Accuracy of anxiety and depression screening tools in heart transplant recipients.
Introduction This section deals with surgical issues that may potentially complicate the immediate post-transplant period. Many of these issues, particularly ones that arise in patient selection can have a very important impact on the immediate post-operative course of the patient and some can have far reaching consequences for long-term graft and patient survival. Donor-recipient matching refers to the avoidance of size discrepancies that can impair graft function. However, in the broader sense, donor factors, particularly ones that might have an adverse impact on graft function, need to be viewed in the context of the recipient’s condition. These factors include the urgency of transplantation, the presence of comorbid disease and the adequacy of physical reserves in the recipient, which are important considerations in the context of the recipient’s ability to tolerate a post-operative course that may be complicated by impaired graft function as the direct result of transplantation of a marginal donor heart. The projected ischemic time is another important variable in decision making regarding the use of a particular donor heart. The projected ischemic time is also emblematic of an important axiom in donor selection and matching to a specific recipient—and that is that factors that may adversely impact post-operative graft function should not be considered in isolation. For example, the use of a heart from a donor who died of toxicity (such as carbon monoxide) should be considered together with other important factors that have potentially compounding adverse effects, such as older donor age and longer rejected ischemic time. Although the techniques of donor heart procurement and implantation are standardized, there are factors such as the method of myocardial preservation and technique of donor heart implantation (biatrial versus bicaval technique) that may influence the post-heart transplant (HT) period. Post-operative complications such as sternal wound infection and pericardial effusion may cause the patient’s convalescence to be prolonged.