Fear of Graft Rejection after Heart Transplantation

PURPOSE: Perceived Threat of the Risk of Graft Rejection (PTRGR) is prominent in organ transplant recipients' lives. When asked about what they fear most, the commonest response is graft rejection. A reasonable assumption is that this perceived threat is also relevant for heart recipients and involves various psychological reactions, such as efforts to cope with the perceived threat. There are no published data on heart recipients' PTRGR. Therefore, the aim of the present study was to explore the perceived threat of the risk of graft rejection and its relationship to psychological general well-being and self-efficacy one to five years after heart transplantation. METHODS: A total of 79 heart recipients due for their yearly follow-up one to fiveyears after heart transplantation were included. The key instrument used was the Perceived Threat of the Risk of Graft Rejection (PTGR) covering three factors. The meaning of the first factor, graft-related threat (GRT), is a perception that the primary disease will return, leaving one as ill as before the transplantation and facing re-transplantation. The second factor, intrusive anxiety (IA), means being constantly aware of the risk of graft rejection and thinking about it all the time. It also means experiencing great anxiety, which is elevated when taking immunosuppressive medication or undergoing a biopsy. Finally, the third factor, lack of control (LOC), involves perceptions that the threat of the risk of graft rejection is beyond one's control, revealing the degree of belief that one can control and protect oneself from the threat. Additional instruments used were the Psychological General Well-being (PGWB) and Self-efficacy in chronic illness. RESULTS: Heart recipients younger than 50 years reported more graft related threat than those older than 50 years. Further, those who had experienced one or more graft rejection reported less graft related threat. Patients with good psychological well-being reported both less intrusive anxiety and higher control than those with poor psychological well-being. CONCLUSION: Fear of graft rejection, especially intrusive anxiety seems related to psychological general well-being after heart transplantation. Successful experience from graft rejection might reduce the graft related threat.