Heart transplant patients' understanding of the graft rejection process

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Abstract Introduction Since heart transplantation became the definitive alternative for the treatment of heart failure, the heart has become the 3rd most transplanted organ in Brazil. Heart graft rejection is one of the most prevalent complications and is directly related to organ survival. All the factors that hinder graft survival over the years do not seem to go unnoticed by transplant patients, since they, when interviewed in studies, reported feeling a significant amount of anxiety and lack of control related to the risk of rejection. However, there are no studies in the literature that seek to understand what, exactly, patients understand by ‘rejection’. Objective To explore the understanding of heart transplant patients about the process of graft rejection, in addition to investigating the sources from which these individuals seek information. Methodology: Qualitative research of an applied and exploratory nature. Meleis' Transition Theory was adopted as a theoretical framework. The participants in this study were heart transplant patients who had already presented graft rejection and were undergoing outpatient follow-up at a university hospital. Data were collected through semi-structured interviews with guiding questions and audio recording. Afterwards, the full transcription was performed and content analysis was used to categorize the statements according to the research objectives. The data saturation criterion was used to interrupt the collection stage. The project was approved by the Research Ethics Committee. Results Nine participants were interviewed, predominantly with complete high school education, retired, and self-declared black race (black and brown). The participants recognized rejection as a reaction of the immune system to the new heart; They highlighted in their speech the importance of endomyocardial biopsy (EMB) for early detection and their surprise at not presenting any signs or symptoms when the EMB result indicated rejection; Doctors and nurses were the professional classes mentioned who talked to the patients about the topic. Conclusions Heart transplant patients know how to define the heart rejection process, although they have difficulty recognizing its asymptomatic aspect. They seek information about rejection from health professionals with whom they have a relationship, and the nurse-patient relationship is a fundamental aspect of longitudinal monitoring.

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