Current recommendations regarding evaluation of cognitive functioning in organ transplant candidates

Practice in evaluating solid organ transplant candidates and recipients with neurological impairment: The European Academy of Neurology neurocritical care panel survey

BACKGROUND

Brain disorders can occur in the context of peripheral organ diseases as well as solid organ transplants. The aim of this study was to explore the involvement of neurologists in the evaluation and management of solid organ transplant candidates and recipients when a nervous system impairment co-exists.

METHODS

We invited all European Academy of Neurology members to answer a web-based survey. Descriptive statistics were used to summarize the results.

RESULTS

In total, 176 respondents completed the survey; neurologists are more involved in the evaluation of neurological complications after (31.8%) than before an organ transplant (21%), when they see a small volume of patients, and mainly for neurological comorbidities. A minority (9%) of neurologists received a specific training on the topic of neurological manifestations of extracranial conditions as well as only 6.2% of them are involved in research activities in the brain-body interactions field.

CONCLUSION

This survey highlights a mismatch between the impressive statistics on brain dysfunction in peripheral organ diseases as well as transplant and the small volume of solid organ transplant candidates/recipients seen by neurologists. According to recent recommendations every organ-eligible candidates should undergo a cognitive screening, however, it is not common that neurologists are involved in the multidisciplinary committee to determine the transplant eligibility. Delirium is the most frequent reason for a neurological consultation after a transplant, but also other critical brain conditions. Educational programs in the field of neurology of systemic diseases are worth being implemented as well as including neurologists in research programs on brain-body interactions.

Neuropsychological and biopsychosocial evolution, therapeutic adherence and unmet care needs during paediatric transplantation: study protocol of a mixed-methods design (observational cohort study and focus groups) - the TransplantKIDS mental health project

The present article describes the protocol of a mixed-methods study (an observational cohort design and focus groups), aimed to examine neuropsychological functioning and other biopsychosocial outcomes, therapeutic adherence and unmet care needs in paediatric population undergoing solid organ or allogeneic hematopoietic transplant during the pre- and post-transplant phases. Following a multi-method/multi-source approach, neuropsychological domains will be comprehensively measured with objective tests (SDMT, K-CPT 2/CPT 3, TAVECI/TAVEC, WISC-V/WAIS-IV Vocabulary and Digit Span subtests, Verbal Fluency tests, Stroop, ROCF, and TONI-4); ecological executive functioning, affective and behavioral domains, pain intensity/interference, sleep quality and therapeutic adherence will be assessed through questionnaires (parent/legal guardians-reported: BRIEF-2 and BASC-3; and self-reported: BASC-3, BPI, PROMIS, AIQ and SMAQ); and blood levels of prescribed drugs will be taken from each patient's medical history. These outcomes will be measured at pre-transplant and at 4-weeks and 6-months post-transplant phases. The estimated sample size was 60 patients (any type of transplant, solid organ, or hematopoietic) from La Paz University Hospital (Madrid, Spain). Finally, three focus group sessions will be organized with patients, parents/guardians, and transplant clinicians (n = 15, with 5 participants per group), in order to qualitatively identify unmet care needs during the pre-, and post-transplant stages of the process. The study protocol was registered at ClinicalTrials.gov (NCT05441436).