Bakgrund: Njuren är det mest donerade organet i Sverige och så många som 445 stycken transplantationer av njurar utfördes 2021. Som sjuksköterska är det viktigt att öka förståelsen kring patientens upplevelse för att främja trygghet och ett gott välbefinnande. Sjuksköterskan har en viktig roll i omvårdnaden i form av information och stöd.  Syfte: Syftet med litteraturstudien var att belysa patienters upplevelser av att vänta på en njurtransplantation. Metod: Det utfördes en litteraturöversikten med en kvalitativ ansats. Med den här metoden identifierades problemområdet som sammanställdes och sammanfattades med hjälp av redan tillgänglig forskning och kunskap för att fastställa kunskapsläget inom området.  Resultat: Det redovisades fem teman utifrån tio kvalitativa vetenskapliga artiklar som beskriver patientens upplevelse i väntan av en njurtransplantation. De fem teman som identifierades var: Att vara inskriven på väntelistan, en väntan utan tydligt slut, livet på paus, lycka och död samt önskan om stöd.  Slutsats: En njurtransplantation var nyckeln till ett nytt liv för människor som levde med en sviktande njure och behandlas med dialys. Många av patienterna som var med på väntelistan hade tappat hoppet och behövde mer information och stöd från vårdpersonalen för att hitta strategier och återfå hoppet för en fungerande vardag. / Background: The kidney is the most donated organ in Sweden and as many as 445 kidney transplants were performed in 2021. As a nurse it's important to improve the understanding of the patient's experience in order to promote security and a good sense of well-being. The nurse has an important role in nursing regarding information and support. Aim: The purpose of this literature study was to shed light on the patient's experience of waiting for a kidney transplant. Method: A literature review was carried out with a qualitative approach. This method identified the problem area, which compiled and summarized already available research and knowledge in order to determine the state of knowledge in the field. Results: Five themes were reported on ten qualitative articles that describe the patient's experience while waiting for a kidney transplant. The five themes were: To be on the waiting list, A wait without a clear ending, Life on pause, Happiness and death and The wish for support.  Conclusion: A kidney transplant was the key to a new life for people living with kidney failure and being treated with dialysis. Many of the patients who were on the waiting list had lost hope and needed more information and support from the healthcare staff to find strategies. Strategies were needed to regain hope and to have a functioning everyday life.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-04-27T14:51:33Z No. of bitstreams: 1 kelliborgesdossantos.pdf: 3267301 bytes, checksum: ebaef8cc5229eeaa466bdd3b3e52d494 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-05-02T01:01:59Z (GMT) No. of bitstreams: 1 kelliborgesdossantos.pdf: 3267301 bytes, checksum: ebaef8cc5229eeaa466bdd3b3e52d494 (MD5) / Made available in DSpace on 2016-05-02T01:01:59Z (GMT). No. of bitstreams: 1 kelliborgesdossantos.pdf: 3267301 bytes, checksum: ebaef8cc5229eeaa466bdd3b3e52d494 (MD5) Previous issue date: 2015-11-27 / Introdução: Nas últimas décadas, o transplante autólogo de células-tronco hematopoéticas (auto-TCTH) tem sido utilizado como uma potencial terapia de salvamento para pacientes portadores de linfomas. Atualmente, inúmeros tipos de protocolos de condicionamento para a realização do auto-TCTH são conhecidos e utilizados com a intenção de melhorar a sobrevida global (SG) e livre de doença (SLD) destes pacientes. Até os dias atuais, nenhum protocolo tem sido considerado superior, com melhores resultados que os outros. Objetivo: Determinar a dose máxima de lomustina tolerada em protocolo de condicionamento (lomustina, etoposide, citarabina e melfalan – LEAM) e avaliar as toxicidades deste protocolo em comparação a série histórica do serviço. Método: Trata-se de uma coorte prospectiva, do tipo 3:3, quantitativa. A primeira etapa do estudo foi realizada para a determinação da dose máxima tolerada (DMT) de lomustina. A segunda etapa, consistiu na comparação com a série histórica de pacientes submetidos ao transplante que utilizaram CBV (carmustina, etoposide e ciclofosfamida) previamente ao auto-TCTH. Resultados: Para determinar a dose máxima tolerada (DMT) de lomustina administrada no D-4, seguida de etoposide (1 g/m2 D-3), citarabina (4g/m2 D-2), e melfalano (140 mg/m2 D-1), foram submetidos ao protocolo um total de 14 pacientes. Foi realizado escalonamento da dose de lomustina a cada 200 mg/m2. A coorte inicial consistiu de lomustina na dose de 200 mg/m2 (L200), seguida de uma coorte com lomustina 400 mg/m2 (L400). Como L400 excedeu a DMT, uma terceira coorte foi criada com lomustina 300 mg/m2 (L300). Seis pacientes foram tratados em L200 (1 Toxicidade Limitante de Dose (TLD) – óbito por sepse), dois pacientes foram tratados em L400 (2 TLD, toxicidade gastrointestinal grau 4) e 6 pacientes foram tratados em L300 (1 TLD, neurológica grau 4, reversível), sendo lomustina 300mg/m2 considerada a DMT. Na segunda fase do estudo participaram 32 pacientes submetidos ao protocolo LEAM. As principais toxicidades encontradas entre os pacientes foram mucosite (53,1%), diarreia (68,8%) e toxicidade cutânea (34,4%). A seguir, os pacientes foram comparados a séria histórica, em que 64 pacientes foram submetidos ao protocolo CBV. Os grupos eram similares no que diz respeito ao estádio, diagnóstico médico idade e sexo. O início da neutropenia e o tempo de duração da mesma foi estatisticamente menor no grupo LEAM em comparação ao grupo CBV, p = 0,00 e 0,035 respectivamente. Não houve diferença entre as toxicidades encontradas nos dois grupos, no entanto, a sobrevida global dos pacientes submetidos ao protocolo LEAM foi superior em comparação ao grupo CBV (p = 0,050). Conclusão: O protocolo LEAM mostrou-se como um regime de condicionamento factível, de rápida administração, associado a curto período de neutropenia e aceitável toxicidade. A sobrevida global foi melhor no protocolo LEAM quando comparada a série histórica do serviço. / Introduction: In recent decades, Autologous Hematopoietic Stem Cell Transplantation (auto-HSCT) has been used as a potential rescue therapy for patients with lymphoma. Currently, numerous types of conditioning protocols for performing auto-HSCT are known and used in order to improve the overall survival (OS) and disease-free survival (DFS) of these patients. Until today, no protocol has been considered superior and produced better results than the others. Objective: Determine the maximum tolerated dose of lomustine in a conditioning protocol (lomustine, etoposide, cytarabine and melphalan – LEAM) and evaluate the toxicities of this protocol in comparison to the historical series of the service. Method: A quantitative, type 3.3 prospective cohort. The first step of the study was carried out to determine the maximum tolerated dose (MTD) of lomustine. The second step consisted in comparing it with the historical series of patients undergoing transplantation who used CBV (carmustine, etoposide and cyclophosphamide) prior to auto-HSCT. Results: To determine the maximum tolerated dose (MTD) of lomustine administered on D-4, followed by etoposide (1 g/m2 (D-3), cytarabine (4 g/m2 (D-2), and melphalan (140 mg/m2 (D-1), a total of 14 patients were submitted to the protocol. The lomustine dose was escalated according to 200 mg/m2 intervals. The initial cohort consisted of lomustine at a dose of 200 mg/m2 (L200), followed by a cohort with lomustine 400 mg/m2 (L400). Because L400 exceeded the MTD, a third cohort with lomustine in a dose of 300 mg/m2 was created (L300). Six patients were treated in L200 (1 DLT, died of sepsis), two patients were treated in L400 (2 DLT, grade 4 gastrointestinal toxicity) and 6 patients were treated in L300 (1 DLT, neurological grade 4, reversible), with lomustine 300mg/m2 being considered the MTD. In the second phase of the study, 32 patients submitted to the LEAM protocol participated. The main toxicities found among the patients were mucositis (53.1%), diarrhea (68.8 %) and dermal toxicity (34.4%). The patients were then compared to the historical series, in which 64 patients were submitted to the CBV protocol. The groups were similar with regard to the stage, medical diagnosis, age and sex. The beginning of neutropenia and its duration was statistically lower in the LEAM group when compared to the CBV group, p = 0.00 and 0.035, respectively. There was no difference between the toxicities found in the two groups, but the overall survival of the patients submitted to the LEAM protocol was higher when compared to the CBV group (p = 0.050). Conclusion: The LEAM protocol proved to be a viable conditioning regimen of rapid administration, associated with a short duration of neutropenia and acceptable toxicity. Overall survival was better in the LEAM protocol when compared to the historical series of the service.

Bakgrund: Idag är det drygt 700 personer som väntar på en njurtransplantation i Sverige. Njurtransplantationen är en räddning från döden för många patienter som genomgår dialys behandling eller andra former av interventioner för att kunna leva ett ”normalt liv”. För att kunna erbjuda den bästa omvårdnaden bör sjuksköterskan ha en god kunskap om patienters upplevelser. Syfte: Avsikten med litteraturstudien var att belysa patienters upplevelser av att vänta på en njurtransplantation. Metod: Litteraturstudien bygger på tio vetenskapliga studier med kvalitativ metod. Kvalitetsgranskning av artiklarna och sammanställning av resultat genomfördes. Resultat: Resultaten presenteras genom två tema som omfattar patienternas upplevelser av att vänta på en njurtransplantation. Teman som valdes ut är:Osäkerhet i väntan på en njurtransplantation; Behovet av stöd från omgivningen. Slutsats: Att få en njurtransplantation innebär en chans till ett nytt liv. Den komplexa processen som en transplantation innebar framkallade många upplevelser hos patienter med njursjukdom. Vårdens insatser bör vara inriktade på att utveckla strategier och vara mer fokuserade på patienternas behov av information och kunskapsutveckling för att kunna hantera upplevelserna vid väntan på en njurtransplantation. / Background: There are currently around 700 people waiting for a kidney transplant in Sweden. Kidney transplantation is a lifesaver for many patients undergoing dialysis or other previous interventions to be able to live a “norma llife”. In order to be able to offer the best care, the nurse should have a good knowledge of patients' experiences. Aim: The purpose of the literature study was to shed light on patients´ experiences of waiting for a kidney transplant. Method: The literature study is based on ten scientific studies with a qualitative method. Quality review of the articles and compilation of results was carried out. Results: The results are presented through two themes that include patients´experiences of waiting for a kidney transplant. Themes selected are: Uncertaintyin waiting for a kidney transplant; The need for support from the environment. Conclusion: Getting a kidney transplant means a chance at a new life. The complex process involved in a transplant evoked many experiences in patients with kidney disease. Healthcare efforts should develop their strategies and be more focused on the patients´ needs for information and knowledge development in order to be able to manage the experiences while waiting for a kidney transplant.