{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:19:40Z","timestamp":1783084780945,"version":"3.54.6"},"reference-count":35,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Lung transplant recipients often live for years with residual respiratory symptoms and psychological distress, but the pathways through which these factors affect quality of life (QoL) are not fully understood. We examined how transplant-specific pulmonary symptom burden and psychological distress relate to generic and transplant-specific QoL in long-term lung transplant recipients. Methods: In this cross-sectional study, 76 adult lung transplant recipients from a single center completed the Lung Transplant Quality of Life (LT-QoL) questionnaire, EQ-5D-5L, SF-36, St George\u2019s Respiratory Questionnaire (SGRQ), and Hospital Anxiety and Depression Scale (HADS). A composite psychological distress index was derived from HADS-Anxiety, HADS-Depression, and the LT-QoL Anxiety\/Depression and Health Distress subscales. Associations were examined using Pearson correlations, hierarchical linear regression (adjusting for age, sex, and time since transplant), and statistical mediation models examining psychological distress as a potential mediator between pulmonary symptoms and QoL outcomes. Results: Pulmonary symptom burden (LT-QoL Pulmonary Symptoms) was in the low\u2013moderate range yet showed robust correlations with poorer generic, transplant-specific, and respiratory-specific QoL (|r| up to 0.82). The psychological distress index demonstrated good internal consistency (\u03b1 = 0.84) and was strongly associated with worse EQ-5D, SF-36, and LT-QoL General QoL scores. In regression models, pulmonary symptoms and psychological distress independently predicted SF-36 overall QoL (R2 = 0.55), whereas psychological distress was the stronger predictor of the EQ-5D Index Value. Statistical mediation analyses were consistent with partial mediation of the association between pulmonary symptoms and SF-36 and the EQ-5D Index Value, while effects on the EQ-VAS and LT-QoL General QoL were largely direct. Conclusions: Even modest pulmonary symptom burden and psychological distress are tightly linked to QoL years after lung transplantation. Routine follow-up should include brief assessment of both domains, and integrated care models that combine optimization of pulmonary status with targeted psychological support may be needed to preserve long-term QoL in lung transplant recipients.<\/jats:p>","DOI":"10.3390\/jcm15135212","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T11:39:11Z","timestamp":1783078751000},"page":"5212","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary Symptoms and Psychological Distress as Correlates and Mediators of Quality of Life in Lung Transplant Recipients: A Cross-Sectional Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7739-0340","authenticated-orcid":false,"given":"Aleksandra","family":"Sta\u0144ska","sequence":"first","affiliation":[{"name":"Division of Quality of Life Research, Department of Psychology, Faculty of Health Sciences, Medical University of Gda\u0144sk, 80-210 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9786-6390","authenticated-orcid":false,"given":"Wojciech","family":"Karolak","sequence":"additional","affiliation":[{"name":"Department of Cardiac & Vascular Surgery, Faculty of Medicine, Medical University of Gda\u0144sk, 80-210 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u0142awomir","family":"\u017begle\u0144","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Faculty of Medicine, Medical University of Gda\u0144sk, 80-210 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacek","family":"Wojarski","sequence":"additional","affiliation":[{"name":"Department of Cardiac & Vascular Surgery, Faculty of Medicine, Medical University of Gda\u0144sk, 80-210 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.healun.2015.07.003","article-title":"A systematic review of health-related quality of life and psychological outcomes after lung transplantation","volume":"35","author":"Seiler","year":"2016","journal-title":"J. Heart Lung Transplant."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1055\/s-0033-1348470","article-title":"Quality of life in lung transplantation","volume":"34","author":"Singer","year":"2013","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1111\/ajt.14081","article-title":"Effect of Lung Transplantation on Health-Related Quality of Life in the Era of the Lung Allocation Score: A U.S. Prospective Cohort Study","volume":"17","author":"Singer","year":"2017","journal-title":"Am. J. Transplant."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1857","DOI":"10.1016\/j.healun.2025.04.014","article-title":"The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: 2025 Annual Report of Heart and Lung Transplantation","volume":"44","author":"Singh","year":"2025","journal-title":"J. Heart Lung Transplant."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.healun.2014.06.014","article-title":"A consensus document for the selection of lung transplant candidates: 2014\u2014An update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation","volume":"34","author":"Weill","year":"2015","journal-title":"J. Heart Lung Transplant."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1097\/TP.0000000000004385","article-title":"Health-related Quality of Life Outcomes Following Single or Bilateral Lung Transplantation: A Systematic Review","volume":"107","author":"Raguragavan","year":"2023","journal-title":"Transplantation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"100182","DOI":"10.1016\/j.clinsp.2023.100182","article-title":"Health-related quality of life following lung transplantation for cystic fibrosis: A systematic review","volume":"78","author":"Raguragavan","year":"2023","journal-title":"Clinics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1186\/s40359-025-03245-3","article-title":"Psychological distress and self-psychological adjustment methods of lung transplant recipients: An overview of systematic reviews","volume":"13","author":"Guo","year":"2025","journal-title":"BMC Psychol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1164\/rccm.201806-1198OC","article-title":"Development and Preliminary Validation of the Lung Transplant Quality of Life (LT-QOL) Survey","volume":"199","author":"Singer","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1164\/ajrccm\/145.6.1321","article-title":"A self-complete measure of health status for chronic airflow limitation. The St. George\u2019s Respiratory Questionnaire","volume":"145","author":"Jones","year":"1992","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_11","first-page":"497","article-title":"Validation of the Polish version of St. George\u2019s respiratory questionnaire in patients with bronchial asthma","volume":"67","author":"Patkowski","year":"1999","journal-title":"Pneumonol. Alergol. Pol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.genhosppsych.2011.11.009","article-title":"Onset and risk factors for anxiety and depression during the first 2 years after lung transplantation","volume":"34","author":"Dew","year":"2012","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1016\/S1053-2498(02)00863-X","article-title":"Psychosocial vulnerability, physical symptoms and physical impairment after lung and heart-lung transplantation","volume":"22","author":"Dew","year":"2003","journal-title":"J. Heart Lung Transplant."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1111\/j.1399-0012.2007.00693.x","article-title":"Symptom experience after lung transplantation: Impact on quality of life and adherence","volume":"21","author":"Kugler","year":"2007","journal-title":"Clin. Transplant."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1111\/ajt.13447","article-title":"Psychosocial Predictors of Mortality Following Lung Transplantation","volume":"16","author":"Smith","year":"2016","journal-title":"Am. J. Transplant."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1111\/tri.13094","article-title":"Depression, social support, and clinical outcomes following lung transplantation: A single-center cohort study","volume":"31","author":"Smith","year":"2018","journal-title":"Transpl. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1111\/jocn.15931","article-title":"The relation between psychological distress and medication adherence in lung transplant candidates and recipients: A cross-sectional study","volume":"31","author":"Heijerman","year":"2022","journal-title":"J. Clin. Nurs."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.psym.2015.12.008","article-title":"The Effect of Pretransplant Depression and Anxiety on Survival Following Lung Transplant: A Meta-analysis","volume":"57","author":"Courtwright","year":"2016","journal-title":"Psychosomatics"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/1477-7525-1-29","article-title":"The Hospital Anxiety And Depression Scale","volume":"1","author":"Snaith","year":"2003","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.12740\/PP\/38139","article-title":"The factorial structure and validity of the Hospital Anxiety and Depression Scale (HADS) in Polish adolescents","volume":"49","author":"Mihalca","year":"2015","journal-title":"Psychiatr. Pol."},{"key":"ref_22","unstructured":"Sta\u0144ska, A., Karolak, W., S\u0142awomir, Z., Singer, J.P., and Jacek, W. (2026, April 01). Polish adaptation of the Lung Transplant Quality of Life (LT-QoL) questionnaire, Preprint, Available online: https:\/\/www.researchsquare.com\/article\/rs-8129195\/v1."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med. Care"},{"key":"ref_24","first-page":"1166","article-title":"Kwestionariusz oceny jako\u015bci \u017cycia SF-36\u2014Wersja polska [Quality of life questionnaire SF-36\u2014Polish version]","volume":"67","author":"Tylka","year":"2009","journal-title":"Kardiol. Pol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"Herdman","year":"2011","journal-title":"Qual. Life Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1016\/j.transproceed.2022.03.015","article-title":"Demographic and Psychosocial Characteristics of Lung Transplant Candidates: Single-Center Analysis","volume":"54","author":"Karolak","year":"2022","journal-title":"Transpl. Proc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1007\/s40273-019-00811-7","article-title":"Valuation of EQ-5D-5L Health States in Poland: The First EQ-VT-Based Study in Central and Eastern Europe","volume":"37","author":"Golicki","year":"2019","journal-title":"Pharmacoeconomics"},{"key":"ref_28","first-page":"484","article-title":"General population reference values for the EQ-5D-5L index in Poland: Estimations using a Polish directly measured value set","volume":"131","author":"Golicki","year":"2021","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_29","first-page":"21","article-title":"Quality of life in patients with postoperative unilateral diaphragm relaxation","volume":"5","author":"Topolnitskiy","year":"2024","journal-title":"Khirurgiia"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1097\/01.tp.0000258599.65257.a6","article-title":"Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation","volume":"83","author":"Dew","year":"2007","journal-title":"Transplantation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1096.e1","DOI":"10.1016\/j.jamda.2017.09.007","article-title":"Management of Dyspnea and Anxiety in Chronic Obstructive Pulmonary Disease: A Critical Review","volume":"18","author":"Yohannes","year":"2017","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.psym.2011.12.012","article-title":"The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): A new tool for the psychosocial evaluation of pre-transplant candidates","volume":"53","author":"Maldonado","year":"2012","journal-title":"Psychosomatics"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1007\/s40472-023-00395-4","article-title":"Prehabilitation in Adult Solid Organ Transplant Candidates","volume":"10","author":"Quint","year":"2023","journal-title":"Curr. Transplant. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"11564","DOI":"10.3389\/ti.2023.11564","article-title":"European Society of Organ Transplantation (ESOT) Consensus Statement on Prehabilitation for Solid Organ Transplantation Candidates","volume":"36","author":"Annema","year":"2023","journal-title":"Transpl. Int."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Topolnitskiy, E.B., Gusakov, V.V., and Volinsky, A.A. (2026). Computed tomography assessment of diaphragm thickness in myasthenia gravis with clinical and functional correlations. 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