Browsing by Author "Krause, Audrey"

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    Fatigue as Reported at 12 Time Points during the First Year Post-Liver Transplant
    (2013) Scott, Patricia J.; Krause, Audrey; Tector, A. Joseph; Kwo, Paul
    BACKGROUND: Although liver transplantation has evolved as an effective procedure, fatigue remains a post-transplant complaint [1]. As yet, there are no published accounts of the experience of fatigue at temporal intervals during the first post-transplant year, and this information would benefit LT candidates in recovery planning. Van Ginneken [2] found that time since transplant was not associated with physical fatigue and reduced activity, but was associated with albumin levels less than 25g/l and with lower GFR. METHODS: Data used in this study were collected through an ongoing, longitudinal, prospective design. Results presented here are for fatigue and biometric data at 12 data points starting one week post hospital discharge, continued weekly for the first 8 weeks, then monthly at 3, 6, 9, and 12 months. RESULTS: We sampled 30 subjects: 19 (70.4%) male and 8 (29.6%) female, age 55.4 ± 9.8 years. A mixed models analysis of variance was done to investigate a change in FACIT over time. The initial model included age, MELD, sex, week, albumin, ALT, BILI T, and CREAT. The final model included age, BILI T, and week. Increasing age and BILI T were associated with greater fatigue (p=0.0376 and p=0.0005, respectively). There was significant decrease in fatigue over time (p<0.0001). Pair-wise comparisons were done to determine which weeks significantly differed. Tukey’s adjustment for multiple comparisons was used. Figure 1 indicates which visits significantly differed. DISCUSSION: Our subjects experienced decreased fatigue over time. The data set was rich with prospectively collected longitudinal information helpful for establishing realistic expectations for post-transplant fatigue. Finding include early weeks of recovery (weeks 2-3) differ from weeks 7+ and that there is no significant change after 3 months, up to one year. No association was seen with Albumin levels although total bilirubin and age were associated with greater fatigue.
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    Impact of medical, health related, social and occupational factors on post-liver transplant recovery: a longitudinal study
    (Office of the Vice Chancellor for Research, 2012-04-13) Scott, Patricia J.; Winslow, Emily; Krause, Audrey; Bah, Fatoumata
    Purpose: Organ transplantation is a serious surgery with nearly 10% of patients failing to survive the first three months. Studies of quality of life reflect an increase post-transplant, as compared to pre-transplant, then reports vary including a trend towards decreasing QOL scores by the end of the first transplanted year. In this first year, patients have an increased risk of re-hospitalization due to infection, failure of the body to accept the graft, problems with anti-rejection medications or post- surgical complications. Methods: A longitudinal study of liver transplant recipients (n=23) followed medical, social, and occupational factors, along with SF-36 measures. Results: Variability in QOL scores at 1, 2, 3, 6, 9, and 12 months were directly related to identifiable factors. In those subjects where health returned in an uncomplicated manner, QOL scores consistently improved with the greatest change occurring over the first six months and then tapering off through the end of the first year. Conclusions: These subjects almost uniformly expressed frustration at the length of time it took to return to a healthy state. In circumstances where recovery was delayed due to medical reasons, QOL scores declined significantly until the problems were resolved. In several cases, QOL scores stayed low as these individuals were unprepared for the potential complications associated with this difficult surgery.
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    Pancreas Transplantation: Personal Factors Associated with Good and Poor Post-Transplant Adaptive Response
    (2013-05) Scott, Patricia J.; Krause, Audrey; Samiran, G.; Taber, T.; Fridell, J.
    Notable differences in patient adaptation after pancreas transplant cause some to thrive and return to independent living, while others struggle with emotional and social problems. In order to prepare vulnerable individuals to better cope after transplant, we investigated pre-transplant factors associated with post-transplant adaptive capacity. The pancreas transplant team de ned; good adaptive response (GAR) in patients who were responsible, resourceful, and optimistic. Poor adaptive response (PAR) was associated with patients who tended to complain and were emotionally dependent. METHODS: Experts included 3 nurse coordinators and 3 social workers. A modified Delphi approach was used to achieve consensus on the de nition of GAR and PAR. 200 of the last transplanted pancreas recipients were selected if they: received a pancreas transplant for type 1 DM, with, or without a kidney, and survived a minimum of six months post-transplant. The experts classified cases into GAR and PAR, contextualized by confidence. We completed a chart abstraction of all 200 cases using pre-transplant data and the extracted variables were regressed on the 54 top weighted GAR cases and the top 40 weighted PAR cases. RESULTS: In the final model, past smoker, currently on disability, simultaneous pancreas and kidney (SPK), and less than high school education significantly predicted probability of having a PAR (p<0.05). The model was a well-fitting model with a Hosmer and Lemeshow goodness of  t test of (p=0.8250 < 0.05). Given the lack of inclusion of any of the predicted social variables for PAR patients we looked at predictors of GAR. The goodness of fit test was a well-fitting model (p= 0.6294 < 0.05). In addition to pancreas after kidney (PAK) having an odds ratio of 10.39, past smoker was 10.99 and current disability was 5.8. Discussion: The association of PAK with GAR and SPK with PAR suggests a possible effect from prior experience with transplant aiding in coping afterwards. Our findings support the need for a prospective study of coping with pancreas transplant and points to more intensive pre-transplant preparation of recipients, particularly those with lesser education.