IntroductionTacrolimus exposure varies early after kidney transplantation, and perioperative factors may complicate therapeutic drug monitoring. Fentanyl is commonly used perioperatively, but its association with dose-normalized tacrolimus exposure is unclear. Project Aims or Questions: This study evaluated whether early perioperative fentanyl exposure was associated with dose-normalized tacrolimus exposure during the first week after kidney transplantation.DesignThis single-center retrospective program evaluation included 43 adult living-donor kidney transplant recipients who received perioperative fentanyl and had evaluable tacrolimus trough concentrations and corresponding oral daily doses. Cumulative fentanyl dose was the conventional exposure measure; body surface area-normalized and patient-controlled analgesia-administered volume measures were exploratory. The outcome was the log-transformed tacrolimus trough concentration divided by the daily tacrolimus dose. Repeated measurements were analyzed using linear mixed models adjusted for clinical covariates.ResultsThe conventional cumulative fentanyl dose through postoperative day 1 was associated with 22.7% higher dose-normalized tacrolimus exposure per 1 standard deviation increase, 95% confidence interval 4.4% to 44.1%, P = .013. In exploratory analyses, body surface area-normalized cumulative exposure through postoperative day 1 had the strongest association, a 24.9% increase, 95% confidence interval 7.3% to 45.4%, P = .004. Exposure through postoperative day 2 showed weaker, nonsignificant associations.ConclusionEarly perioperative fentanyl exposure, particularly cumulative exposure through postoperative day 1, was associated with higher dose-normalized tacrolimus exposure during the first postoperative week after kidney transplantation. These findings support contextual interpretation of early tacrolimus monitoring while recognizing confounding by clinical status and the exploratory nature of body surface area-normalized findings.

IntroductionOrgan donation and transplantation remain underutilized in Trinidad and Tobago despite the rising burden of chronic kidney and end-stage renal disease. Limited public understanding, low awareness of existing legislation, and persistent sociocultural and religious concerns contribute to low donation rates. This study examines knowledge, attitudes, and perceived barriers toward organ donation within the country's sociocultural and legislative context.Research QuestionsWhat demographic, psychosocial, and systemic factors influence willingness to donate organs, and how do knowledge, attitudes, cultural beliefs, and family discussions shape support for organ donation?DesignA national cross-sectional household survey was conducted using stratified cluster sampling across 1047 households. A modified version of the 2012 U.S. National Survey of Organ Donation assessed public awareness, willingness to donate, and influencing factors. Analyses included 1-way analysis of variance and Pearson correlation to evaluate relationships between demographic variables, knowledge, and willingness to donate.ResultsAmong 1047 respondents, 80.4% reported no knowledge of the Human Tissue Transplant Act. Higher education was positively associated with willingness to donate (P < .05). Misconceptions, fear, and religious concerns were major barriers. Family discussion strongly predicted willingness, explaining 31.7% of the variance. Although 70% opposed financial incentives, those who supported incentives showed higher willingness to donate (P < .05).ConclusionOrgan donation readiness in Trinidad and Tobago remains limited due to low legal awareness and sociocultural barriers. Promoting informed family discussions and implementing culturally responsive education campaigns may enhance willingness to donate and strengthen the national transplantation framework.

IntroductionSolid organ transplant nursing is a critical specialty that influences patient outcomes throughout the transplantation process. However, the global development, collaboration patterns, and thematic evolution of research in this field have not been systematically mapped.AimThis study examined global research trends, collaboration networks, and thematic evolution in solid organ transplant nursing research published between January 1995 and January 2026. A bibliometric analysis was conducted using the Web of Science Core Collection. A total of 1432 eligible publications were analyzed using the bibliometrix package in R. Publication output, citation performance, authorship, country contributions, keyword co-occurrence, and thematic evolution were evaluated. Publications from January 2026 were included but treated as partial-year data in trend analyses.ResultsAnnual publication output showed sustained growth from 1995 to 2025. The dataset comprised 567 sources and 7147 authors, with an average of 5.94 authors per document and an international collaboration rate of 13.48%. The United States contributed the largest share of publications (30.59%), followed by China, Brazil, Canada, and the United Kingdom. Keyword analysis identified 89 frequently occurring terms, with dominant themes including nursing, kidney transplantation, outcomes, and quality of life, reflecting increasing attention to patient-centered care, long-term outcomes, and survivorship.ConclusionsSolid organ transplant nursing research has grown substantially over the past 3 decades, with increasing emphasis on patient-centered outcomes and chronic care. These findings provide a comprehensive overview of the field and highlight opportunities to strengthen international collaboration and advance evidence-based, technology-supported nursing interventions.

IntroductionAdvancements in transplant care have led to an increasing number of women with solid organ transplantation (SOT) living through peri- and postmenopause. Menopause can significantly impact quality of life, and the added burden of SOT may exacerbate symptoms. Few studies have evaluated the menopausal experience in this population, and existing data rarely use validated questionnaires.Research QuestionThis study aimed to characterize menopausal symptoms and menopausal hormone therapy (MHT) use in peri- and postmenopausal SOT recipients using validated measures.DesignA cross-sectional survey study of female patients ≥18 years who underwent SOT between 2018 and 2023 was conducted at a tertiary transplant center. A reproductive and sexual health questionnaire incorporating validated instruments, including the Menopause Rating Scale (MRS), was administered.ResultsAmong peri- and postmenopausal SOT recipients (n = 192), 8.9% reported use of MHT. The median MRS total score was 8.0, consistent with mild-to-moderate symptom severity overall. Symptom severity differed by menopausal status for vasomotor symptoms (P =.03), sleep disturbances (P = .04), depressive mood (P = .04), and anxiety (P <.001), with perimenopausal participants generally reporting more symptoms in these domains than postmenopausal participants. Despite these differences, overall symptom severity remained mild to moderate in both groups.ConclusionMenopausal symptoms among female SOT recipients are common but generally mild to moderate, with low utilization of MHT. The lack of increased vasomotor burden compared to prior literature may reflect under-recognition or misattribution of symptoms to transplant-related factors. Incorporating menopause-specific screening into transplant care may improve symptom recognition, quality of life, and long-term health outcomes.

IntroductionTransplant candidates are assessed for caregiver support adequacy by transplant social workers as required by U.S. federal regulations. Research to date does not account nor adjust for interventions performed by transplant social workers to mitigate social support risk concerns on outcomes.Research QuestionThe objective of this study was to describe the social support assessment and interventions conducted by transplant social workers during the pretransplant evaluation process.MethodsA cross-sectional survey of transplant social workers was conducted through the Society for Transplant Social Workers. The survey inquired about social support assessment domains, requirements, and interventions to mitigate risk concerns.ResultsA total of 141 transplant social workers participated. Majority were White (n = 124, 87.9%), female (n = 128, 90.8%) and held licensure at the highest level (n = 118, 83.7%). All organ groups and U.S. Organ Procurement Transplant Network regions were represented. The majority (n = 100, 70.9%) reported using a standard assessment tool. All reported multiple assessment domains within their social support assessment though with variability in overlapping domains. All participants reported conducting interventions to mobilize social support with notable overlap in interventions.ConclusionTransplant social workers perform social support assessment and interventions to mitigate social support concerns. Research to date does not adequately capture nor adjust for interventions by transplant social workers to mitigate risk and facilitate transplant preparedness among potential transplant candidates. Future research should explore the effectiveness of transplant social work interventions to form guidelines for transplant social work practice.

IntroductionOur institution implemented the Kidney Adherence Call Evaluations (KACE) program as a prospective medication nonadherence screening and education method in select deceased donor kidney transplant candidates, referred by transplant providers. Assessments were completed by first post-graduate year pharmacy residents with preceptor oversight. We aimed to 1) estimate resident time commitments to KACE, 2) evaluate changes in medication adherence tool usage from initial to last KACE encounters, and 3) assess transplant listing status at 6 months after KACE completion.DesignA retrospective longitudinal cohort, single-center program assessment was conducted of KACE encounters performed by residents between July 1, 2020 and June 25, 2024. Candidates were categorized as using adherence tools if they reported 1 or more of the following: (a) pill box use, (b) method to keep track of refills and/or auto-refill use, (c) contacting providers before making any medication changes, (d) possession of an active medication list, (e) use of medication reminders for doses, or (f) carrying medications on their person when away from home.ResultsResidents completed 744 KACE encounters for 193 candidates over 459 h. Overall, 49.2% of candidates had at least 1 tool improvement in their medication adherence tool usage. Six months after KACE completion, 50.8% of candidates were not transplant-listed and 27.5% were inactive.ConclusionWith a large and dedicated commitment from pharmacy residents, the KACE program led to increased medication adherence tool use in almost half the candidates. After KACE completion, many candidates still had additional evaluations to complete before transplant listing.

IntroductionOrgan donation (OD) is a life-saving intervention, but its success depends on public willingness to donate.AimThis study aimed to assess the knowledge, attitudes, and composite willingness of the Lebanese general public toward OD, and to explore conditions influencing donation decisions.DesignA cross-sectional study was conducted in Lebanon (December 2024-June 2025) using an online questionnaire distributed via snowball sampling. Knowledge, attitudes, and willingness toward OD were assessed using three carefully constructed and validated scales.ResultsThe study included 830 participants, of whom 503 (60.6%) were females. Nearly all participants (97.6%) had heard of OD, but only 20.2% demonstrated good knowledge; 66.7% had a positive attitude (PA); and 43.9% demonstrated favorable composite willingness toward OD, whereas only 34.9% reported current willingness to register as organ or tissue donors. Higher odds of favorable composite willingness were observed among postgraduates (Adjusted Odds Ratio (aOR)=1.75, 95% confidence interval (CI)=[1.12-2.74]), females (aOR=1.66, 95%CI= [1.21-2.26]), workers in the medical/health field (aOR=2.14, 95%CI=[1.55-2.95]), and those employed in the private sector (aOR=2.02, 95%CI=[1.24-3.28]). Common barriers included family and social pressures, fear of discussing death, lack of knowledge, and religious concerns.ConclusionsAmong this predominantly young, educated, and digitally connected Lebanese population, PAs toward OD were common, whereas knowledge and current willingness to register as an organ donor remained limited. Participants reported greater willingness under several hypothetical facilitating conditions, suggesting that informational, social, and structural factors may influence OD decisions. These findings may help inform future strategies to promote OD in Lebanon.

IntroductionDelayed graft function in kidney transplant recipients is defined as the need for dialysis within 7 days of transplant and is associated with poor patient outcomes, including acute organ rejection and shortened allograft lifespan. Furosemide has been used with the goal of preventing delayed graft function by decreasing metabolic demand and ischemic injury; however, there is no consensus regarding duration of furosemide use after kidney transplantation.Project AimTo assess the effect of postoperative intravenous furosemide duration on delayed graft function rates in kidney transplant patients.DesignThis study was a single-center, retrospective chart review of adult patients who received a kidney transplant between January 1, 2021 and June 30, 2023. Included patients were grouped by whether they received furosemide for less than or greater than 48 h post-operatively. The primary outcome was delayed graft function measured by the occurrence of post-transplant dialysis during their hospital stay up to post-operative day 7. Secondary outcomes included the cumulative dose of furosemide within the first 7 days post-transplant and cold ischemic time.ResultsA total of 200 patients were included in this analysis; 64 in the acute-duration group (<48 h of furosemide) and 136 in the prolonged-duration group (>48 h of furosemide). Four patients (6.3%) in the acute-duration group developed delayed graft function, compared to 53 patients (39.0%) in the prolonged-duration group (P < .001).ConclusionKidney transplant patients receiving furosemide for longer than 48 h post-operatively were associated with delayed graft function within 7 days of their transplant.

Study aimsTo examine the association of psychological and cognitive indicators with treatment nonadherence following heart transplantation.MethodsA 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).ResultsBased 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.ConclusionAnxiety, 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.

Pancreas transplantation remains a highly specialized and life-enhancing procedure for selected patients with insulin-dependent diabetes mellitus. As national transplant volumes have declined over the past decade, many U.S. transplant centers are finding it increasingly difficult to satisfy the personnel credentialing standards established by the Organ Procurement and Transplantation Network (OPTN). These standards, designed to ensure safety and competency, require documented case volumes and training experience that are difficult to achieve in today's landscape, where most programs perform fewer than 10 pancreas transplants annually, and training opportunities are limited. This growing mismatch between regulatory expectations and real-world practice highlights the need to reassess current personnel criteria and consider more flexible, competency-based approaches that maintain quality while supporting program viability and patient access.

IntroductionLittle is known about end-of-life care of young adult solid organ transplant-recipients and how it compares to care received by nontransplant-recipient young adults with chronic illness.Research Questions(1) What aggressive and palliative care methods are used among young adults by solid organ transplant status (ie, recipient vs nonrecipient), and (2) what factors, including transplant recipient status, predict receiving a palliative care consult in the last 90 days of life.DesignData on young adults (18-39 years) with a history of solid organ transplant (recipient cohort) or cancer, heart disease, and/or HIV (nonrecipient cohort) were obtained from the clinical data warehouse of a large academic medical center/primary transplant center. The nonrecipient cohort (n = 412) was propensity score matched to the recipient cohort (n = 412) on gender, race, and age at death. Aggressive care was the use of cardiopulmonary resuscitation (CPR), dialysis, tube feedings, emergent intubation, extracorporeal membrane oxygenation, and mechanical ventilation. Data on receipt of and reason for palliative care consult were also extracted, and logistic regression was used to identify factors associated with receiving a palliative care consult.ResultsA larger percentage of nonrecipients received CPR (36.0% vs 20.0%, P < .01) and emergent intubation (16.8% vs 6.1%, P < .01), whereas a larger percentage of recipients received dialysis (31.7% vs 19.9%, P < .01). A larger percentage of palliative care consults for symptom management were noted in the recipient cohort (49.2% vs 22.2%, P = .04).ConclusionsSimilarities in care between the cohorts may indicate transplant recipient status does not impact end-of-life care in young adults.

IntroductionRabbit anti-thymocyte globulin (rATG) induction ideal dosing strategies in kidney transplant recipients have not been fully elucidated.Project AimsThis study compares the impact of ideal body weight-based versus actual body weight-based rATG dosing on drug purchasing costs and kidney transplant outcomes.DesignRetrospective, single-center chart review of kidney transplant recipients receiving rATG induction using (1) actual body weight-based dosing between May 17, 2019, and Mar 13, 2020, versus (2) ideal body weight-based dosing between May 17, 2022, and Mar 13, 2023. The primary endpoint is the rATG drug cost/kidney transplant recipient [measured by average wholesale price] compared between cohorts. Secondary endpoints are rates of biopsy-proven acute rejection, readmissions secondary to infection, myelosuppression (leukopenia or neutropenia), and viremia (Epstein-Barr virus, cytomegalovirus, and BK virus) measured for 6 months. Study design adhered to EQUATOR STROBE guidelines for reporting cohort studies.ResultsOverall, rATG ideal body weight-based dosing resulted in a median $3838 saved per kidney transplant recipients, based on average wholesale price, and a statistically significant reduction in cost versus actual body weight-based dosing (P = .02). Secondary outcomes were generally similar between groups, with a difference in Epstein-Barr viremia (P = .017) not translating to a significant difference in readmissions for infection (P = .226).ConclusionOur institution conducts around 250 kidney transplants annually, and considering the majority will receive rATG induction, this dosing protocol estimates average wholesale price drug purchasing cost-savings of about $900 000/year without compromising early clinical outcomes.

IntroductionWhile lifelong immunosuppressive therapy is pivotal for liver transplant recipients, nonadherence driven by complex biological, psychological, and social challenges remains a significant clinical problem. This study explored recipients' experiences with immunosuppressive therapy within the framework of the biopsychosocial model.MethodsThis descriptive qualitative study included 16 liver transplant recipients recruited via purposive sampling at a hospital in the Aegean region of Türkiye. Data were collected through in-depth interviews and analyzed using qualitative content analysis. Following an inductive identification of themes, a deductive mapping approach was employed to integrate the findings within the biological, psychological, and social dimensions of the biopsychosocial model.ResultsRecipients' mean age was 54.56 ± 13.47 years. The analysis revealed 2 main themes and 7 subthemes. In the biological dimension, recipients viewed medications as a "way to survive," though physical quality of life was compromised by persistent "side effects." The psychological dimension was characterized by "doubts" and "psychological effects," where recipients developed hypervigilance toward bodily sensations and experienced anxiety regarding missed doses. Within the social dimension, the theme "a difficult situation" highlighted how rigid medication schedules and fear of infection led to restricted social participation. Recipients described the development of "improving health and coping behaviors," utilizing individualized strategies and social supports to maintain adherence.ConclusionsThis study demonstrates the complex interplay between the biological, psychological, and social dimensions of medication experiences. Although participants view medications as a vital necessity, they experience adherence challenges due to psychological difficulties and social limitations, highlighting the need for holistic support strategies.

IntroductionWhile the benefits of deceased donor kidney transplant versus dialysis are clear, the impact of graft longevity remains unclear.Research QuestionsThis study assessed survival between patients with failed grafts and patients who remained on dialysis alone.DesignUtilizing the Organ Procurement and Transplant Network database, adults on dialysis listed for deceased donor kidney transplant between 1/2005 and 12/2017 were identified (n = 265 280; n = 129 062 [48.7%] transplant; n = 136 218 [51.3%] dialysis alone, not transplanted). A multivariable Cox proportional hazards model incorporating confounding covariates and utilizing transplant status (dialysis alone, functioning graft, failed graft) as a time-varying covariate was constructed. Representative patients were then fit to this model to assess survival probability.ResultsPatients who underwent transplant experienced a 65% reduction in mortality compared to those remaining on dialysis. However, graft failure (n = 19 389, 15.0% of transplants) was associated with a 47% increase in hazard rate compared to dialysis. When an average-risk patient was fit to this model, with transplant 4 years after dialysis initiation, a graft required longevity of 3 years to convey a survival probability benefit at 5 years postoperatively (9 years from waitlisting, 35%) over remaining on dialysis through the same time point (9 years from waitlisting, 32%).ConclusionsThese results argue for scrutiny of anticipated graft longevity and its expected impact on individual outcomes and advocate for 3-year graft survival as a critical clinical measure for transplant programs.