Progress in Transplantation最新文献

IntroductionThe utility of routine monitoring of apixaban anti-Xa levels in lung transplant recipients remains uncertain due to insufficient data. This population presents unique characteristics including altered renal function and medication interactions that may affect serum apixaban concentrations. Project Aims: This study evaluated the correlation between apixaban anti-Xa levels and specific covariates in lung transplant recipients to identify influential variables.DesignData from adult inpatient lung transplant recipients who had received apixaban between August 8, 2021, and December 12, 2023, at a single transplant center was analyzed. Multiple linear regression analysis was conducted, adjusting for gender, age, serum creatinine, weight, azole antifungal use, package insert deviation, dose, and level timing. Safety was assessed based on thrombotic events and major bleeding incidents during hospital admission.ResultsSeventy-eight unique apixaban anti-Xa levels were analyzed. Higher age, serum creatinine, and apixaban dose, as well as closer level timing to administration and female gender correlated with elevated anti-Xa levels. Thrombotic events occurred in 27% of cases, with one major bleeding incident.ConclusionApixaban anti-Xa levels correlated with age, serum creatinine, dose, and timing of administration in lung transplant patients. This questions the utility and necessity of obtaining apixaban anti-Xa levels despite the unique patient cohort. Larger trials are needed to assess the absolute correlation of anti-Xa levels with bleeding and thromboembolic outcomes in this population.

Introduction: Organ shortage is a global issue. A disaster like an earthquake not only increases the number of people in need of organs but also negatively affects the treatment processes of patients who have already undergone transplants.

Aim: The aim of this study is to examine the impact of the earthquake that occurred on February 6, 2023, in Türkiye on organ donation and transplantation.

Methods: The study was conducted using open-access statistical data of 2022-2023 years available on the official website of the Tissue, Organ Transplantation, and Dialysis Services of the Ministry of Health in Türkiye.

Results: It was found that the earthquake did not affect the number of organ transplants, organ donations, brain death diagnoses, and family consent in Türkiye, but in the provinces affected by the earthquake, it decreased the number of organ donations, brain death diagnoses, and living donors and increased the number of family consent.

Conclusion: Healthcare professionals in disaster-affected regions should receive specialized training to maintain critical organ donation protocols, supported by decentralized coordination systems that ensure the continuity of these processes even when central networks are disrupted.

Introduction: Durable left ventricular assist devices serve as a critical bridge to heart transplantation for patients with advanced heart failure. Yet the demands placed on care partners (CPs) are often underestimated, and their well-being in supporting postimplant recovery is frequently overlooked. Methods/Approach: This qualitative single-site study explored the struggles and support needs of 13 CPs who participated in audio-recorded interviews following device placement. Findings: Data analysis, using inductive content analysis, revealed 6 major themes: feeling unprepared, being hypervigilant, feeling overwhelmed, the vanishing CP, lacking self-care, and needing connection with other CPs. Findings revealed that CPs often felt overlooked by healthcare teams, contributing to emotional distress and isolation, while inadequate education on perioperative complications and minimal peer support reinforced their sense of being unprepared. Conclusion: These results underscored the integral role that CP well-being played in sustaining successful device management and ensuring patients remained eligible for heart transplantation. Psychosocial services, peer support, and structured educational programs may help mitigate the strain experienced by CPs and improve transplantation outcomes. Embedding CP needs into the transplant pathway, beginning at implantation, was essential to preventing burnout, maintaining candidacy, and improving overall posttransplant success. Refinements in CP-centered interventions may help reduce hospital readmissions, enhance device adherence, and support emotional resilience. By prioritizing CP support within advanced heart failure management, transplant programs can optimize both patient and CP well-being and foster positive outcomes. Such focus ensures bridging to transplantation and hope for families.

Introduction: Dialysis social workers are integral in the transplant evaluation process; however, research on dialysis social workers' perspectives on access to kidney transplantation is limited. Methods: A mixed methods study examining dialysis social workers' perspectives on transplant barriers and facilitators. Dialysis social workers completed online surveys and participated in virtual, semi-structured interviews. Qualitative data were recorded, transcribed, and analyzed using thematic analysis. Quantitative data were analyzed descriptively. Results: Twenty-seven dialysis social workers completed surveys, and 15 participated in qualitative interviews. Participants were predominantly female (93%) and White (89%). While the majority (67%) had practiced as a social worker for 6+ years, most had ≤5 years of dialysis experience (52%). The majority described the transplant referral process as somewhat easy (67%) and rated their relationship with transplant programs as either fair or good (78%). Both survey and interview data identified similar patient-level barriers, such as lack of social support and obesity. Interviews further elucidated organizational and system level barriers including tensions between dialysis and transplant centers, transplant center accessibility, and systemic discrimination. Identified facilitators included patient motivation, transplant center communication, and transplant resources. Conclusion: Dialysis social workers provided a unique perspective on barriers and facilitators to kidney transplantation. While barriers to transplant were often considered at the patient level, organizational and system level factors were crucial to understanding transplant access. These findings could inform future efforts between dialysis and transplant centers to improve access to kidney transplantation.

IntroductionEntertainment portrayals of organ donation continue to inform viewers' beliefs. Research showed many of the belief's individuals have about organ donation rose from exposure to popular entertainment programs such as Grey's Anatomy. Grey's Anatomy routinely portrays medical doctors in a realistic way as altruistic and heroic medical care providers.Research QuestionThe central question asked was whether favorable portrayals resulted in audience's perceiving real world doctors as altruistic and in turn, favorable organ donation registration attitudes.DesignThe current study employed a cross-sectional survey to adults.ResultsThe current study found a positive association between show exposure and show realism among adults (N = 211). Moreover, show realism was positively associated with a belief in doctor altruism. In turn, altruism was positively associated with favorable perceptions toward registering as an organ donor.ConclusionThe results showed that realism influenced beliefs about medical provider altruism, which in turn can affect attitudes toward organ donation. The next step in this research is to employ rigorous experimental designs to identify the specific contexts and narratives in which these medical portrayals have the greatest impact.

Introduction: Anxiety symptoms influence health outcomes in pediatric organ transplant recipients. Assessing the quality of anxiety scales is critical to address the psychological challenges these patients face. Variability in how anxiety is conceptualized across scales highlights the need for selecting appropriate instruments.

Objective: This systematic review aimed to search and synthesize anxiety scales used in pediatric organ transplant studies, evaluate their reliability and validity, examine factors and group differences related to anxiety, and identify promising scales for this population.

Methods: A systematic search was conducted using the terms "(Anxiety) AND (organ transplant) AND (child* OR youth OR pediatric* OR adolescen*)." Ten electronic databases were accessed.

Results: Eighteen anxiety scales from 30 articles were identified. Fourteen scales measured specific anxiety types. Most scales demonstrated good to excellent reliability and validity. Associations between anxiety and demographics, psychological well-being, factors related to illness and treatment were observed. Five types of anxiety-related differences among groups and 6 promising anxiety scales for the target population were identified.

Discussion: General and specialized anxiety scales were identified. Incomplete reporting of psychometric evidence restricted the quality assessment. Limitations include cultural and publication biases. Future research should focus on transplant-specific scales with psychometric validation across culturally diverse settings to ensure their quality and applicability.

Conclusion: This review identified well-validated scales, such as State-Trait Anxiety Inventory for Children and Generalized Anxiety Disorder-7, effective for quick screening. Specialized instruments were used for nuanced anxiety concepts such as needle-related anxiety, illness-specific anxiety, and anxiety during the transition to adult care, but further psychometric validation is needed.

Introduction: There is a need for a noninvasive, affordable, sensitive, and specific biomarker to diagnose early acute rejection, to negate the need for frequent biopsies. Dd-cfDNA is a powerful adjunct yet there is limited data on the ethnic differences in its values. There is anecdotal evidence that dd-cfDNA values at rejection may be higher in Black as compared to non-Black recipients. This study aims to add to this literature while defining such variability and comparing it to previously validated cutoffs for dd-cfDNA of 0.5% or 1%.

Design: This was a single-center retrospective observational study of patients who underwent graft biopsies with a preceding, paired, dd-cfDNA value. Recipients were separated into White, Black, and Hispanic racial and ethnic groups, and dd-cfDNA values at rejection versus nonrejection were compared.

Results: With 0.5% and 1% cutoffs, false negative rates for rejection were 13% and 22%, respectively. The false positive rate was 38.4%. 12.2% of Black recipients, 11.8% of Hispanic recipients, and 44% of White recipients had rejection with a negative AlloSure^®. Values >0.5% corresponded to histologic rejection in 61.5% of Black, 66.7% of White, and 56.3% of Hispanic recipients. Antibody-mediated rejection occurred in 65.5% of rejection cases in Black recipients, while exhibiting the lowest rate of T-cell-mediated rejection. Dd-cfDNA values gave an accurate diagnosis of rejection in 52.8% of recipients with AMR versus 19.3% in TCMR.

Conclusion: This study demonstrated that dd-cfDNA was applicable to Black recipients with a robust ability to detect antibody-mediated rejection, as compared to White and Hispanic recipients.

Introduction: Eliminating racial inequities in access to kidney transplantation requires multilevel interventions that target both patients and health systems.

Research question: The aim of this study was to determine whether adding culturally sensitive, web-based patient education to a transplant center-level intervention was associated with increased knowledge, motivation to pursue living donor kidney transplant, and confidence in the behavioral skills to discuss living donation among Black/African American patients with end-stage kidney disease.

Design: A total of 411 transplant candidates were randomized to intervention (N = 222) or control groups (N = 189) and completed measures at baseline and immediate follow-up during the transplant evaluation visit.

Results: Results indicated no significant change in knowledge across time or study condition. At immediate follow-up, participants of both study conditions exhibited a significantly higher motivation to pursue living donation (t = 3.066, P < .01) versus at baseline. Both study conditions demonstrated increased confidence in the behavioral skills to discuss living donation over time (t = 3.580, P < .001). Process evaluation findings demonstrated limited engagement with the online video content across both conditions.

Conclusion: Results suggest that the intervention did not perform better than control but raised important considerations for the delivery of transplant education targeting Black/African American patients in a busy clinical setting.