Evaluating resilience as a predictor of outcomes in lung transplant candidates

Association of Grit and Resilience With Short-Term Post-Transplant Outcomes in Lung Allograft Recipients

The importance of mental toughness on lung transplant outcomes is unknown. We performed a pilot study to assess whether pretransplant grit and resilience are associated with short-term posttransplant outcomes. We enrolled 31 lung transplant candidates, of whom 7 (26%) had greater mental toughness, defined as the upper tertile for both grit and resilience within our cohort. There were no differences in baseline characteristics between patients with higher and lower mental toughness. Greater mental toughness was associated with a shorter hospital length of stay (LOS) [12 days (interquartile range, IQR 10-12) vs. 17 days (IQR 14-24), p = 0.02] and reduced posttraumatic stress severity [median 0 (IQR 0-2) vs. 6.5 (IQR 4-9), p < 0.01]. On multivariable analyses adjusting for age and Duke Activity Status Index, greater mental toughness was associated with a shorter hospital LOS [beta = -11.96 (95% CI 0.05-23.86), p < 0.05] and reduced PTSD [beta = -10.7 (95% CI -21.6-0.04), p = 0.053]. Lung transplant candidates with greater mental toughness may have improved short-term outcomes.

Optimism, Resilience, and General Self-Efficacy Predict Lower Somatic Burden during the COVID-19 Pandemic

There is scarce evidence of a relationship between positive and psychosomatic characteristics. This study aimed to examine the associations of somatic burden with psychological resources such as optimism, resilience, and general self-efficacy. Russian participants (n = 1020) completed measures of psychological resources at Time 1 and somatic symptoms at Time 2. The results showed that somatic burden decreased with greater levels of optimism, resilience, and general self-efficacy. Regarding health and sociodemographic characteristics, female sex increased somatic burden in the model with optimism scores, university education decreased somatic burden in the model with resilience scores, and history of COVID-19 disease increased somatic burden in the models with optimism, resilience, and general self-efficacy scores. This study has theoretical and practical contributions. It combines positive psychology and psychosomatic medicine and highlights the value of psychological resource interventions in the treatment and prevention of somatic burden. These findings may be useful for scientists, clinicians, and practitioners.

Single-center experience with early liver transplantation for acute alcohol-related hepatitis-Limitations of the SALT score and directions for future study

Alcohol-related liver disease (ALD) is the leading indication for liver transplantation worldwide. Since Mathurin et al. described their experience in providing early liver transplantation for patients with ALD in 2011, other centers have followed suit with generally favorable survival outcomes. This patient population poses a unique clinical challenge given the expedited nature of the evaluation and the lack of any significant sobriety period prior to transplantation. The SALT (Sustained Alcohol Use Post-Liver Transplant) score is a standardized psychometric tool increasingly used to help stratify the risk of relapse and guide listing decisions for these challenging clinical situations. In 2018, our center introduced a protocol for early liver transplantation for acute alcohol-related hepatitis (AAH). In this article, we offer a retrospective review of 26 patients transplanted between May 2018 and May 2021, including at least 1-year follow-up, and compare outcomes to initial SALT scores; we further identify additional factors that may impact post-transplant success. As transplant committees continue to weigh the ethical dilemma of denying lifesaving treatment against the obligation to remain stewards of a limited resource, we aim to contribute to a more nuanced understanding of risk regarding early transplantation for ALD.

Psychological review of hemodialysis patients and kidney transplant recipients during the COVID-19 pandemic

BACKGROUND

Kidney transplantation (KT) and end-stage renal disease (ESRD) requiring hemodialysis (HD) increase the incidence of morbidity and mortality associated with coronavirus disease 2019 (COVID-19) infection. The COVID-19 pandemic has had a negative effect on the psychological well-being of COVID-19 patients, especially those with a high-risk of infectious complications. The prevalence of anxiety and depression is known to be higher in ESRD patients undergoing HD than in the general population. On the other hand, KT recipients have different treatment requirements compared to HD patients, including adherence to complex immunosuppressive regimens and compliance with follow-up appointments. We hypothesized that psychosocial difficulties and stressors would differ between ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic. If so, each group may require different interventions to maintain their psychosocial well-being.

AIM

To measure and compare the levels of stress, anxiety, depression, concerns related to the pandemic, and coping skills in ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic.

METHODS

This cross-sectional study was performed at a training and research hospital. The study included ESRD patients undergoing HD (HD group) and KT recipients (with stable graft function for ≥ 6 mo prior to the study) (KT group). Patients completed a demographics form, the impact of events scale, the hospital anxiety and depression scale, and the Connor-Davidson resilience scale. Laboratory findings at the last clinical follow-up were recorded. The χ² test was used to assess the relationship between the HD and KT groups and the categorical variables. The relationships between the scale scores were analyzed using Pearson’s correlation test, and differences between the groups were analyzed using the independent groups t-test.

RESULTS

The study included 125 patients, of which 89 (71.2%) were in the HD group and 36 (28.8%) were in the KT group. The levels of anxiety and depression were higher in the HD group than in the KT group [9.36 ± 4.38 vs 6.89 ± 4.06 (P = 0.004) and 8.78 ± 4.05 vs 6.42 ± 4.26 (P = 0.004), respectively], whereas the post-traumatic stress score was higher in the KT group [46.75 ± 13.98 vs 37.66 ± 18.50 (P = 0.009)]. The concern with the highest intensity in the HD group was transmission of COVID-19 to family and friends (93.3%) and in the KT group was loss of caregiver and social support (77.8%). Concerns regarding financial hardship, stigmatization, loneliness, limited access to health care services, failure to find medical supplies, and transmission of COVID-19 to family and friends were more prevalent in the HD group. Connor-Davidson resilience scale tenacity and personal competence, tolerance, and negative affect scores were higher in the KT group than in the HD group [43.47 ± 11.39 vs 33.72 ± 12.58, 15.58 ± 4.95 vs 11.45 ± 5.05, and 68.75 ± 17.39 vs 55.39 ± 18.65 (P < 0.001), respectively]. Biochemical parameters, such as creatine, urea, phosphorus, parathyroid hormone, and calcium, were lower, and the albumin and hemoglobin values were higher in the KT group than in the HD group (P < 0.001).

CONCLUSION

Psychosocial difficulties and the level of stress differ in ESRD patients undergoing HD and KT recipients; therefore, psychosocial interventions should be tailored for each patient group.

Active coping, resilience, post-traumatic growth, and psychiatric symptoms among early and late liver transplant survivors

Understanding survivorship experiences at different stages postliver transplantation (poat-LT) is essential to improving care. Patient-reported concepts including coping, resilience, post-traumatic growth (PTG), and anxiety/depression, have been implicated as important predictors of quality of life and health behaviors after LT. We aimed to descriptively characterize these concepts at different post-LT survivorship stages. This cross-sectional study featured self-reported surveys measuring sociodemographic, clinical characteristics, and patient-reported concepts including coping, resilience, PTG, anxiety, and depression. Survivorship periods were categorized as early (1 y or below), mid (1-5 y), late (5-10 y), and advanced (10 y or above). Univariable and multivariable logistic and linear regression modeling examined factors associated with patient-reported concepts. Among 191 adult LT survivors, the median survivorship stage was 7.7 years (interquartile range: 3.1-14.4) and median age was 63 years (range: 28-83); most were male (64.2%) and Caucasian (84.0%). High PTG was more prevalent in the early survivorship period (85.0%) than late survivorship (15.2%). High trait resilience was only reported by 33% of survivors and associated with higher income. Lower resilience was seen among patients with longer LT hospitalization stays and late survivorship stages. About 25% of survivors had clinically significant anxiety and depression, which was more frequent among early survivors and females with pre-LT mental health disorders. In multivariable analysis, factors associated with lower active coping included survivors ≥65 years, non-Caucasian race, lower levels of education, and nonviral liver disease. In a heterogeneous cohort including early and late LT survivors, there was variation in levels of PTG, resilience, anxiety, and depression at different survivorship stages. Factors associated with positive psychological traits were identified. Understanding determinants of LT survivorship has important implications for how we should monitor and support LT survivors.

Unique problems for the design of the first trials of transplanting porcine kidneys into humans

Over the past year, 3 scientific teams conducted experiments of genetically edited porcine organs into human recipients, 3 of whom were deceased and 1 living. In this editorial, we describe challenges for the design of initial xenotransplantation clinical trials and focus on patient selection, consent, and requisite post-transplant follow-up. Given the uncertain clinical benefit of xenotransplantation, we propose that patient selection criteria might include novel elements, such as approaching patients who have a low quality of life and a strong aversion to continued dialysis therapy. We set expectations related to the importance of informing and protecting family members and medical teams who could be exposed to zoonotic viral infection from the donor organ and/or receive unwanted publicity. Meeting these challenges in trial design and oversight will require multidisciplinary expertise, a conceptual model that extends beyond the individual patient, and creative collaboration between scientists and regulatory agencies.

Lung transplantation: candidate selection and timing of transplant

PURPOSE OF REVIEW

Over the past two decades, lung transplant has become the mainstay of treatment for several end-stage lung diseases. As the field continues to evolve, the criteria for referral and listing have also changed. The last update to these guidelines was in 2014 and several studies since then have changed how patients are transplanted. Our article aims to briefly discuss these updates in lung transplantation.

RECENT FINDINGS

This article discusses the importance of early referral of patients for lung transplantation and the concept of the 'transplant window'. We review the referral and listing criteria for some common pulmonary diseases and also cite the updated literature surrounding the absolute and relative contraindications keeping in mind that they are a constantly moving target. Frailty and psychosocial barriers are difficult to assess with the current assessment tools but continue to impact posttransplant outcomes. Finally, we discuss the limited data on transplantation in acute respiratory distress syndrome (ARDS) due to COVID19 as well as extracorporeal membrane oxygenation bridge to transplantation.

SUMMARY

The findings discussed in this article will strongly impact, if not already, how we select candidates for lung transplantation. It also addresses some aspects of lung transplant such as frailty and ARDS, which need better assessment tools and clinical data.