Construção e validação do diagnóstico de enfermagem risco de resposta disfuncional do enxerto hepático

Abstract

This study aimed to construct and clinically validate the nursing diagnosis "Risk of Dysfunctional Graft Response in Liver Transplantation (RDGRLT)" by defining and listing the elements that constitute the risk of dysfunction and/or failure of the transplanted liver graft, according to the standardized language of the Nursing Diagnoses International (NANDA-I). The study was conducted in two stages. The first stage involved a systematic review of purported etiological factors of Dysfunctional Graft Response in Liver Transplantation (DGRLT) reported in adult liver transplant patients and the construction of the concept of RDGRLT. The second stage consisted of the clinical validation of the potential etiological factors identified in the first stage. For the first stage, the review followed the Joanna Briggs Institute (JBI) reviewer's manual, with the research question: What etiological factors are associated with dysfunctional graft response in adult liver transplant patients? Electronic article searches were conducted in the Scopus, Web of Science, PubMed, Cinahl, Lilacs, and Cochrane databases. Initially, the descriptors "primary graft dysfunction" and "liver transplantation" were used with the Boolean operator AND. All analyses were conducted using the R software (R-project.org), and odds ratio estimates and their confidence intervals were calculated for each study included in the risk factor analysis. After this process, factors associated with RDGRLT were identified. The identification of respective risk factors for dysfunctional graft response was carried out through a case-control study characterized as individualized, observational, and retrospective. Data collection was performed through secondary data obtained from the medical records of hospitalized patients in two public hospitals serving as transplant centers in the city of Fortaleza, Brazil. An instrument was used based on the etiological factors identified in the first stage of the study, for which operational definitions were constructed. Additionally, sociodemographic and clinical variables of the donor and five relevant variables of the recipient were included. In conclusion, the results of this research highlighted etiological factors and indicators associated with the Risk of Dysfunctional Graft Response in Liver Transplantation that provide valuable contributions to the practice of nursing diagnosis in this complex clinical context. Validated risk factors, such as recipient age, number of transfusions, body mass index (BMI), and the presence of renal dysfunction, offer a solid foundation for the assessment and monitoring of patients undergoing liver transplantation.