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BackgroundThe psychological functioning of living donor (LD) and deceased donor (DD) recipients are important factors for emotional adjustment to transplantation. This study investigated differences in medical, sociodemographic and emotional factors between these two groups.MethodsA total of 241 kidney transplant recipients (68 LD, 173 DD) completed questionnaires on emotional and behavioural responses to transplantation, including quality of life, anxiety and depression, social support and experience with immunosuppressive medication.ResultsOverall, LD recipients were younger, better educated, more often employed and had a shorter duration of dialysis prior to transplantation. Findings indicate that LD recipients expressed more guilt towards the donor than DD recipients. In addition, more LD recipients experienced clinically significant levels of anxiety. Both groups experienced high levels of negative effects of immunosuppressant medication. No differences between LD and DD recipients were found for gender, relationship status, time since transplantation or transplant rejection treatment during the last 12 months. In addition, perceived social support and quality of life were comparable between the two groups.ConclusionsFeelings of guilt and anxiety may be an important focus for interventions to improve emotional adjustment to transplantation, especially in LD recipients.

Dear Sirs, Adherence to immunosuppressants is crucial for allograft survival in kidney transplant (KTx) patients [1]. Amongst others, lacking knowledge and misconceptions about immunosuppressants might lead to nonadherence and could be improved by education [2]. In our center, patients waiting for KTx visit the outpatient clinic at least once before and every 1-3 years after listing. During each visit, the importance of regular and correct immunosuppressant intake is discussed. Immediately after KTx, the same is explained on the ward and in structured lectures during rehabilitation which 2 of 3 of the patients attend. However, misconceptions about immunosuppressants are regularly revealed during follow-up visits. We wondered how much our patients knew about correct immunosuppressant handling. As part of a recent study on adherence [3], we therefore asked the patients to answer a self-developed questionnaire consisting of 8 multiple choice questions about basic and more specific details concerning immunosuppressant intake (Table 1).Of 239 patients participating, 17 patients (7.1%) answered all questions and 190 (79.5%) more than 50% correctly. On average, 5.66 AE 1.40 questions (70.1%) were correctly answered. There were no significant correlations between test results and age, educational level, immunosuppressant blood level variability, depression and anxiety scores, self-reported adherence with immunosuppressants (for details, see [3]), and the frequency of appointments with a nephrologist. The percentage of correct answers was negatively correlated with time since transplantation (Pearson À0.176, P = 0.007). Female patients had slightly but significantly better results than male patients (5.94 AE 1.37 vs. 5.52 AE 1.40, P = 0.026), and living donor recipients had better results than deceased donor recipients (6.13 AE 1.07 vs. 5.48 AE 1.47, P = 0.001). Surprisingly, participation in a rehabilitation program did not lead to better results (5.73 AE 1.44 vs. 5.57 AE 1.34, P = 0.377).Our questionnaire might not meet the highest scientific standards, but our results give some interesting clues about health literacy in our KTx cohort. Overall, knowledge was disappointingly low, which is in line with the literature [4,5], and seemed to decrease with time since transplantation. The better test results in living donation recipients might be explained by a more intense preparation. Preparation time for living donation is relatively short (0.5-2 years), but patients see a transplant coordinator multiple times during that short time period. Most patients knew that grapefruit can influence immunosuppressant levels, but not that pomegranate potentially does the same, revealing another problem: pomegranate only came into focus recently [6], and patients usually do not receive structured education on new findings during follow-up. Furthermore, physicians and nurses themselves might lack knowledge and, therefore, might not be able to inform their patients properly [7].Within the last years, we and other centers have begun to fo...

The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed information about the clinical classification and diagnosis of pulmonary hypertension, and furthermore provide novel recommendations for risk stratification and follow-up assessments. However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to the clinical classification and initial diagnosis of PH. This article summarizes the results and recommendations of this working group.

ZusammenfassungDie Entwicklung von Adipositas nach einer Organtransplantation erhöht das Risiko für Komplikationen bis hin zum Transplantatverlust. In einer Querschnittsuntersuchung mit 241 nierentransplantierten Patienten wurde der Zusammenhang zwischen Adipositas und verschiedenen Maßen zur Bestimmung der Adhärenz mit Immunsuppressiva (IS) (Selbstbericht, Arzteinschätzung, Biopsie-gestützte Rejektionen, Variationskoeffizient der IS-Talspiegel) untersucht. Zum Zeitpunkt der Transplantation waren 12,9% (n=31) der Patienten adipös und zum Nachuntersuchungszeitpunkt (im Durchschnitt nach 7,2 Jahren) waren 23,7% (n=57) adipös (BM ≥ 30 kg/m2). Wir konnten keinen Unterschied zwischen adipösen und nicht adipösen Patienten in der selbst-beurteilten Adhärenz, der Adhärenzeinschätzung durch die betreuenden Ärzte und dem Vorliegen einer Biopsie-gestützten Rejektion während der letzten 12 Monate finden. Adipöse Patienten wiesen allerdings eine höhere Serumvariabilität der IS-Talspiegel auf im Vergleich zu nicht-adipösen Patienten (p=0,03). Die Serumvariabilität ist allerdings kein reines Adhärenzmaß. Insgesamt gibt es keine überzeugenden Hinweise darauf, dass Adipositas die IS Adhärenz bei Patienten nach Nierentransplantation negativ beeinflusst.