Symptom experience after solid organ transplantation.
OBJECTIVE
Understanding patients' perceptions and responses to immunosuppression-related symptom experiences following solid organ transplantation increases the likelihood that interventions can be designed to support long-term graft survival.


METHODS
This review summarizes and integrates evidence on transplant patients' symptom experiences related to immunosuppression side-effects in terms of symptom occurrence and symptom distress and other aspects of posttransplant treatment regimen. Empirical data of 18 reports on symptom experiences published between 1981 and April 2008 have been analyzed systematically. This report is organized to address the following areas of findings: (1) overview about instruments to assess symptom experiences, (2) descriptive information concerning symptom occurrence and related distress, (3) potential impact of symptom experiences on patient adherence, and (4) review of evidence between symptom experiences and health outcomes in terms of health-related quality of life (HRQoL).


RESULTS
Symptom experience scores remain high among all types of solid organ transplantation including kidney, liver, heart, and lung transplant, with no patterns related to symptom occurrence and distress. "Female gender" is consistently related to higher levels of symptom occurrence and symptom distress. Understanding the patients' appraisal of symptoms and side-effects related to the immunosuppressive therapy is a key to step forward by developing strategies to (1) reducing nonadherence triggered by symptom occurrence and distress, (2) decreasing non-adherence-related rejection, and (3) improving HRQoL by tailored symptom management.


CONCLUSIONS
As many side-effects are related to particular immunosuppressive drugs and dosages, a more in-depth understanding of the relationships among the concepts of symptom experience, nonadherence, and HRQoL may guide clinical decision making in the future.
Kugler
Christiane
C
Department of Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany. kugler.christiane@mh-hannover.de
Geyer
Siegfried
S
Gottlieb
Jens
J
Simon
Andre
A
Haverich
Axel
A
Dracup
Kathleen
K
D006304:Health Status; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016377:Organ Transplantation / Q000523:psychology*; D017063:Outcome Assessment, Health Care / Q000379:methods; D011788:Quality of Life; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires
D007166:Immunosuppressive Agents