Este trabalho teve como objetivos compreender a dinâmica familiar na experiência do transplante hepático pediátrico, bem como identificar as demandas e recursos da família. Utilizou-se como referencial teórico o Interacionismo Simbólico e como referencial metodológico a Teoria Fundamentada nos Dados. A análise comparativa dos dados possibilitou desvendar o significado da experiência da família com uma criança na situação de transplante hepático. Foi possível identificar dois fenômenos que compõem esta experiência: TENDO A VIDA CONTROLADA PELO TRANSPLANTE, que representa a vulnerabilidade da família ao vivenciar as incertezas e o medo constantes no decorrer da experiência de doença da criança; e LUTANDO PARA RESGATAR A AUTONOMIA, que consiste no movimento de reação da família diante do primeiro fenômeno, adaptando-se continuamente para enfrentar o estresse e sofrimento desencadeados pela situação de doença. A articulação desses fenômenos permitiu identificar a categoria central NÃO PODENDO VIVER COMO ANTES, a partir da qual propõe-se um modelo teórico explicativo da experiência / The aims of this study were to understand the family dynamics during the pediatric liver transplantation experience, and to identify the demands and resources of the family. The study used the Symbolic Interactionism as a theoretical reference and the Grouded Theory Methodology. The comparative anaylisis of the data enabled to unfold the meaning of the experience of the family with a child living the liver transplantation experience. Two phenomena were identified: HAVING LIFE UNDER TRANSPLANTATION´S CONTROL represents the vulnerability of the family living with uncertainty and fear across the child´s illness experience; and STRUGGLING TO RESCUE THEIR AUTONOMY is the reaction of the family when exposed to the first phenomenon, and consists on a continuous adaptation to face all the suffering and stress triggered by the illness situation. The relationship of these two phenomena allowed the identification of the central category named NOT BEING ABLE TO LIVE LIKE BEFORE based on which it was possible to propose a theoretical model to explain the experience

A cirrose hepática é a consequência de todas as doenças crônicas, de longo prazo, que acometem o fígado e é caracterizada a insuficiência hepática (IH) e a hipertensão portal (HP). As coagulopatias vistas em pacientes cirróticos são dependentes de diversos mecanismos, que envolvem tanto a IH como a HP, e que comprometem as funções fisiológicas rotineiras do fígado, entre elas a síntese de todos os fatores de coagulação, com exceção do fator de von Willebrand. Todos os trabalhos publicados até hoje em odontologia não puderam associar os dois testes geralmente utilizados no pré-operatório desses pacientes, o INR e a contagem de plaquetas, com a presença de eventos hemorrágicos. O objetivo deste trabalho foi avaliar a presença de sangramento intra e pós-operatório de pacientes cirróticos, submetidos a exodontias, e verificar se existe associação entre parâmetros laboratoriais (plaquetas, hemoglobina, INR, TTPa, ureia, creatinina) e clínicos (complicações da cirrose, estágio da doença, MELD, tipo de exodontia, tempo de cirurgia, número de dentes extraídos). Foi realizado um estudo observacional retrospectivo analítico, de corte transversal de pacientes cirróticos em fila de transplante do Centro de Atendimento a Pacientes Especiais (CAPE) da Faculdade de Odontologia da Universidade de São Paulo (FOUSP). Foram transferidos para o EpiInfo, originando um banco de dados, as informações constantes do prontuário de 224 pacientes. Em 99 pacientes foram executados 190 atendimentos que resultaram em 333 dentes extraídos. A maioria dos pacientes era do sexo masculino (75,44%), com idade média de 51,27 anos e escolaridade de nível fundamental (23,56%). A maior causa de cirrose foi a hepatite C (40,18%), e as complicações da cirrose mais comuns foram a circulação colateral (66,80%), encefalopatia hepática (56,30%) e ascite (64,20%). Em 190 hemogramas foi identificada plaquetopenia (95,80%); anemia, em 129 (67,90%) e alterações da série branca em 110 (57,80%). A média do INR foi de 1,45 (mínimo 1,03 e máximo 2,71) e a de plaquetas 76.380 (mínimo 16.000 e máximo de 216.000). Apenas 12 pacientes apresentaram eventos hemorrágicos no intra-operatório e 12 no pós-operatório. A única associação positiva foi entre a contagem de plaquetas e os eventos hemorrágicos intra-operatórios (p=0,26; teste de Mann Whitney, confirmada a associação através de análise de regressão linear). Todos os eventos foram controlados com medidas locais. Pacientes cirróticos em fila de transplante de fígado apresentam poucos eventos relacionados com sangramento e todos de pouca severidade. Existe uma chance maior de sangramento intra-operatório à medida que a contagem de plaquetas diminui, mas o sangramento é controlado com medidas locais simples. Os eventos hemorrágicos pós-operatórios não puderam ser associados com nenhuma das variáveis, mas nenhum paciente necessitou de transfusão e a resolução do quadro foi espontânea. / Hepatic cirrhosis is the result of all long-term chronic diseases, which can compromise the liver, and is characterised by hepatic insufficiency (HI) and portal hypertension (PH). The coagulopathies seen in cirrhotic patients depend on several mechanisms involving both HI and PH, which impairs the routine physiological functions of the liver, such as synthesis of all coagulation factors, except the von Willebrand factor. All dental studies published until today could not associate the two tests commonly used prior to tooth extraction in these patients, namely, INR and platelets count, for presence of haemorrhagic events. The objective of this work was to assess the presence of intra- and post-operative bleeding in cirrhotic patients undergoing tooth extraction and to verify whether there exists an association between laboratory (i.e. platelets, haemoglobins, INR, TTPa, urea, creatinine) and clinical parameters (i.e. cirrhosis complications, disease stage, MELD score, type of tooth extraction, surgery time, number of teeth extracted). This is a cross-sectional, retrospective, observational study of cirrhotic patients who were on the liver transplant waiting list at the Healthcare Centre for Special Patients (CAPE) of the University of São Paulo Faculty of Dentistry (FOUSP). Data were obtained from the medical records of 224 patients and the Epi Info software was used to generate a database. A total of 190 visits were performed for 99 patients, resulting in 333 teeth extracted. The majority of the patients were male (75.44%) with mean age of 51.27 years old and elementary education level (23.56%). The greatest cause was hepatitis C (40.18%) and the most common cirrhosis complications were collateral circulation (66.80%), hepatic encephalopathy (56.30%) and ascite (64.20%). Plateletopenia (95.80%) was identified in 190 blood counts, anaemia (67.90%) in 129, and white blood cell changes in 110 (57.80%). The mean scores for INR was 1.45 (minimum 1.03 and maximum 2.71) and for platelets was 76,380 (minimum 16,000 and maximum 216,000). Only 12 patients presented haemorrhagic events during surgery and 12 after it. The only positive association was found between platelet counts and intra-operative haemorrhagic events (P = 0.26; Mann Whitney\'s test, confirmed with linear regression analysis). All the bleeding events were controlled with local measures. Cirrhotic patients who were on the liver transplant waiting list had a few bleeding events, all with little severity. Intra-operative haemorrhagic events are more likely to occur when the platelet count is low, but bleeding can be handled with simple local measures. Post-operative haemorrhagic events could not be associated with any variable, but no patient needed blood transfusion as the clinical picture improved spontaneously.

A cirrose hepática é a consequência de todas as doenças crônicas, de longo prazo, que acometem o fígado e é caracterizada a insuficiência hepática (IH) e a hipertensão portal (HP). As coagulopatias vistas em pacientes cirróticos são dependentes de diversos mecanismos, que envolvem tanto a IH como a HP, e que comprometem as funções fisiológicas rotineiras do fígado, entre elas a síntese de todos os fatores de coagulação, com exceção do fator de von Willebrand. Todos os trabalhos publicados até hoje em odontologia não puderam associar os dois testes geralmente utilizados no pré-operatório desses pacientes, o INR e a contagem de plaquetas, com a presença de eventos hemorrágicos. O objetivo deste trabalho foi avaliar a presença de sangramento intra e pós-operatório de pacientes cirróticos, submetidos a exodontias, e verificar se existe associação entre parâmetros laboratoriais (plaquetas, hemoglobina, INR, TTPa, ureia, creatinina) e clínicos (complicações da cirrose, estágio da doença, MELD, tipo de exodontia, tempo de cirurgia, número de dentes extraídos). Foi realizado um estudo observacional retrospectivo analítico, de corte transversal de pacientes cirróticos em fila de transplante do Centro de Atendimento a Pacientes Especiais (CAPE) da Faculdade de Odontologia da Universidade de São Paulo (FOUSP). Foram transferidos para o EpiInfo, originando um banco de dados, as informações constantes do prontuário de 224 pacientes. Em 99 pacientes foram executados 190 atendimentos que resultaram em 333 dentes extraídos. A maioria dos pacientes era do sexo masculino (75,44%), com idade média de 51,27 anos e escolaridade de nível fundamental (23,56%). A maior causa de cirrose foi a hepatite C (40,18%), e as complicações da cirrose mais comuns foram a circulação colateral (66,80%), encefalopatia hepática (56,30%) e ascite (64,20%). Em 190 hemogramas foi identificada plaquetopenia (95,80%); anemia, em 129 (67,90%) e alterações da série branca em 110 (57,80%). A média do INR foi de 1,45 (mínimo 1,03 e máximo 2,71) e a de plaquetas 76.380 (mínimo 16.000 e máximo de 216.000). Apenas 12 pacientes apresentaram eventos hemorrágicos no intra-operatório e 12 no pós-operatório. A única associação positiva foi entre a contagem de plaquetas e os eventos hemorrágicos intra-operatórios (p=0,26; teste de Mann Whitney, confirmada a associação através de análise de regressão linear). Todos os eventos foram controlados com medidas locais. Pacientes cirróticos em fila de transplante de fígado apresentam poucos eventos relacionados com sangramento e todos de pouca severidade. Existe uma chance maior de sangramento intra-operatório à medida que a contagem de plaquetas diminui, mas o sangramento é controlado com medidas locais simples. Os eventos hemorrágicos pós-operatórios não puderam ser associados com nenhuma das variáveis, mas nenhum paciente necessitou de transfusão e a resolução do quadro foi espontânea. / Hepatic cirrhosis is the result of all long-term chronic diseases, which can compromise the liver, and is characterised by hepatic insufficiency (HI) and portal hypertension (PH). The coagulopathies seen in cirrhotic patients depend on several mechanisms involving both HI and PH, which impairs the routine physiological functions of the liver, such as synthesis of all coagulation factors, except the von Willebrand factor. All dental studies published until today could not associate the two tests commonly used prior to tooth extraction in these patients, namely, INR and platelets count, for presence of haemorrhagic events. The objective of this work was to assess the presence of intra- and post-operative bleeding in cirrhotic patients undergoing tooth extraction and to verify whether there exists an association between laboratory (i.e. platelets, haemoglobins, INR, TTPa, urea, creatinine) and clinical parameters (i.e. cirrhosis complications, disease stage, MELD score, type of tooth extraction, surgery time, number of teeth extracted). This is a cross-sectional, retrospective, observational study of cirrhotic patients who were on the liver transplant waiting list at the Healthcare Centre for Special Patients (CAPE) of the University of São Paulo Faculty of Dentistry (FOUSP). Data were obtained from the medical records of 224 patients and the Epi Info software was used to generate a database. A total of 190 visits were performed for 99 patients, resulting in 333 teeth extracted. The majority of the patients were male (75.44%) with mean age of 51.27 years old and elementary education level (23.56%). The greatest cause was hepatitis C (40.18%) and the most common cirrhosis complications were collateral circulation (66.80%), hepatic encephalopathy (56.30%) and ascite (64.20%). Plateletopenia (95.80%) was identified in 190 blood counts, anaemia (67.90%) in 129, and white blood cell changes in 110 (57.80%). The mean scores for INR was 1.45 (minimum 1.03 and maximum 2.71) and for platelets was 76,380 (minimum 16,000 and maximum 216,000). Only 12 patients presented haemorrhagic events during surgery and 12 after it. The only positive association was found between platelet counts and intra-operative haemorrhagic events (P = 0.26; Mann Whitney\'s test, confirmed with linear regression analysis). All the bleeding events were controlled with local measures. Cirrhotic patients who were on the liver transplant waiting list had a few bleeding events, all with little severity. Intra-operative haemorrhagic events are more likely to occur when the platelet count is low, but bleeding can be handled with simple local measures. Post-operative haemorrhagic events could not be associated with any variable, but no patient needed blood transfusion as the clinical picture improved spontaneously.

<p> </p><p>Bakgrund: Väntelistorna för de patienter som står i kö för en levertransplantation blir allt längre i alla länder runt om i världen. Väntetiden upplevs för patienterna som en psykiskt och socialt påfrestande tid eftersom det är oklart om och när ett organ som passar blir tillgängligt. Det är viktigt att sjuksköterskan antar utmaningen att möta lidandet och den lidande människan och bidra till att minska detta. Syfte: Syftet med litteraturstudien var att belysa och beskriva patienters upplevelser i väntan på en levertransplantation. Metod: Litteraturstudien bygger på totalt 10 kvalitativa och kvantitativa vetenskapliga artiklar. Resultat: Att bli uppsatt på väntelistan för en ny lever upplevdes av många patienter som en enorm lättnad och de fick en känsla av hopp samtidigt som det innebar en fysisk och psykisk begränsning i tillvaron. Rädsla och ångest på grund av ovissheten var också ett stort problem för deltagarna. Informationen och stödet ansågs vara viktigt under väntetiden. Diskussion: Upplevelsen av förändrad självbild och identitet, ångest samt behovet av information och stöd i väntan diskuterades och kopplades samman med Joyce Travelbees omvårdnadsteori samt sjuksköterskans kompetens. Slutsats: För att kunna utveckla omvårdnaden kring patienter som väntar på en levertransplantation krävs det mer forskning som belyser upplevelsen av väntan före en levertransplantation.</p><p> </p> / <p><p>Background: The number of patients on waiting lists for a liver transplant is growing in all countries around the world. These patients experience the waiting as a psychologically and socially stressful time, because it is unclear if and when a suitable organ will become available. It is important for the nurse to try to relieve the suffering of these patients. Aim: The purpose of this study was to illustrate and describe patients' experiences while waiting for a liver transplant. Method: This literature study was based on a total of ten articles describing research performed using qualitative and quantitative methods. Results: Being put on the transplant waiting list gave the patients feelings of substantial relief and hope, but at the same time involved physical and mental limitations in their daily lives. Fear and anxiety due to the uncertainty of the situation was also a significant problem for the liver candidates. Information and support was regarded as important during the waiting time. Discussion: The experiences of a changed self-image and identity, anxiety, and the need for information and support were discussed and linked to Joyce Travelbee’s nursing theory and to the skills of nurses. Conclusion: To be able to develop nursing care related to cases involving liver transplants, more research is needed to highlight the things the patients experience while waiting to undergo such surgery.</p></p>

Bakgrund: Väntelistorna för de patienter som står i kö för en levertransplantation blir allt längre i alla länder runt om i världen. Väntetiden upplevs för patienterna som en psykiskt och socialt påfrestande tid eftersom det är oklart om och när ett organ som passar blir tillgängligt. Det är viktigt att sjuksköterskan antar utmaningen att möta lidandet och den lidande människan och bidra till att minska detta. Syfte: Syftet med litteraturstudien var att belysa och beskriva patienters upplevelser i väntan på en levertransplantation. Metod: Litteraturstudien bygger på totalt 10 kvalitativa och kvantitativa vetenskapliga artiklar. Resultat: Att bli uppsatt på väntelistan för en ny lever upplevdes av många patienter som en enorm lättnad och de fick en känsla av hopp samtidigt som det innebar en fysisk och psykisk begränsning i tillvaron. Rädsla och ångest på grund av ovissheten var också ett stort problem för deltagarna. Informationen och stödet ansågs vara viktigt under väntetiden. Diskussion: Upplevelsen av förändrad självbild och identitet, ångest samt behovet av information och stöd i väntan diskuterades och kopplades samman med Joyce Travelbees omvårdnadsteori samt sjuksköterskans kompetens. Slutsats: För att kunna utveckla omvårdnaden kring patienter som väntar på en levertransplantation krävs det mer forskning som belyser upplevelsen av väntan före en levertransplantation. / Background: The number of patients on waiting lists for a liver transplant is growing in all countries around the world. These patients experience the waiting as a psychologically and socially stressful time, because it is unclear if and when a suitable organ will become available. It is important for the nurse to try to relieve the suffering of these patients. Aim: The purpose of this study was to illustrate and describe patients' experiences while waiting for a liver transplant. Method: This literature study was based on a total of ten articles describing research performed using qualitative and quantitative methods. Results: Being put on the transplant waiting list gave the patients feelings of substantial relief and hope, but at the same time involved physical and mental limitations in their daily lives. Fear and anxiety due to the uncertainty of the situation was also a significant problem for the liver candidates. Information and support was regarded as important during the waiting time. Discussion: The experiences of a changed self-image and identity, anxiety, and the need for information and support were discussed and linked to Joyce Travelbee’s nursing theory and to the skills of nurses. Conclusion: To be able to develop nursing care related to cases involving liver transplants, more research is needed to highlight the things the patients experience while waiting to undergo such surgery.

This thesis sought to improve our understanding of how kidneys become injured as a consequence of organ donation, with the aim of improving the outcomes of transplantation. Every year, hundreds of patients on the waiting list die whilst awaiting a kidney transplant. With an ever-increasing demand for suitable organs, supply cannot keep up with the pressures on the transplant waiting list. As a consequence the transplant community are forced to use organs that previously would not have been considered suitable for transplant, including from older donors with additional comorbidities. This thesis aimed to develop an understanding as to how the kidney becomes injured during the donation process, identifying which key cellular homeostatic processes are disturbed as a consequence of donation. The thesis outlines the experimental development of rodent models of organ donation replicating the donation process for donation after brain death (DBD) and donation after circulatory death (DCD) donors and also the development of a kidney ischaemia reperfusion injury (IRI) model. Proteomics was subsequently used to identifying global protein alterations in the kidney as a consequence of brain death and ischemia reperfusion injury using bioinformatics tools to identify involvement of cellular pathways. The results indicated alterations in mitochondrial function and metabolic homeostasis occurring following brain death. Alterations in cellular metabolism and mitochondrial function were then confirmed using metabolomics and mitochondrial functional assays. I subsequently evaluated how alterations in cellular hypoxia and the hypoxia inducible factor system is altered in the brain dead organ donor kidney and aimed to target this system as a means of conditioning the brain dead organ donor to prevent mitochondrial and metabolic mediated injury to kidney cells following brain death. This involved exploring the role of prolyl hydroxylase inhibitors, including dimethyloxalylglycine, on mitochondrial function and whether this could be a therapeutic target in organ donation. This thesis provides important insights into the mechanism of injury of kidneys following brain death, providing evidence that even before procurement and preservation in the DBD donor alterations in mitochondrial function and metabolic homeostasis occur. I provide preliminary data on the use of prolyl hydroxylase inhibitors in altering mitochondrial function. I also outline my involvement in other ongoing projects in organ donation and machine perfusion that also aim to improve the outcomes of deceased donor kidney and liver transplantation.

Este trabalho teve como objetivos compreender a dinâmica familiar na experiência do transplante hepático pediátrico, bem como identificar as demandas e recursos da família. Utilizou-se como referencial teórico o Interacionismo Simbólico e como referencial metodológico a Teoria Fundamentada nos Dados. A análise comparativa dos dados possibilitou desvendar o significado da experiência da família com uma criança na situação de transplante hepático. Foi possível identificar dois fenômenos que compõem esta experiência: TENDO A VIDA CONTROLADA PELO TRANSPLANTE, que representa a vulnerabilidade da família ao vivenciar as incertezas e o medo constantes no decorrer da experiência de doença da criança; e LUTANDO PARA RESGATAR A AUTONOMIA, que consiste no movimento de reação da família diante do primeiro fenômeno, adaptando-se continuamente para enfrentar o estresse e sofrimento desencadeados pela situação de doença. A articulação desses fenômenos permitiu identificar a categoria central NÃO PODENDO VIVER COMO ANTES, a partir da qual propõe-se um modelo teórico explicativo da experiência / The aims of this study were to understand the family dynamics during the pediatric liver transplantation experience, and to identify the demands and resources of the family. The study used the Symbolic Interactionism as a theoretical reference and the Grouded Theory Methodology. The comparative anaylisis of the data enabled to unfold the meaning of the experience of the family with a child living the liver transplantation experience. Two phenomena were identified: HAVING LIFE UNDER TRANSPLANTATION´S CONTROL represents the vulnerability of the family living with uncertainty and fear across the child´s illness experience; and STRUGGLING TO RESCUE THEIR AUTONOMY is the reaction of the family when exposed to the first phenomenon, and consists on a continuous adaptation to face all the suffering and stress triggered by the illness situation. The relationship of these two phenomena allowed the identification of the central category named NOT BEING ABLE TO LIVE LIKE BEFORE based on which it was possible to propose a theoretical model to explain the experience

Orientador: Sandra Cecilia Botelho Costa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T05:17:03Z (GMT). No. of bitstreams: 1 Silva_AnaCarolinaGuardiada_M.pdf: 824536 bytes, checksum: dc87f957a639ab7206e1a727070c8b0e (MD5) Previous issue date: 2008 / Resumo: O Citomegalovírus (CMV) e o Herpesvírus humano 6 são vírus universais pertencentes à subfamília dos betaherpesvírus. Esses vírus permanecem latentes, podendo ser reativados por um período de imunossupressão, como acontece em pacientes submetidos a transplantes de fígado. O CMV é um importante patógeno oportunista, que influencia negativamente esses pacientes. O HHV-6 é um vírus linfotrópico, alem de infectar outras células como monócitos e células endoteliais, usando o receptor celular CD-46. A reativação do HHV-6 tem sido associada com a do CMV e rejeição do enxerto. Nos transplantados de fígado a reativação do HHV-6 tem aparecido junto com a infecção do CMV. O CMV tem sido associado como importante causa de mortalidade e morbidade nos transplantados de órgãos sólidos. Esses vírus podem causar disfunção no enxerto, supressão da medula e pré-disposição para a doença por CMV. Este estudo detectou o DNA do CMV e HHV-6 em 41 transplantados de fígado usando a Nested- PCR. Este método foi escolhido por ser mais sensível e possibilitar a genotipagem. Também analisamos a co-infecção e o impacto clínico desses vírus nos transplantados hepáticos. 145 biópsias foram analisadas (41 - biópsias de doador e 104 - biópsias pós-transplante). 23 (15.8%) das 145 foram positivas para o CMV e 53 (36.5%) positivas para o HHV-6. 19 (13%) tiveram a co-infecção na mesma amostra. 21 pacientes tiveram rejeição ao enxerto e desses 16 tiveram infecção viral. A presença desses vírus observado, nas biópsias hepáticas dos doadores e no pós- transplante, sugere que as infecções no pré-transplante são importante via de transmissão desses vírus aos receptores, causando episódios de rejeição. / Abstract: Cytomegalovirus (CMV), Human Herpesvirus-6 (HHV-6), belong to the ß-herpesvirus subfamily. These viruses can be reactivated from latency during immunosuppression. period especially after liver transplantation, CMV has been the most important opportunistc infection that negatively influences the outcome of patients. HHV-6 is a lymphotropic virus, but it may also infect other cells, such as monocytes and epithelial cells, using the CD46-molecule as a cellular receptor. HHV-6 reactivations are often seen associated with CMV infection and allograft rejection. In liver transplant patients, HHV-6 reativations are frequently found together with CMV infection. CMV has been implicated as an important causes of morbidity and mortality among solid organ transplant patients. Both have been related to graft dysfunction, bone morrow suppression, and predisposition to CMV disease. In this study, CMV and HHV-6 DNA were detected in 41 liver transplant patients, using nested polymerase chain reaction (PCR). This method was chosen because increase the sensibility and with the products we can be classified into CMV genotypes. We also evaluate the co-infection and the clinical impact between those virus in liver transplant patients. 145 biopsies were tested, (41 - liver donor biopsies and 104 - liver post- transplant), Twenty three (15,8%) of 145 liver biopsies were CMV- PCR positive and fifty three (36,5%) of 145 were positive HHV-6- PCR. Nineteen (13%) of 145 biopsies were both CMV and HHV-6 positive. 21 patients had allograft rejection and 16 had infection for this virus. With the presence of the viruses observed in the samples of the donor and post-transplant, suggests that pre-transplant HHV-6 and CMV infection may be a risk factor post-transplant. They had associated with allograft refection. / Mestrado / Mestre em Farmacologia

Antalet potentiella kandidater till en levertransplantation är högre än tillgången till donatorer. En levertransplantation övervägs när transplantationen kan bidra till ökad livskvalitet eller när sjukdomen förväntas ge en kortare livstid än den förväntade generella livslängden hos människan. Syftet var att beskriva erfarenheter hos personer som har genomgått en levertransplantation. En allmän litteraturstudie med deduktiv ansats. Tio resultatartiklar hämtade från två olika databaser som analyserats med en innehållsanalys. Resultatfynden kategoriserades utifrån en modell för överlevnad vid levertransplantation. Kategorierna var fysiskt välbefinnande, psykologiskt välbefinnande, socialt välbefinnande och spirituellt välbefinnande. Att genomgå en levertransplantation påverkade vardagen och den upplevda hälsan hos personer som mottagit en ny lever. Trots känslor av rädsla, oro och nedstämdhet så upplevde personerna ett hopp om en möjlig framtid. En utveckling av modellen för överlevnad vid levertransplantation kan möjliggöra för att den ska kunna implementeras och används som underlag i vården av personer som fått en ny lever i framtiden. Litteraturtudien kan stödja sjuksköterskan i att implementera ett personcentrerat förhållningssätt där patienten får vara delaktig i vården. / The number of potential candidates for a liver transplant is higher than the availability of donors. A liver transplant is considered when the transplant can contribute to increased quality of life or when the disease is expected to have a shorter lifespan than the expected overall life expectancy in humans. The purpose was to describe the experiences of people who have undergone a liver transplant. A general literature study with a deductive approach. Nine articles retrieved from two different databases analyzed with a content analysis. The results were categorized on the basis of a survivorship model in liver transplantation. The categories were physical well-being, psychological well-being, social well-being and spiritual well-being. Undergoing a liver transplant affected the everyday life and perceived health of people who received a new liver. Despite feelings of fear, anxiety and depression, the people experienced hope for a possible future. A development of the model for liver transplantation survivorship can enable for it to be implemented and used as a basis in the care of people who have received a new liver in the future. The literature study can support the nurse in implementing a person-centered approach where the patient can be involved in the care.

No description available.