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.

IntroductionDue to the organ shortage, effective treatments for early graft dysfunction are critically needed. Early graft dysfunction is associated with a prolonged hospital stay, acute rejection, and mortality. Ischemia-reperfusion injury is a major contributor to early graft dysfunction. Inhaled anesthetics may reduce ischemia-reperfusion injury and improve donation and transplant outcomes.ObjectiveThis review aimed to summarize clinical studies of inhaled anesthetics administration to deceased donors, investigating downstream effects on transplant outcomes.MethodsWe searched MEDLINE, EMBASE, Cochrane Library, and conference proceedings for clinical studies comparing deceased donors' treatment with inhaled anesthetics to either placebo or no intervention and evaluating outcomes for any organ transplantation. Reviewers independently screened and selected studies, extracted data, and assessed the risk of bias. We assessed the overall quality of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.ResultsThree studies with different inhaled anesthetics regimens were included. Most studies have assessed the effects of sevoflurane. Conflicting results were reported on early graft dysfunction since 1 study showed a reduced incidence, while the other 2 did not report any difference. Two studies evaluated graft function, with peak serum alanine transaminase and aspartate aminotransferase improvements in the intervention groups. No difference in graft survival was reported between the 2 studies. The quality of evidence was very low for all outcomes.DiscussionCurrent studies offer limited evidence to support the use of inhaled anesthetics preconditioning in deceased donors. Since there is physiological plausibility of their use, rigorous randomized clinical trials are needed to establish clear conclusions on their benefits.

Introduction: Solid organ transplant recipients have extensive self-care responsibilities. Limited health literacy (HL) can hinder effective self-management and long-term outcomes. Objective: A scoping review of HL instruments is needed to summarize their use in solid organ transplant. Methods: A systematic search was conducted using Medline, Embase, and CINAHL databases to identify studies that measured HL in the context of solid organ transplant. Search results were uploaded into Mendeley, and duplicates were removed. Two reviewers screened the abstracts and full texts for eligibility and discrepancies were resolved by the research team. Data extraction included publication details, study features, and HL instruments. Results: Of 721 articles identified for title and abstract assessment, 94 articles were further reviewed for full-text eligibility, and 50 were included in the review. HL instruments included: the Brief HL Screen (BHLS) and iterations (with 16 studies), Newest Vital Sign (NVS) (15 studies), Rapid Estimate of Adult Literacy in Medicine (REALM) (8 studies), Test of Functional HL in Adults (TOFHLA) (7 studies), HL Questionnaire (HLQ) (6 studies), eHL Scale (eHEALS) (4 studies), Brief Medical Numbers Test (BMNT) (3 studies), Decision-Making Capacity Assessment Tool (DMCAT) (2 studies), Short Assessment of HL (SAHL) (1 study). Discussion: Seven studies used multiple HL instruments in their analysis. Some instruments had multiple versions, such as the original TOFHLA and its shortened form (S-TOFHLA), and the original REALM and its transplant-specific version (REALMT). Conclusion: This review provides an overview of HL instruments for transplant healthcare providers who may want to incorporate HL measurement into practice.

IntroductionGender disparity remains a global issue in access to renal replacement therapy and kidney transplantation among patients with end-stage kidney disease.AimThis study examined trends in donor type, recipient age, and dialysis modality in kidney transplantation in Türkiye from 2013 to 2022. A secondary aim was to explore gender disparities in kidney transplantation and treatment modalities for end-stage kidney disease using registry data.MethodsThis descriptive and cross-sectional study analyzed the distribution and trends of kidney transplants in Türkiye between 2013 and 2022. The data were obtained from the publicly accessible Registry of Nephrology, Dialysis, and Transplantation reports in Türkiye. Per million population increase/decrease rate, χ2 linear trend, and χ2 R by C were used.ResultsOver time, transplants from living donors increased, while deceased donor transplants decreased. The highest rates of living donor transplants were in 2022, 2021, and 2019. Transplants in high-risk age groups increased significantly. There were differences in donor type among patients receiving hemodialysis, peritoneal dialysis, or preemptive transplantation (p < .001). Preemptive transplants showed the most significant increase, especially from living donors in 2022. Between 2013 and 2022, kidney transplantation increased by 24.67% in men and 19.94% in women. Female transplant rates were lowest in 2016, 2020, and 2021, indicating a persistent gender gap. There was no significant gender difference in the incidence of hemodialysis or peritoneal dialysis.ConclusionLiving donor transplants, especially preemptive ones, increased markedly over the past decade. Gender disparities persist, and efforts should focus on improving access for women and promoting deceased donor programs to ensure equity.

Patient-centered outcomes are increasingly recognized by the transplant community as a key component to improving knowledge and patient counseling, and long-term outcomes after living kidney or liver donation are not well understood. With efforts underway to follow living donors and donor candidates long term, it is critical that living donors and candidates drive the process of patient-centered data collection. Living donors on the Scientific Registry of Transplant Recipients' Living Donor Steering Committee were engaged to brainstorm and prioritize which data elements should be captured. Committee members identified long-term lab values, difficulty with normal activities, and diagnosis of chronic kidney or liver disease as critical long-term outcomes. Additional high-priority elements included short-term lab values, deaths related to donation, mortality among donors compared to nondonors, hospital readmissions, costs and physical limitations related to donation, and whether a donor would donate again. Finally, living donors wanted to know the risk of organ failure among donors compared to nondonors. This prioritization exercise provided valuable insights from living donors to help determine key themes and discrete data elements that should be prioritized for long-term collection and reporting to living donors and living donor candidates.

IntroductionCognitive impairment in liver transplant recipients can lead to poor health outcomes, and identifying at-risk individuals is important to provide timely support. Poor social conditions, including poor socioeconomic status and lack of social support, have been suggested as potential contributors to cognitive impairment. Further, individuals with poor social conditions may experience psychological symptoms, such as depression and anxiety, which can further affect cognition.AimThis preliminary study explored longitudinal associations between social conditions, depression and anxiety symptoms, and cognition in liver transplant recipients.DesignA total of 23 adult liver transplant candidates were enrolled, with 9 receiving liver transplantation, who were followed for up to 1-year post-transplant. Cognition was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status. Social conditions and psychological symptoms were assessed through surveys. Linear mixed-effects models adjusted for age and education were used to examine the relationships between social conditions, psychological symptoms, and cognition. Moderation analysis was also conducted to explore interactions between social conditions and psychological symptoms.ResultsCognitive scores remained stable over time. Social conditions were not associated with cognition, whereas higher levels of depression and anxiety symptoms were associated with worse cognitive performance. No significant interaction was found between social conditions and psychological symptoms on cognition.ConclusionDepression and anxiety symptoms, but not social conditions, showed associations with cognition in liver transplant recipients. These findings suggest the importance of assessing psychological symptoms in this population to identify those at risk for cognitive impairment.

IntroductionWomen comprise 55% to 65% of living kidney donors. Most studies focus on individuals who underwent donor nephrectomies, rather than potential living donors prior to engagement with the healthcare system. Therefore, the underlying reasons for gender discrepancy are unclear.Research questionAmong relatives of patients with renal disease, do men and women differ in willingness to be evaluated for living kidney donation, regardless of prior donation behavior?DesignAn online survey administered in 2019 to US adult members of the Qualtrics Survey Panel whose relatives had weak or failing kidneys. The survey was designed to examine perspectives of living kidney donation from realistic potential donors. Self-reported willingness was compared between men and women for statistically significant differences. Average marginal effects of male gender on willingness and interaction effects estimated with multivariable logistic regression, adjusted for respondent/patient demographics and relationship.ResultsA total of 1647 responses showed 7.1% higher willingness among men (P = .016). Among those whose relatives (N = 808) were seeking transplants [subgroup], men had 13.1% higher willingness (P = .002). Interaction effect analysis showed men aged 70 to 79 years, with insurance, self-reported very good health, and self-reported medical contraindications, had significantly higher willingness than corresponding women. In the transplant subgroup, men aged 18 to 39 years and with full-time employment also had higher willingness.ConclusionMen showed 7.1% higher willingness to be evaluated for living kidney donation. Rather than reflecting a fixed difference, the existence and degree of gender difference were context-dependent. Identifying strategic interventions to facilitate male donation in contexts where they reported high willingness could improve access to transplantation.