Report from the American Society of Transplantation Psychosocial Community of Practice Adherence Task Force: Real‐world options for promoting adherence in adult recipients

Starting in 2015, the American Society of Transplantation Psychosocial Community of Practice, with representatives of the Transplant Pharmacy Community of Practice, convened a taskforce to develop a white paper that focused on clinically practical, evidenced‐based interventions that transplant centers could implement to increase adherence to medication and behavioral recommendations in adult solid organ transplant recipients. The group focused on what centers could do in their daily routines to implement best practices to increase adherence in adult transplant recipients. We developed a list of strategies using available resources, clinically feasible methods of screening and tracking adherence, and activities that ultimately empower patients to improve their own self‐management. We limited the target population to adults because they predominate the research, and because adherence issues differ in pediatric patients, given the necessary involvement of parents/guardians. We also examined broader multilevel areas for intervention including provider and transplant program practices. Ultimately, the task force aims to foster greater recognition, discussion, and solutions required for implementing practical interventions targeted at improving adherence.     

Liver Transplantation for Alcoholic Liver Disease: Survival of Patients Transplanted with Alcoholic Hepatitis Plus Cirrhosis as Compared with Those with Cirrhosis Alone

From January 1986 through December 1991, a total of 221 patients with alcoholic liver disease received liver transplantation. In 147 of these cases, complete pretransplant histopathologic, demographic, and laboratory data (minimum of CBC, AST, ALT, total bilirubin, albumin, and prothrombin time) were available for review. Forty-five (30%) of the 147 recipients had alcoholic hepatitis plus cirrhosis (AH), whereas 70% had cirrhosis (CIRR) alone. Age and sex were similar in the subgroups, but the patients with CIRR had a greater AST/ALT ratio, longer protime, and lower platelet count (all p < 0.01). Coexistent hepatitis B (4.7%) or hepatitis C (4.1%) was similar in both groups. Current survival is 80% for patients with AH and 84% for those with CIRR (NS). Overall, survivors were younger (43.4 ±1.7 years) than nonsurvivors (53.6 ± 3.2) (p < 0.01), an age influence that was significant in the CIRR group (p <; 0.01) but not in the AH group. Inexplicably, the AST/ALT ratio was greater in AH survivors (1.5 ± 0.2) than it was in nonsurvivors (0.4 ± 0.1) (p < 0.01). In patients with CIRR, the platelet count was greater in survivors (252 ± 29 vs. 86 + 11 ± 10⁹ cells/liter).
The data support the clinical impression that patients with chronic decompensated cirrhosis referred for liver transplantation had more severe complications of their liver disease than did those with AH. Survival in both subgroups was similar, but overall the survivors are nearly a decade younger than the nonsurvivors. Because the diagnosis of AH implies a briefer period of alcohol abstention, it was interesting to note that liver transplantation could be accomplished as successfully with AH as with CIRR.     

Social consequences in adult life of end-stage renal disease in childhood

OBJECTIVE: To describe employment achievement and social independence of adults with childhood end-stage renal disease (ESRD) and to explore determining factors. STUDY DESIGN: Employment, occupational level, living arrangements, social engagements, and subjective health perception were cross-sectionally established between 1998 and 2000 in 144 of all living 187 adult Dutch patients with ESRD with an onset at age 0 to 15 years between 1972 and 1992. Potential clinical determinants were established by means of a review of all medical charts. RESULTS: Compared with age-matched Dutch citizens, patients were more often involuntarily unemployed (19.4% vs 11.1%), had a lower occupational level, more often still lived with their parents, and more often had no partner. A low occupational level was associated with a dialysis duration >8 years (OR, 9.6; 95% CI, 1.9-47.6); living at the parental home was associated with the male sex (OR, 3.4; 95% CI, 1.5-7.8) and with a dialysis duration >8 years (OR, 3.7; 95% CI, 1.3-10.2). CONCLUSION: Prolonged dialysis during childhood may decrease the ability to gain high-skilled professions and social independence. Unemployment is twice as high in adult patients with childhood ESRD than in healthy persons, but more than twice as low as compared with young ESRD patients with an adult onset of the disease, according to previous reports.     

Inflammatory Response to Pulmonary Ischemia–Reperfusion Injury

Lung ischemia–reperfusion (IR) injury is one of the most important complications following lung transplant and cardiopulmonary bypass. The pulmonary dysfunction following lung IR has been well documented. Recent studies have shown that ischemia and reperfusion of the lung may each play significant yet differing roles in inducing lung injury. The mechanisms of injury involving neutrophil activation, and the release of numerous inflammatory mediators and oxygen radicals also contributes to lung cellular injury, pneumocyte necrosis, and apoptosis. We herein review the current understanding of the underlying mechanism involved in lung IR injury. The biomolecular mechanisms and interactions which lead to the inflammatory response, pneumocyte necrosis, and apoptosis following lung IR therefore warrant further investigation.     

A nationwide analysis of re-exploration after liver transplant

Background

A retrospective review to investigate rate and outcomes of re-exploration following liver transplantation in the United States.

Risk factors for early readmission after total pancreatectomy and islet auto transplantation

Background

Little published data exist examining causes of hospital readmission following total pancreatectomy with islet autotransplantation (TPIAT).

Trajectories of self‐care agency and associated factors in lung transplant recipients over the first 12 months following transplantation

Self‐care agency (SCA), defined as one's ability and willingness to engage in self‐care behaviors, can influence actual performance of self‐care behaviors in lung transplant recipients (LTRs). Understanding patterns of SCA over time may inform the design of interventions to promote self‐care in LTRs. Using group‐based trajectory modeling, we sought to identify patterns and correlates of SCA among 94 LTRs over the first 12 months post‐transplant. Baseline measures of sociodemographic, clinical, and psychosocial factors, and longitudinally assessed psychological distress were examined for their associations with predicted trajectory group membership. Three distinct stable (ie, zero slope) SCA trajectories were identified as follows: persistently low, persistently moderate, and persistently high. Based on the final multivariate model, requiring a re‐intubation after transplant (P=.043), discharged to a facility rather than home (P=.048), and reporting a higher level of baseline anxiety (P=.001) were significantly associated with lower SCA. Linear mixed models revealed that higher levels of anxiety and depression were associated with lower SCA in the persistently moderate and low SCA groups over the 12‐month time period (Ps<.05). LTRs who require a re‐intubation after transplant and are discharged to a facility other than home, and report high psychological distress, may need additional assistance to engage in post‐transplant self‐care behaviors.     

Cardiovascular mortality among liver transplant recipients with nonalcoholic steatohepatitis in the United States—a retrospective study

Nonalcoholic steatohepatitis (NASH) has become an increasingly important indication for liver transplantation (LT), and there has been a particular concern of excessive cardiovascular‐related mortality in this group. Using the United Network for Organ Sharing‐Standard Transplant Analysis and Research (UNOS STAR) dataset, we reviewed data on 56,995 adult transplants (January 2002 through June 2013). A total of 3,170 NASH liver‐only recipients were identified and were matched with 3,012 non‐NASH HCV+ and 3,159 non‐NASH HCV? controls [matched 1:1 based on gender, age at LT (±3 years), and MELD score (±3)]. Cox regression analysis revealed significantly lower hazard of all‐cause (HR 0.669; P < 0.0001) and cardiovascular‐related mortality (HR 0.648; P < 0.0001) in the NASH compared to the non‐NASH group after adjusting for diabetes, BMI, and race. Relative to the non‐NASH HCV‐positive group, NASH group has lower hazard of all‐cause (HR 0.539; P < 0.0001) and cardiovascular‐related mortality (HR 0.491; P < 0001). A lower hazard of all‐cause mortality (HR 0.844; P = 0.0094) was also observed in NASH patients compared to non‐NASH HCV‐negative group, but cardiovascular mortality was similar (HR 0.892; P = 0.3276). LT recipients with NASH have either lower or similar risk of all‐cause and cardiovascular‐related mortality compared to its non‐NASH counterparts after adjusting for diabetes, BMI, and race.     

Outcome of Liver Transplantation in Hepatocellular Carcinoma Patients at Siriraj Hospital

Background

Liver transplantation (LT) is one of the standard treatments for hepatocellular carcinoma (HCC), and the outcomes have become better after introduction of strict patient selection, such as the Milan criteria. However, several expanded criteria, such as the University of California San Francisco (UCSF) criteria, have demonstrated similar survival outcomes. The aim of this study was to verify survival outcomes of LT for HCC at Siriraj Hospital.

Coexistent End-stage Nonalcoholic Steatohepatitis and Colon Cancer: Should We Do Liver Transplantation?

Background

Colon cancer accompanying decompensated liver cirrhosis is a rare clinical condition. Usually, treatment of colon cancer is prioritized, with cirrhosis dealt with later.