COVID-19 pandemic as a risk factor for the reactivation of herpes viruses.

The appearance on the skin of herpes virus lesions, concomitantly with the coronavirus disease 2019 (COVID-19) pandemic, leads us to suspect an underlying infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Diagnostic reverse transcriptase polymerase chain reaction tests and immunoglobulin M (IgM) and IgG seroconversion studies have therefore been carried out. We present three cases of herpes virus infections in immunocompetent patients: one of the infections was herpes simplex 1 in a 40-year-old woman, and the other two were herpes varicella-zoster infections in a 62-year-old man and a 25-year-old woman. The patients were in the care of the southern health district of Seville of the SAS (Andalusian Health Service) during the Spanish state of alarm over the COVID-19 pandemic. The SARS-CoV-2 infection was confirmed in only one of the three cases. In this study, we briefly review the etiopathogenic role of the COVID-19 pandemic situation, whereby immunodeficiencies are generated that favour the appearance of other viral infections, such as herpes virus infections.

How Thinking About the Donor Influences Post-traumatic Growth in Liver Transplant Recipients.

OBJECTIVE: The aim of this work was to find out whether thinking frequently about the donor influences post-traumatic growth of liver transplant recipients. METHODS: The sample of 240 patients selected was made up of 185 men and 55 women with an overall mean age of 60.21 (SD 9.3) years. All of them had received liver transplants from cadaver donors. Transplant recipients were asked whether they thought frequently about the donor (yes or no) and filled out the Post-traumatic Growth Inventory. The t test for unpaired samples was applied to analyze how thinking frequently about the donor or not influenced post-traumatic growth. We also calculated the effect sizes by means of Cohen d or Cohen w depending on the nature of the variables analyzed (quantitative or qualitative). RESULTS: The liver transplant recipients who thought frequently about the donor, compared with those who did not, had higher total scores on post-traumatic growth (P = .000; d = 0.57; medium effect size). Furthermore, considering the effect sizes, the differences between the subgroups were more relevant on the following subscales: new possibilities (P = .000; d = 0.53; medium effect size), appreciation of life (P = .000; d = 0.60; medium effect size), and spiritual change (P = .000; d = 0.54; medium effect size). CONCLUSIONS: Patients who think frequently about the donor have more post-traumatic growth than those who do not.

Family Caregivers of Liver Transplant Recipients: Coping Strategies Associated With Different Levels of Post-traumatic Growth.

OBJECTIVE: Analyze the influence of 2 variables (post-traumatic growth and time since liver transplantation) on coping strategies used by the transplant recipient's family members. METHODS: In all, 218 family members who were their main caregivers of liver transplant recipients were selected. They were evaluated using the Posttraumatic Growth Inventory and the Brief COPE. A 3 × 3 factorial analysis of variance was used to analyze the influence that post-traumatic growth level (low, medium, and high) and time since transplantation (≤3.5 years, >3.5 to ≤9 years, and >9 years) exerted on caregiver coping strategies. RESULTS: No interactive effects between the two factors in the study were found. The only significant main effect was the influence of the post-traumatic growth factor on the following variables: instrumental support (P = .007), emotional support (P = .005), self-distraction (P = .006), positive reframing (P = .000), acceptance (P = .013), and religion (P = <.001). According to the most relevant effect sizes, low post-traumatic growth compared with medium growth was associated with less use of self-distraction (P = .006, d = -0.52, medium effect size), positive reframing (P = .001, d = -0.62, medium effect size), and religion (P = .000, d = -0.66, medium effect size), and in comparison with high growth, it was associated with less use of positive reframing (P = .002, d = -0.56, medium effect size) and religion (P = .000, d = 0.87, large effect size). CONCLUSION: Regardless of the time elapsed since the stressful life event (liver transplantation), family members with low post-traumatic growth usually use fewer coping strategies involving a positive, transcendent vision to deal with transplantation.

Comparison of the affective symptomatology between liver transplant recipients and patients with multiple sclerosis considering their functional impairment.

OBJECTIVES: We aimed to compare the affective symptomatology in two medical conditions under immunotherapy (cadaveric liver transplantation [G1] and multiple sclerosis [G2]), considering their functional impairment, and to assess the clinical significance of the results regarding a representative age-adjusted sample of the general Spanish population (G3). METHODS: Using a cross-sectional design, 164 patients (82 per clinical group) were selected, matched for gender, and homogenized regarding age and functional impairment according to the Physical functioning subscale from the SF-36 Health Survey. The criterion variables were the Mental health and Role-emotional SF-36 subscales and the Hospital Anxiety and Depression Scale. An analysis of covariance was conducted, controlling for age and the Physical functioning score as covariates. Cohen's d was reported as an effect size index and to analyze the clinical significance regarding a representative age-adjusted sample of the general Spanish population (n = 7881). RESULTS: No statistically significant differences were found between conditions in any affective dimension (P > .05; ds1₋2 from 0.08 to 0.30) or in the percentage of clinical cases regarding the anxious (P = .628) or depressive spectrum (P = .716). The neurological patients showed clinically significant impairment in both SF-36 subscales (ds2₋3 = 0.55 and 0.52, respectively), but transplant recipients only differed from the general population in Role-emotional (d1₋3 = 0.81). CONCLUSIONS: Despite having controlled for functional impairment, important deterioration in daily functioning was still found in liver recipients due to emotional problems, and no relevant differences were observed even when compared with a neurodegenerative condition such as multiple sclerosis.

Influence of acute cellular rejection and depressive symptomatology on liver transplant recipients' quality of life.

BACKGROUND: The objective of this study was to analyze the influence of two variables (acute cellular rejection and depressive symptomatology) on liver transplant recipients' quality of life. METHODS: Using a 2 × 2 factorial design, two groups were selected: 44 patients who had acute cellular rejection and 44 patients without this medical complication. After an average of 6 years since the transplant, patients were assessed with the Hospital Anxiety and Depression Scale and the SF-36 Health Survey. Analysis of variance, t test for unpaired samples, and Cohen's d effect size index were applied. RESULTS: The presence of clinical depressive symptomatology negatively affected all dimensions of quality of life (P < .001; large effect sizes); and interactive effects between factors acute cellular rejection and depressive symptomatology were found in the dimensions role-physical (P = .049) and bodily pain (P = .017). Transplant recipients with clinical depressive symptomatology scored lower on both dimensions (role-physical, P = .110, d = 0.52, medium effect size; bodily pain, P = .001, d = 1.25, large effect size) if they had an acute cellular rejection. In contrast, if they did not exceed the clinical threshold for depressive symptomatology, there were no differences in these dimensions (role-physical, P = .239, d = -0.33, small effect size; bodily pain, P = .555, d = 0.16, null effect size) between transplant recipients with and without acute cellular rejection. CONCLUSIONS: Clinical depressive symptomatology is associated with poorer quality of life in liver transplant recipients; and the long-term differences in the dimensions role-physical and bodily pain between liver transplant recipients with and without acute cellular rejection depend on patients' mental health.

Evolution of quality of life in renal transplant recipients and patients with multiple sclerosis: a follow-up study.

OBJECTIVE: We aimed to compare the evolution of quality of life in 2 medical conditions under immunotherapy (cadaveric renal transplantation [G1] and multiple sclerosis [G2]), and to assess the clinical significance of the results compared with a representative age-adjusted sample of the general Spanish population (G3). METHODS: Using a mixed design (2 × 2), the SF-36 Health Survey was administered to 60 patients with one of these clinical conditions (30 in each group; the patient group factor), matched for gender, and homogenized regarding age and working status. All renal patients had undergone transplantation 6 months before the first assessment, and all neurological patients presented a relapsing-remitting course and a mild-moderate disability level. Both patient groups were assessed a second time 6 months later (the phase factor). A mixed analysis of covariance was computed controlling for age as a covariate. Cohen's d was reported as an effect size index and to analyze the clinical significance regarding a representative age-adjusted sample of the general Spanish population (n = 5821). RESULTS: Statistically significant differences were found between patient groups in vitality, bodily pain, social functioning, and mental health (P < .01), in which worse levels were displayed by patients with multiple sclerosis in both phases (Cohen's ds1-2 from 0.61 to 1.40). Likewise, an interactive effect was observed in physical functioning [F(1,57) = 12.93; P = .001], such that the performance of daily physical activities improved in renal recipients after 6 months, but it decreased in neurological patients. Patients with multiple sclerosis showed higher, clinically significant impairment in all SF-36 dimensions in both phases compared with renal recipients (Cohen's ds2-3 from -0.50 to -1.61), who presented clinically significant impairment in general health, role-physical, and role-emotional (Cohen's ds1-3 from -0.73 to -1.28). CONCLUSIONS: Renal transplant recipients need specialized health care 1 year after transplantation because they still display relevant impairment in daily functioning compared with the general population.

Evolution of anxious-depressive symptomatology in liver and kidney transplant recipients: hospitalization and 12-month post-transplantation phases.

OBJECTIVE: The objective of this study was to compare the evolution (hospitalization in the transplantation unit and at 12 months post-transplantation) of anxious and depressive symptomatology in cadaveric transplant recipients as a function of type of organ implanted (liver or kidney). METHODS: Using a 2 × 2 mixed factorial design, 2 groups were selected: 34 liver transplant recipients and 41 kidney transplant recipients. Both groups were assessed in 2 phases: (1) in the transplantation unit after discharge from the intensive care unit; and (2) 12 months after discharge from the hospital following implantation surgery. The Hospital Anxiety and Depression Scale and the Scale for the Assessment of Social Support were administered. A mixed analysis of covariance was used to assess the influence on transplant recipients' anxious-depressive symptomatology of 2 independent factors: phase (hospitalization in the transplantation unit and at 12 months post-transplantation) and organ (liver and kidney). Perceived social support and age were included as covariates in the analyses. We also calculated d and w as effect size indexes. RESULTS: Interactive effects of the factors phase and organ were found in the variable anxiety (P = .005). Specifically, the following simple effects were significant: (1) kidney transplant recipients presented more anxious symptomatology while hospitalized in the transplantation unit than at 12 months post-transplantation (P = .001; d = 0.52; medium effect size); and (2) kidney transplant recipients presented more anxious symptomatology than liver transplant recipients while hospitalized in the transplantation unit (P = .013; d = -0.59; medium effect size). No statistically significant effect was obtained for the variable depression. CONCLUSION: Worse mental health (anxious symptoms) was associated with kidney transplant recipients but not with liver recipients while recovering from the implantation surgery in the transplantation unit.

Longitudinal study of liver transplant recipients' quality of life as a function of their perception of general health: at waiting list and at 3, 6, and 12 months post-transplantation.

OBJECTIVE: The objective of this study was to compare the evolution (at waiting list, and at 3, 6, and 12 months post-transplantation) of quality of life of cadaveric liver transplant recipients as a function of their perception of general health. METHODS: Two groups (15 patients with better and 15 with worse self-perception of health 1 year after transplantation) were assessed at the pretransplantation and post-transplantation phases using the EuroQol (EQ-5D) questionnaire. Mixed analysis of covariance was performed with 2 factors: phase (at waiting list and at 3, 6, and 12 months post-transplantation) and perception of general health (better and worse). Cohen's d was also calculated. RESULTS: Interactive effects were found in the variables pain/discomfort (P = .010) and anxiety/depression (P = .001). The following simple effects reached large effect sizes. Transplant recipients presented more pain/discomfort when on the waiting list than at 3 months (worse self-perception, P = .022, d = 1.35; better self-perception, P = .001, d = 0.95). At 6 months (P = .001, d = -1.45) and at 12 months (P = .001, d = -1.75), transplant recipients with worse self-perception displayed more pain/discomfort. Transplant recipients with better self-perceived health showed more anxiety/depression when on the waiting list than at 3 months (P = .004, d = 1.49), at 6 months (P = .005, d = 1.48), and at 12 months (P = .001, d = 1.97). Patients with worse self-perception presented more anxiety/depression when on the waiting list than at 6 months (P = .030, d = 1.21) and 12 months compared with at 3 months (P = .011, d = -0.97) and 6 months (P = .001, d = -1.39). At 12 months, transplant recipients with worse self-perception showed more anxiety/depression (P = .001, d = -2.18). CONCLUSION: Pain/discomfort and, especially, anxiety/depression contribute to liver transplant recipients' worse general health status 1 year after transplantation.

Comparison of quality of life between two clinical conditions with immunosuppressive therapy: liver transplantation and multiple sclerosis.

OBJECTIVE: We aimed to compare quality of life in two clinical conditions treated with immunosuppressants: cadaveric liver transplant recipients and multiple sclerosis patients. We also assessed the clinical significance of these results regarding a representative age-adjusted sample of the general Spanish population. METHODS: Using a cross-sectional design, the SF-36 Health Survey was used to evaluate 62 patients with these chronic conditions (31 in each group) who were matched for gender. An analysis of covariance was performed to control for the influence of time from multiple sclerosis diagnosis and liver transplantation surgery until assessment. Student t test of covariate-adjusted mean values was used as the statistical test and Cohen's d effect size index, to assess the magnitude of intergroup differences and assess clinical significance. RESULTS: Significantly worse scores were observed among the neurological patients compared with transplant recipients regarding role-physical (P = .038), general health (P = .003), vitality (P = .034), and physical functioning (P = .049), with medium effect sizes (Cohen's ds from -0.511 to -0.785). Against normative values, liver transplant recipients displayed relevant differences in all SF-36 subscales (Cohen's ds from -0.569 to -0.974) except for mental health (small effect size). Likewise, multiple sclerosis patients showed much greater differences versus the general population (Cohen's ds from -0.846 to -1.760). CONCLUSIONS: Liver transplant recipients showed better quality of life than multiple sclerosis patients (medium effect sizes) in physical quality-of-life dimensions. Interestingly, despite having controlled for time from diagnosis/transplantation, both medical conditions showed clinically significant impairments (large and medium effect sizes) in physical and psychosocial quality-of-life domains. We concluded that transplant recipients belong to a population that still requires special health care because, even after having undergone their treatment of choice, they do not achieve normal levels of biopsychosocial functioning.

Biopsychosocial functioning in liver patients of alcoholic etiology as a function of self-perceived pain level.

OBJECTIVE: To compare the biopsychosocial functioning among liver transplantation and cirrhotic patients as a function of self-perceived pain level. METHODS: We selected two groups of liver patients of the same gender (men) and disease etiology (alcoholic): there were 39 liver transplant recipients and 34 severe cirrhotic patients. The Hospital Anxiety and Depression Scale and the SF-36 Health Questionnaire were used. We applied analysis of covariance, with age and model end-stage liver disease (MELD) scores as covariates to assess the influence of two independent factors: (1) group (liver transplant recipients and cirrhotic patients), and (2) self-perception of pain (mild and high). We also calculated Cohen's d as an effect size index. RESULTS: No interactive effects were found between factors group and self-perceived pain in any of the variables studied. With regard to the main effects, we found statistically significant differences in the following variables between: a) liver transplant recipients and cirrhotic patients: anxiety (P = .000), depression (P = .003), role-physical (P = .001), mental health (P = .016), general health (P = .000), vitality (P = .000), and physical functioning (P = .000); and b) liver patients with mild and high self-perceived pain: anxiety (P = .008), depression (P = .000), role-physical (P = .002), mental health (P = .000), vitality (P = .000), and physical functioning (P = .001). In all the indicated variables, with medium and large effect sizes (Cohen's ds from 0.58 to 1.64), the cirrhotic patients and patients with a high level of self-perceived pain had much poorer mental health and quality of life. CONCLUSION: Alcoholic cirrhotic male patients with a high level of self-perceived pain had the greatest biopsychosocial impairment, even exceeding the clinical threshold in the anxiety and depression scales; and the highest biopsychosocial well-being was associated with liver transplant recipients with a mild level of self-perceived pain.

Coping strategies in liver patients as a function of relatives' anxiety level.

OBJECTIVE: To determine whether differences in the coping strategies used by liver patients during the pretransplantation phase were a function of their relatives' level of anxiety. MATERIALS AND METHODS: We assessed 75 pre-liver transplantation patients and 75 relatives (one per patient). To assess relatives' anxiety status, we used the Hospital Anxiety and Depression Scale (HADS), and the Questionnaire of Coping with Stress in Cancer Patients (CAEPO) to study patients' coping strategies. Three subgroups of relatives were established as a function of their scores on the HADS anxiety subscale: normal anxiety (G(1)), dubious anxiety (G2), and clinical anxiety (G(3)). To verify intergroup differences in the coping strategies used by the patients, we used the nonparametric Kruskal-Wallis H test. We also performed pairwise comparisons with nonparametric Mann-Whitney U test (with Bonferroni's correction) and Cohen's d as an effect size index. RESULTS: Focusing on the most relevant effect sizes, the pairwise contrasts indicated the following differences: a) normal anxiety (G(1)) and dubious anxiety (G(2)): seeking social support (d = 0.502); b) normal anxiety (G(1)) and clinical anxiety (G(3)): coping and active fighting (d = 0.607), self-control and emotional control (d = 0.658), and seeking social support (d = 0.944); and c) dubious anxiety (G(2)) and clinical anxiety (G(3)): coping and active fighting (d = 0.743), self-control and emotional control (d = 0.722), and seeking social support (d = 0.515). CONCLUSION: In general, during the pre-liver transplantation study, the liver patients whose relatives showed clinical levels of anxiety used these three healthy coping strategies to a lesser extent: coping and active fighting, self-control and emotional control, and seeking social support.

Affective status in liver transplant recipients as a function of self-perception of general health.

OBJECTIVE: We aimed to determine whether there were differences with regard to anxiety and depressive symptomatology between liver transplant recipients with better (G(1)) versus worse (G(2)) self-perceptions of general health compared with pre-liver transplantation cirrhotic patients (G(3)). METHODS: The groups of patients included 168 recipients including 85 and 83 with better or worse self-perceptions of general health, respectively, and 75 cirrhotic pre-liver transplantation patients. For the psychological assessment we used the Hospital Anxiety and Depression Scale and the general health dimension of the SF-36 Health Questionnaire. The following analyses were used: Analysis of variance (ANOVA) with post hoc pairwise comparisons by means of Tukey's test and Cohen's d, an effect size index. RESULTS: Significant differences were observed among the three groups for the variables of anxiety (P = .000) and depression (P = .000). Specifically, liver transplant recipients with better self-perceptions of general health displayed lower scores (better mental health) compared with those showing worse self-perceptions or cirrhotic patients. There were no differences between the latter two groups. The differences in these variables were relevant (large effect sizes) for anxiety (Cohen's d(1-2) = -1.075, Cohen's d(1-3) = -1.155) and for depression (Cohen's d(1-2) = -1.145, Cohen's d(1-3) = -1.158). CONCLUSION: The anxious-depressive status was not necessarily better among liver transplant recipients. There was great variability among them as a function of self-perceived general health. Transplant recipients with worse self-perception of general health presented the same anxiety-depressive levels as patients with severe liver disease in the pretransplantation phase; the latter groups reach the clinical threshold on the depression scale.

Relatives' mental health during the liver transplantation process.

OBJECTIVE: To compare the mental health of relatives of liver transplant patients during the three phases: pretransplantation, waiting list, and posttransplantation. MATERIALS AND METHODS: This follow-up study used the Hospital Anxiety and Depression Scale (HADS) to assess the relatives of 35 liver transplant patients (one relative for each patient). The anxiety-depression status was compared across the three liver transplant phases: pretransplant study (G(1)), from the first to the third month after admission to the waiting list (G(2)), and the 3 months after liver transplantation (G(3)). Student t test for paired samples was used for statistical analysis, and Cohen d calculated as an effect size index. RESULTS: Significant differences were observed (P = .000) among the three phases in anxiety and depression variables. In both, the greatest affective symptomatology corresponded to the phases prior to the liver transplantation (G(1) and G(2)) and the lowest in the post-liver transplant stage (G(3)). Relevant differences (large effect size) were noted between pre- and posttransplant phases in both HADS subscales: anxiety (Cohen d(1-3) = 1.197; Cohen d(2-3) = 0.817) and depression (Cohen d(1-3) = 1.228; Cohen' d(2-3) = 1.239). CONCLUSION: Relatives show poorer mental health during the phases prior to liver transplantation compared with the posttransplantation.

Quality of life in spanish patients with liver transplant.

BACKGROUND: Liver transplantation is the optimal method of treatment in patients with end-stage liver failure. Transplantation medicine has significantly progressed in the last time, but some psychology and psychosomatic problems still remain unsolved. Health-Related Quality of Life (HRQL) in liver transplant is considered a useful measure of evolutionary process of the illness. OBJECTIVE: The authors analyzed the evolution of HRQL in pre-transplant (waiting-list patients) and post-transplant (first year after liver transplant) periods of liver transplant Spanish patients. METHODS: A prospective and longitudinal study was carried out among patients who received a liver transplant from a deceased donor. They were assessed in four phases: at the time of inclusion on the transplant waiting-list, and 3, 6, and 12 months after receiving the graft. We used a structured interview and SF-36 and Euroqol-5D (EQ-5D) Health Questionnaires. RESULTS: The greater differences were found between pre-transplant and post-transplant stages with less well-being in the stage before the transplant. No significantly differences were observed when comparing the 3, 6 and 12 months from post-transplant stage. CONCLUSION: The HQRL of liver patients improved after the transplant, being appreciated a tendency to the stabilization from three months onwards. We suggest that the psychological intervention, in liver patients, should be conducted in waiting-list patients and in the first 3 months post-transplant, periods with a poor mental health (anxiety, depression, and stress by fear to the unknown thing) and a low adhesion to the treatment that can generate a smaller graft and/or patient survival.

Influence of relatives' anxious symptomatology on the quality of life of pretransplant hepatic patients.

OBJECTIVES: We sought to analyze the influence of anxiety symptoms of relatives of patients undergoing a pretransplant study on the quality of life of the hepatic patients body pain, physical role, mental health, general health, vitality, social functioning, emotional role, and physical functioning. MATERIALS AND METHODS: We assessed 2 groups: 51 patients with hepatic cirrhosis and 51 of their closest relatives who were studied while the patients were hospitalized to undergo the pretransplant study. We used a "Psychosocial Survey" (in both groups), the "Hospital Anxiety and Depression Scale" (HADS) in the relatives, and the "SF-36 Health Survey" (in the patients). RESULTS: The results showed that the patients whose relatives presented clinical levels of anxiety showed the worst quality of life, specifically for the dimensions "mental health" (P=.016) and "emotional role" (P=.041).

Comparison of anxious and depressive symptomatology among pretransplant hepatic patients and their relatives.

OBJECTIVE: We sought to compare the anxiety and depressive symptoms of patients undergoing pretransplant evaluation with those of their closest relatives. MATERIALS AND METHODS: We assessed 51 patients with hepatic cirrhosis and 51 relatives who were the main care giver for each patient. All subjects were assessed during the interval when the patients were hospitalized to undergo the medical assessment to determine their inclusion on the waiting list for liver transplantation. In both groups, we used a "Psychosocial Survey" and the "Hospital Anxiety and Depression Scale." RESULTS: Significant differences were observed in anxiety (P=.001), but not in depression (P=.820). Specifically, relatives presented higher levels of anxiety compared with the hepatic patients. CONCLUSION: The relatives were worse off psychologically than the patients.

Health-related quality of life evolution in patients after heart transplantation.

We analyzed the evolution of the health-related quality of life during the first year after heart transplantation (HT). A prospective, longitudinal study was performed in 13 heart transplant recipients who were assessed at four different stages: at inclusion on the HT waiting list and at 3, 6, and 12 months after receiving the graft. The instruments used were a structured interview and the 36-item Short-Form Health Survey. The results showed that, compared with pre-HT, there was progressive improvement in physical, psychologic, and social areas post-HT and that health-related quality of life was stable 6 months after receipt of the graft.

Influence of the psychological state of relatives on the quality of life of patients at 1 year after transplantation.

We analyzed the influence of the psychological state of relatives on the quality of life of patients at 1 year after transplantation. We selected 2 groups: 94 transplant patients (47.9% liver, 40.4% kidney, and 11.7% heart) of mean age 49.42 years (SD, 11.21 years) and their close relatives (n = 94). All participants were assessed at 1 year after transplantation, using a Psychological Survey (both groups); the Hospital Anxiety and Depression Scale and the Quality of Life Questionnaire (transplant patients); and the Leeds Scales for the Self-Assessment of Anxiety and Depression (relatives). The results revealed that transplant patients whose relatives had more symptoms of anxiety and depression at 1 year after transplantation showed a decreased quality of life.

[Health related quality of life evolution in kidney transplanted patients]. / Evolución de la calidad de vida relacionada con la salud en los trasplantados renales.

OBJECTIVE: We analyzed the evolution in the Health Related Quality of Life (HRQOL) during the first year following renal transplant. METHODS: Prospective and longitudinal study carried out with 28 patients who received a primary cadaveric renal transplant. The tests applied were a structured interview and SF-36, Euroqol- 5D (EQ-5D) Health Questionnaires and End-Stage Renal Disease Symptom Checklist- Transplantation Module (ESRD-SCL). RESULTS: With the course of time, the renal patients improve in four areas: physical (<> and <>), psychological (<> and <>), execution of daily tasks (<> and <>) and subjective perception of own state of health (<>). CONCLUSIONS: The HRQOL in renal transplant patients improves with the course of time.

The influence of posttransplant anxiety on the long-term health of patients.

We analyzed whether a high level of anxiety in posttransplant patients affected their health, namely, symptoms of anxiety and depression and the quality of life, at 1 year after transplantation. We selected 166 transplant patients (47% liver, 42.8% kidney, and 10.2% heart) of mean age 48.91 years (SD = 11.22). The psychological evaluation was performed in two phases: post-intensive care unit (when the transplant patients were admitted to the transplant unit) and posthospitalization (1 year after organ transplantation). The instruments applied were a "Psychosocial Interview," "The Hospital Anxiety and Depression Scale," and "Quality of Life Questionnaire." The results showed that a high level of posttransplant anxiety is harmful in the long term to the health of transplant patients: affected individuals showed symptoms of anxiety and depression as well as reduced functioning in social, emotional, physical, and financial areas.