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Lung transplantation, heart transplantation, and heart-lung transplantation are life-saving treatment options for patients with lung and/or cardiac failure. Evolution in these therapies over the past several decades has led to better outcomes with application to more patients. The complexity and severity of illness of patients in the pretransplant phase has steadily increased, making posttransplant intensive care unit management more difficult. Despite these factors and the pervasive complications of immunosuppressive therapy, outcomes continue to improve., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Renal complications are common following heart and/or lung transplantation and lead to increased morbidity and mortality. Renal dysfunction is also associated with increased mortality for patients on the transplant wait list. Dialysis dependence is a relative contraindication for heart or lung transplantation at most centers, and such patients are often listed for a simultaneous kidney transplant. Several factors contribute to the impaired renal function in patients undergoing heart and/or lung transplantation, including the interplay between cardiopulmonary and renal hemodynamics, complex perioperative issues, and exposure to nephrotoxic medications, mainly calcineurin inhibitors., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Management of the cardiac transplant recipient includes careful titration of inotropes and vasopressors. Recipient pulmonary hypertension and ventilatory status must be optimized to prevent allograft right ventricular failure. Vasoplegia, coagulopathy, arrhythmias, and renal dysfunction also require careful management to achieve an optimal outcome. Primary graft dysfunction (PGD) can be an ominous problem after cardiac transplantation. Although mild degrees of PGD may be managed medically, mechanical circulatory support with extracorporeal membrane oxygenation or temporary ventricular assist devices may be required. Retransplantation may be necessary in some cases., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Infections in heart and lung transplant recipients are complex and heterogeneous. This article reviews the epidemiology, risk factors, specific clinical syndromes, and most frequent opportunistic infections in heart and/or lung transplant recipients that will be encountered in the intensive care unit and will provide a practical approach of empirical management., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Aims and Objectives: To explore the experiences of spouses of heart transplant recipients and to consider how an understanding of these experiences may inform nursing practice., Background: There is a lack of knowledge about the experiences of spouses of heart transplant recipients during the pretransplant wait. Evidence suggests that spousal support improves post-transplant outcomes of heart transplant recipients; therefore, it is important to understand how nurses can improve spouses' psychological well-being during the pretransplant wait., Design: Integrative review., Method: A search of six electronic databases between November 2015-December 2015 and a hand search yielded 510 citations; nine studies met the review eligibility criteria. Inclusion criteria were applied to selected studies for review. Methodological quality of selected studies was evaluated, and data were extracted and compiled., Results: Six themes were identified: uncertainty, thoughts about death, changes to lifestyle and priorities, loss of sense of self, quality of life and learning to cope. Spouses experience high levels of stress caused by uncertainty about the patient's survival, increased responsibilities and changes to their lifestyle., Conclusion: The results reveal that the pretransplant period is all-consuming for spouses of heart transplant recipients. The impact of the pretransplant wait on spouses' well-being should be recognised by nurses, and improvements must be made in support and education available to spouses during the pre-transplant period., Relevance for Clinical Practice: There is a need for improved education about the transplant process, and reinforcement of positive coping strategies., (© 2016 John Wiley & Sons Ltd.)

Since the beginning of United Network of Organ Sharing data collection in 1987, a total of 8,333 pediatric patients have received a heart transplant in the United States. Because these patients now have longer graft success with improved care and immunosuppression, many of them are entering adolescence and young adulthood. Primary care pediatric nurse practitioners need to be alert to the prevalence of noncompliance with treatment in heart transplant patients, which continues to be highest in adolescence. Low compliance in adolescence increases morbidity, contributes to decreasing quality of life, and is the leading reason for graft failure and mortality in this age group. This article will review common barriers to treatment adherence in the adolescent heart transplant patient, discuss the role of the primary care pediatric nurse practitioner in preventing noncompliance, and review strategies that the primary care pediatric nurse practitioner can implement to improve compliance in this patient population., (Copyright © 2017 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Objetivo: To identify how the clinical and educational nursing care based on the Theory of Human Becoming can contribute to the transcendence process of heart transplant patients in pursuit of good living., Method: Research-intervention developed with four heart transplant patients linked to a reference transplant hospital in Ceara. Data was collected through interviews in 2014 and analyzed using Parse's theoretical framework and pertinent literature., Resultados: Transplant patients revealed they gave living in such condition an ambiguous meaning, showing satisfaction and dissatisfaction. Dietary restrictions, difficulties with medication and curiosity about the transplant were identified as disharmonies involving the process. Care was developed focused on educating the transplant patients, approaching the themes healthy eating, organ rejection, immunosuppressant use and facts about heart transplantation., Conclusion: Educative care based on Parse favors the decision-making and autonomy of individuals regarding their health, contributing to transcendence in pursuit of good living.

Heart failure impacts a multitude of individuals each year. Treatment is based on the progression of the disease and severity of symptoms. Cardiac transplant is the gold standard treatment of advanced heart failure, although the availability of organs limits the number of transplants received each year. Postoperative care and monitoring for cardiac transplant is complex and requires specialized nurses and providers at transplant centers for successful outcomes. This article outlines cardiac transplant from preoperative care through transplant, as well as posttransplant monitoring and care including discharge. Special attention is focused on management in the intensive care unit setting and potential complications that can occur in the immediate postoperative period. Interventions for potential complications are also highlighted.

Intra-aortic balloon pumps have traditionally been inserted via the femoral artery, limiting patients' activity and exposing patients to complications of immobility. For patients awaiting cardiac transplant, these complications may threaten a successful outcome, or at the least, complicate recuperation after transplant. A novel approach to insertion of balloon pumps via the subclavian artery is presented here, including routine nursing care, complications and related nursing actions, and experience with and advantages of this method. A team approach to care of these patients, including rehabilitation and exercise protocols, is recommended., (©2016 American Association of Critical-Care Nurses.)

Heart transplantation is a recommended and curative treatment option for patients with advanced heart failure symptoms despite receiving optimal medical and device therapy. The availability of donor organs limits the number of patients able to receive a heart transplant. The overall outcome of patients able to receive a heart transplant is determined by the successful delivery of essential nursing care. Understanding the specific interventions and therapies unique to this patient population is critical to their care. This article reviews considerations for the intensive care unit clinician in the management of heart transplant patients in this setting., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Over the past 20 years, solid organ transplantation has evolved from experimental treatments to an effective alternative for the treatment of various diseases, including heart failure. Treatment non-adherence is a limiting factor for the success of heart transplants. A systematic review of the evidence is needed to examine the effectiveness of interventions for managing adherence to treatment in heart transplant patients., Objective: The primary objective of this systematic review was to synthesize the best available evidence regarding interventions for managing adherence to pharmacological and non-pharmacological treatments in heart/heart-lung transplant patients., Inclusion Criteria: This review considered primary studies that included patients 18 years old or older, who had undergone heart or heart-lung transplantation (regardless of gender, ethnicity, comorbidities or whether they had received other treatments or not) who were receiving pharmacological and non-pharmacological treatments.This review considered studies that evaluated the effectiveness of interventions in managing adherence to pharmacological or non-pharmacological treatments among adult heart/heart-lung transplant patients. Primary studies comparing standard care with any type of intervention to maintain treatment adherence were considered.This review considered any experimental study design including randomized controlled trials; other research designs, such as non-randomized controlled trials and before and after studies, were also considered for inclusion.The primary outcome considered was patient adherence to pharmacological or non-pharmacological treatments by means of objective or self-report assessment., Search Strategy: Published and unpublished studies in English, Portuguese and Spanish were searched in electronic databases. Searches were completed in January 2014., Methodological Quality: Two independent reviewers, using the standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument, assessed methodological quality., Data Extraction: Data were extracted using the standardized data extraction tool from Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument., Data Synthesis: Statistical pooling was not possible due to substantial heterogeneity of the studies; therefore data were presented as a narrative summary., Results: Three quasi-experimental studies were included in this review. One study found that a dose reduction of immunosuppressive medications from a twice-daily to a once-daily regimen had a positive impact on treatment adherence; one found no significant difference in treatment adherence between patients who received educational intervention conducted in a teaching laboratory and those who received standard care; the third one also reported no significant difference in outcomes between a multifaceted intervention consisting of internet-based interactive workshops and standard care., Conclusions: The current best evidence to guide decisions regarding interventions to manage treatment adherence in heart transplant patients is limited. There is weak evidence that psycho-educational interventions (other than the standard care) has a positive impact on adherence and that decreasing the complexity of the treatment regimen by reducing the daily dose of the immunosuppressant drug improves adherence in heart transplant patients.

Aim: This article describes the rationale, design and methodology of the Building research initiative group: chronic illness management and adherence in transplantation (BRIGHT) study. This study of heart transplant patients will: (1) describe practice patterns relating to chronic illness management; (2) assess prevalence and variability of non-adherence to the treatment regimen; (3) determine the multi-level factors related to immunosuppressive medication non-adherence., Background: The unaltered long-term prognosis after heart transplantation underscores an urgent need to identify and improve factors related to survival outcomes. The healthcare system (e.g. level of chronic illness management implemented) and patient self-management are major drivers of outcome improvement., Design: The study uses a survey design in 40 heart transplant centres covering 11 countries in four continents., Methods: Theoretical frameworks informed variable selection, which are measured by established and investigator-developed instruments. Heart transplant recipients, outpatient clinicians and programme's directors complete a survey. A staged convenience sampling strategy is implemented in heart transplant centres, countries and continents. Depending on the centre's size, a random sample of 25-60 patients is selected (N estimated 1680 heart transplant recipients). Five randomly selected clinicians and the medical director from each centre will be invited to participate., Conclusion: This is the first multi-centre, multi-continental study examining healthcare system and heart transplant centres chronic illness management practice patterns and potential correlates of immunosuppressive medication non-adherence. The knowledge gained will inform clinicians, researchers and healthcare policy makers at which level(s) interventions need to be implemented to improve long-term outcomes for transplant recipients., (© 2014 John Wiley & Sons Ltd.)