite scale of SF-12 (p⫽0.20). Caregiver distress scales of social impact and personal cost negatively impacted QOL (p⫽0.01, p⫽0.05, respectively). Conclusions: Family caregivers experience increased distress 4 months or more after hospital discharge, with a negative impact on QOL. Future studies should focus on confirming findings and developing intervention strategies to support family caregivers.
The Journal of Heart and Lung Transplantation February 2009
social support 5 to 10 yrs after heart HT (P⬍.05). No significant associations between pts physiologic characteristics and satisfaction with social support were observed at 5 and 10 yrs post HT. Pts with higher degree of stress (P⬍.001), depressive moods (P⬍.0001), mobility limitation (P⬍.01) and symptom (P⬍.001) reported less satisfaction with social support at 5 years, and such negative associations continued to grow and became stronger at 10 years after HT. At 5 and 10 years, perceived satisfaction with social support was a significant (P⬍.001) predictor of QOL post HT after controlling for pts demographic, physiologic, and psychosocial characteristics. Conclusions: Social support was significantly related to long-term QOL outcomes after HT. It is important for researchers to identify pts at risk for poor QOL outcomes and to develop interventions that will facilitate the best QOL possible following heart transplantation.
179 Impact of Donor-Transmitted Coronary Atherosclerosis on Quality of Life and Quality-Adjusted Life Years after Heart Transplantation O. Grauhan1, H. Chang2, W. Albert1, N. Hiemann1, R. Meyer1, H. Lehmkuhl1, M. Dandel1, C. Knosalla1, M. Hubler1, M. Pasic1, R. Hetzer1 1German Heart Institute Berlin, Berlin, Germany; 2 Taipeh Veterans General Hospital, Taipeh, Taiwan
178 The Relationship of Social Support and Quality of Life 5 to 10 Years after Heart Transplantation C. White-Williams1, K.L. Grady2, E.C. Wang2, D.C. Naftel3, B. Rybarczyk4, J.B. Young5, D. Pelegrin5, S. Myers3, J. Kirklin3, J. Czerr5, J. Kobashigawa6, J. Chait6, A. Heroux7, R. Higgins8 1 University of Alabama, Birmingham, AL; 2Northwestern Memorial Hospital, Chicago, IL; 3University of Alabama, Birmingham, AL; 4Virginia Commonwealth University, Richmond, VA; 5The Cleveland Clinic, Cleveland, OH; 6UCLA Medical Center, Los Angeles, CA; 7Loyola University Medical Center, Chicago, IL; 8Rush University Medical Center, Chicago, IL Purpose: Detailed information regarding social support and its relationship with quality of life (QOL) 5 to 10 years (yrs) after heart transplantation (HT) is unknown. The purposes of this longitudinal study were to examine demographic, physiologic, and psychosocial characteristics and their relationship to social support after HT, and identify if perceived satisfaction with social support is a predictor of QOL post HT. Methods and Materials: Data were collected from 555 HT pts (78% male, 88% white, mean age⫽53.8yrs) at 4 U.S. sites using the following instruments: HT Social Support Index, Sickness Impact Profile, HT Symptom Checklist, QOL Index, Cardiac Depression Scale, and chart review. Statistical analyses included Pearson correlations and multiple regressions. Results: There were no associations between age, education, and ethnicity and perception of social support at 5 and 10 yrs after HT. Married pts, however, reported significantly higher satisfaction with
Purpose: Insufficient donor screening result in accidental transmission of significant coronary artery sclerosis (CAS) in 5-10% of heart transplantations. The purpose of this study was to evaluate the impact of donor-transmitted CAS (DCAS) on quality of life (QOL) after HTX and quality-adjusted life years (QALY). Methods and Materials: In 1253 consecutive HTX single-vessel DCAS (⬎49%) was found in 53 patients (DCAS1 group) and double- or triple-vessel DCAS in 26 patients (DCAS2/3 group) by means of angiography and/or autopsy. “Short-Term Inventory 36 Health Survey” (SF-36) scale was used to analyze the HTX patients’ health-related QOL. QALY were calculated by analysis of Kaplan-Meier curves and SF-36 questionnaires. Coronary vessels were screened by angiography and endomyocardial biopsy for macro- and microvasculopathy, respectively. Patients without DCAS, who were matched for sex, age and indication, served as controls (NDCAS). Results: Thirty-day mortality in the NDCAS, DCAS1 and DCAS2/3 groups was 12.2%, 13.2% and 61.5%, respectively. However, beyond the first year the annual decrease in all groups was comparable (5.4%/year, 4.3%/year, and 5.0%/year). The SF-36 questionnaire showed no significant differences between the groups in the longterm survival, despite the fact that more coronary interventions were performed in the DTCA groups than in the NDTCA group. No differences were found in the development of macrovasculopathy; the incidence of microvasculopathy began to differ significantly 2 years after HTX, however without any clinical impact. Qualityadjusted life years were comparable in NDCAS (8.0 QALY) and DCAS1 (8.5 QALY) but worse in DCAS2/3 (2.2 QALY). Conclusions: Donor-transmitted coronary atherosclerosis represents a risk for early graft failure but reduces neither long-term survival thereafter nor quality of life (QOL). On the other hand, donor screening by angiography seems to be a good investment to avoid the loss of about 6 quality-adjusted life years (QALY) by transmitted coronary atherosclerosis.
180 What They Say Versus What We See: ‘Hidden’ Distress and Impaired Quality of Life in Heart Transplant Recipients