Progress in Transplantation

To examine the association of psychological and cognitive indicators with treatment nonadherence following heart transplantation.

A cross-sectional exploratory study was conducted in a single heart transplant center. The study included 74 heart transplant patients (42 men, 56.8%), with a mean age of 54.1 (SD±12.7), assessed at least 6 months after transplantation. The instruments used were GAD-7 (anxiety symptoms), PHQ-9 (depression symptoms), MoCA-B (cognitive screening), the Inventory of perceived barriers related to self-care after heart transplantation, and BAASIS (adherence to the immunosuppressant meds).

Based on the past 4 weeks' recall, nonadherence behavior was observed in 59.5% (n=44) of the participants. Difficulties of adherence to immunosuppressant therapy occurred during the adherence process in the initiation phase (8.1%, n = 6), implementation phase (52.7%, n = 39), and persistence phase (2.7%, n = 2) of the BAASIS model. Nineteen patients (25.7%) missed doses of immunosuppressant medication, and 44.6% (33 patients) altered their medication schedule in the past month. Anxiety symptoms (GAD-7) and patient-level perceived barriers were associated with nonadherence (BAASIS). Mild cognitive impairment was found in 10.8% (n = 8) but did not associate with nonadherence. Among participants, 64.9% (n=48) experienced complications after their transplant.

Anxiety, perceived barriers to treatment and self-care, may all contribute to nonadherence. These findings underscore the importance of screening for psychological and cognitive indicators in the post-cardiac transplant period. Healthcare professionals must proactively evaluate and support the psychological concerns of patients after heart transplantation, as they play a potential role in nonadherence behavior.

Posttransplant diabetes mellitus (PTDM) can increase morbidity and mortality in liver transplant recipients. Although hepatitis C seropositivity is a known risk factor for PTDM, the impact of viremia versus no viremia at time of transplant is unknown.

This program evaluation sought to compare PTDM in hepatitis C seropositive patients with and without viremia at the time of liver transplant.

This single-center retrospective review included adult hepatitis C seropositive liver transplant recipients transplanted between January 1, 2010 to September 5, 2017 without pretransplant diabetes. Primary outcome was PTDM within 1 year. Secondary outcomes included evaluating 1-year posttransplant death-censored graft loss, mortality, and metabolic outcomes.

Fifty-seven liver transplant recipients with hepatitis C were included, of which 53% (n = 30) were viremic at transplant. Baseline characteristics were similar between groups. Significantly more patients with pretransplant viremia developed PTDM by 1-year posttransplant compared to the patients without viremia (43% vs 11%, P = 0.01). There were no differences between groups outside of more patients with viremia requiring antihypertensives by 1-year posttransplant compared to patients without viremia (57% vs 22%, P = 0.01).

Liver transplant patients with hepatitis C viremia at transplant were more likely to develop PTDM at 1 year compared to those without pretransplant viremia. This is an added consideration when deciding the timing of direct-acting antiviral (DAA) utilization in the context of liver transplant for hepatitis C seropositive patients.

Kidney transplant education in dialysis facilities could be optimized with internet resources, like videos, but most qualitative research predates widespread availability of online video education about kidney transplantation. To improve understanding of dialysis staff transplant education practices, as well as the potential value of video, we conducted focus groups of dialysis center staff members in Buffalo, NY.

Seventeen focus groups (97 participants: 53 nurses, 10 dialysis technicians, 6 social workers, 6 dieticians, 7 administrative personnel, 2 trainees, and 1 insurance coordinator) from 8 dialysis facilities in Buffalo, NY, were conducted, audio-recorded, transcribed, and analyzed. After thematic data analysis, a diverse patient and caregiver community advisory board was invited to comment, and their voices were integrated. Findings: Five key themes were identified that captured barriers to transplant education delivery and how online video could be a facilitator: (1) delivery of transplant education was reliant on one person, (2) other dialysis staff had time to answer transplant questions but felt uninformed, (3) patient lack of interest in existing supplementary transplant education, (4) patient disinterest in transplantation education was due to education timing, feeling overwhelmed, and transplant fear/ambivalence, and (5) video education could be flexible, low effort, and spark transplant interest. Study limitations are potential selection bias and inclusion of English-speaking participants only.

Dialysis staff barriers of time, insufficient knowledge, and limited resources to provide education to patients and their care partners may be mitigated with online educational videos without increasing staff workload.