Perspectives of Kidney Transplant Recipients, Transplant Candidates, and Living Kidney Donors on the Role of Patients’ Self-Narratives and Experiences of Creative Writing Workshops: A Qualitative Study

Background:

Kidney transplantation is the best treatment for kidney failure but is associated with medical, psychological, and existential challenges for patients. Patients’ experiential knowledge can help other patients facing these challenges. Patients’ self-narratives and creative writings are ways to operationalize this experiential knowledge. Creative writing has been described as a therapeutic tool for patients with chronic disease. Over the past year, we conducted creative writing workshops with kidney transplant recipients (KTRs), living kidney donors (LKDs), kidney transplant candidates (KTCs), and professional writers. During these workshops, patients were invited to explore different aspects of their experiences of their transplant or donation journey through narrative-writing, poetry, comic art, and screenwriting.

Objective:

The objectives of this study were to gather the perspectives of KTRs, KTCs, and LKDs on the role of patients’ self-narratives and creative writing, and to collect patients’ experiences of the creative writing workshops.

Design:

Focus groups and individual interviews.

Setting:

The Center hospitalier de l’Université de Montréal (CHUM) kidney transplant program.

Participants:

KTRs, LKDs, and KTCs attending the CHUM kidney transplant clinic between February 2020 and January 2021.

Methods:

We conducted 2 focus groups and 8 semi-structured individual interviews with 7 KTRs, 8 LKDs, and 5 KTCs from the CHUM between June and November 2020, before the creative writing workshops. We also conducted 10 semi-structured interviews with 5 KTRs, 1 KTC, and 4 LKDs in March 2021, after their participation in the creative writing workshops. The interviews were recorded and transcribed. Thematic and content analyses were conducted.

Results:

KTRs, LKDs, and KTCs had multiple significant moments to share from their transplant/donation journey. These moments were highly emotional and marked by uncertainty. The creative writing workshops were described as therapeutic by participants, because they offered a safe space for group-facilitated reflection, including a discovery and learning process, and normalization, relativization, and appreciation of the transplant/donation experience. The creative writing workshops also provided an opportunity to give back to others (helping other patients, promoting kidney donation and continuing this process in the future through the web platform).

Limitations:

Our participants came from a single French-speaking urban transplant center in Quebec and were highly educated.

Conclusion:

The study set out to capture the perspectives of KTRs, LKDs, and KTCs through the sharing of self-narratives and their participation in creative writing workshops related to their transplant or donation journey. A website was set up to publish patients’ creative writings (https://recitsdudonetdelavie.lorganon.ca/les-recits/). Further study is needed to assess the website’s impact on other patients.

Trial registration:

Not registered.

Detection and complete genome sequence of a divergent isolate of cucumber fruit mottle mosaic virus on Coccinia grandis in Sudan

Cucurbit-infecting tobamoviruses known so far belong to six acknowledged or tentative species. Except for cucumber green mottle mosaic virus (CGMMV), which is present worldwide, they are geographically restricted, mostly to Asia, and have not been observed in Africa so far. A tobamovirus isolate infecting a wild Coccinia grandis plant was collected in central Sudan in 2012. Its host range appeared to be mostly limited to cucurbits. Its full-length genome sequence was determined and found to be 85% identical to those of isolates of cucumber fruit mottle mosaic virus (CFMMV) described in Israel and Korea, whereas the aa sequence identity to CFMMV isolates was 92 to 95%, depending on the protein. Based on its biological and molecular properties, we suggest that the Sudanese isolate should be considered a divergent isolate of CFMMV. This is the first description of CFMMV in Africa. Its high divergence from isolates from Israel and Korea suggests a lack of recent exchanges between CFMMV from Sudan and the other known populations.

New species in the papaya ringspot virus cluster: Insights into the evolution of the PRSV lineage

The "Papaya ringspot virus (PRSV) cluster" of cucurbit-infecting potyviruses contains five acknowledged species that have similar biological, serological and molecular properties. Additional data suggest there are other uncharacterized species from various locations in the world that likely belong to the PRSV cluster including a new PRSV-like virus reported from Sudan in 2003. Molecular and biological data indicated that the virus from Sudan belongs to a new species, tentatively named wild melon vein banding virus (WMVBV). The complete nucleotide sequence of a second virus from Sudan revealed it was a divergent relative of Moroccan watermelon mosaic virus (MWMV). Based on sequence similarity this virus was determined to be a distinct species and tentatively named Sudan watermelon mosaic virus (SuWMV). Molecular analyses indicate that SuWMV is a recombinant between WMVBV- and MWMV-related viruses. Based on surveys performed in Sudan between 1992 and 2012, SuWMV appeared 10 times more frequent than WMVBV in that country (14.6% vs. 1.5% of the samples tested). The geographic structure and molecular diversity patterns of the putative and acknowledged species suggest that the PRSV-like cluster originated in the Old World about 3600 years ago, with an important diversification in Africa.

Comparative molecular epidemiology provides new insights into Zucchini yellow mosaic virus occurrence in France

Zucchini yellow mosaic virus (ZYMV, genus Potyvirus) causes important crop losses in cucurbits worldwide. In France, ZYMV epidemics are sporadic but occasionally very severe. This contrasts with Watermelon mosaic virus (WMV, genus Potyvirus) which causes regular and early epidemics. Factors influencing ZYMV epidemiology are still poorly understood. In order to gain new insights on the ecology and epidemiology of this virus, a 5-year multilocation trial was conducted in which ZYMV spread and populations were studied in each of the 20 plot/year combinations and compared with WMV. Search for ZYMV alternative hosts was conducted by testing weeds growing naturally around one plot and also by checking ZYMV natural infections in selected ornamental species. Although similar ZYMV populations were observed occasionally in the same plot in two successive years suggesting the occurrence of overwintering hosts nearby, only two Lamium amplexicaule plants were found to be infected by ZYMV of 3459 weed samples that were tested. The scarcity of ZYMV reservoirs contrasts with the frequent detection of WMV in the same samples. Since ZYMV and WMV have many aphid vectors in common and are transmitted with similar efficiencies, the differences observed in ZYMV and WMV reservoir abundances could be a major explanatory factor for the differences observed in the typology of ZYMV and WMV epidemics in France. Other potential ZYMV alternative hosts have been identified in ornamental species including begonia. Although possible in a few cases, exchanges of populations between different plots located from 500 m to 4 km apart seem uncommon. Therefore, the potential dissemination range of ZYMV by its aphid vectors seems to be rather limited in a fragmented landscape.

Sheep histocompatibility antigens: a population level comparison between lymphocyte antigens previously defined in France, England and Scotland, and sheep red cell groups

A comparison test was performed to look for correlations between the three nomenclature systems for sheep histocompatibility antigens which have been previously described in France, England and Scotland. 187 French sheep from a wide variety of breeds were typed for lymphocyte antigens with antisera which detect the OLA, P and ED series of antigens; they were also tested against 387 uncharacterized French antisera. Six clusters of sera were found which showed correspondence between antigens of at least two of the three nomenclatures; five of these clusters gave high r values of 0.78-0.94. New antisera from French sheep were found which contributed to the above clusters but few additional clusters were noted. No correlation was found between any of the lymphocyte groups of antisera tested and the sheep red cell antigens which were also tested.

The major histocompatibility complex of sheep (OLA) and two minor loci

Among 11 lymphocyte factors defined in sheep, 9 are the products of multiple alleles at 2 closely linked loci: OLA-A and OLA-B. A tenth factor is the product of a gene at a third locus: OL-X probably on the same chromosome, but in this case very distant from OLA. The last factor is the product of a gene at a fourth locus: OL-Z, independent of OLA-A and B.

Evaluation of an expert system linked to a rapid antibiotic susceptibility testing system for the detection of beta-lactam resistance phenotypes

Interpretive reading of antibiotic disc agar diffusion tests indicates the resistance mechanisms, if any, expressed by a bacterium. An expert system for determining resistance mechanisms using rapid automated antibiotic susceptibility tests has been developed. The beta-lactam susceptibility of each of 300 strains of clinically significant species of enterobacteria, displaying natural and acquired resistance mechanisms, was determined by disc agar diffusion and by a rapid automated method of susceptibility testing associated with an expert system. For every strain, the conclusion of the expert analysis of the automated test was compared with the commonly accepted interpretation of disc agar diffusion tests. Of the 300 strains studied, 275 were similarly interpreted (91.7% agreement). The susceptible and naturally beta-lactam-resistant phenotypes (wild phenotypes) were equally recognized by both methods. Similarly, the results of the two methods concurred for most of the acquired resistance phenotypes. However, for 25 strains (8.3%) the results diverged. The expert system proposed an erroneous phenotype (5 strains), several phenotypes including the correct one (17 strains), or no phenotype (1 strain). For 2 strains the natural resistance mechanism was not detected at first by the automated method but was subsequently deduced by the expert analysis according to bacterial identification. These results demonstrate that satisfactory interpretive reading of automated antibiotic susceptibility tests is possible in 4 to 5 hours but requires careful selection of the antibiotics tested as phenotypic markers.

[Limy bile syndrome. Study of a case with double localization in the gallbladder and common bile duct]

We report the case of a patient with limy bile located in both the gallbladder and common bile duct, and disappearing spontaneously. Since the first description of this syndrome in 1911, approximately 300 cases have been reported in the literature, including 20 cases with double localization. The male/female ratio was 1/3. All patients were more than 40 year old. Conventional radiogram was sufficient to establish diagnosis. Spontaneous disappearance of limy bile is rare. The etiopathogenesis remains unclear; cholecystectomy is appropriate.

Sheep major histocompatibility (OLA) complex: linkage between a scrapie susceptibility/resistance locus and the OLA complex in Ile-de-France sheep progenies

As seen on their family trees, Ile-de-France sheep with scrapie show genetic susceptibility to this disease, which is transmitted via scrs, an autosomal recessive gene. Scrapie occurred in homozygous recessive sheep, whereas the presence of the dominant resistance allele Scrr sufficed to prevent this disease in heterozygous animals. This hypothesis, previously proposed by Parry (1962), was tested in a study involving 133 crossings of sheep of different genotypes, and verified in the observed progenies. In a contaminated environment, susceptibility to the disease seemed to be transmitted by the scrs gene, whose frequency was increasing and varied in different progenies: the gene was propagated by inbreeding combined with selection; scrapie did not appear in the progeny of a homozygous resistant ram with the Scrr/Scrr genotype. On the family trees, linkage between the Scr locus and the OLA-A and -B loci is clearly visible; it often allowed the transmission of resistance or susceptibility haplotypes to be detected by OLA typing and followed from one generation to the next. The Scrr, OLA-A4, B6 haplotype was not found in any diseased sheep born before 1979, but was propagated by healthy sheep. During and after 1979, several recombinations of this haplotype were observed, giving a recombined haplotype with reciprocal linkage (scrs, OLA-A4, B6), disseminated by one sire in particular. The rate of recombination of Scr and OLA loci is estimated to be between 11 and 16%. The possibility of early selection against the disease without loss of qualities desired by the breeder is discussed.

Bent-limb disease in lambs. Apparent transmission with an autosomal recessive gene linked to the OL-Z minor lymphocyte antigen locus and the I locus involved in the expression of R and O antigens in sheep

In crossbred Charmois lambs, Bent-limb disease appears to be associated with the phenotype 'z,i' which corresponds to a doubly recessive genotype at the two loci OL-Z (a minor lymphocyte antigen locus independent of OLA, the major histocompatibility complex of the sheep) and I (involved in genetic control of the expression of R and O antigens found in various body fluids and on erythrocytes). The disease seems to be controlled by a single autosomal recessive gene, provisionally named bl (its normal or healthy allele Bl being dominant) which is distinct from, though linked to, the genes at the OL-Z and I loci (observed haplotype: bl,z,i). In the Lacaune breed, besides the already observed bl,z,i haplotype, there is an additional one: bl,z,I. In Vendéen sheep, and in animals which belong to two other breeds, the bl,Z11,I haplotype (bl linked to the two dominant alleles) appears to be relatively frequent. Further studies are needed in order to confirm the genetic hypothesis suggested by the present data.

Sheep major histocompatibility complex OLA: gene frequencies in two French breeds with scrapie. Evidence for a linkage between OLA and resistance or susceptibility to the disease

Gene frequencies of 13 sheep lymphocyte factors (11 factors controlled by the sheep OLA complex including three closely linked loci, and two factors by two minor loci) were compared in 189 sheep of two breeds: a. infected with scrapie, b. healthy in a contaminated environment, and c., normal. In a and c, OLA gene frequencies were similar. In healthy sheep in a contaminated environment (b), some OLA gene frequencies were higher in one breed and lower in the other. In each breed, three antigens had their frequencies significantly modified; two of them were the same in the two breeds, but they showed an inverse variation. Thus, the relative risk of clinical scrapie decreased in one breed and increased in the other for the same OLA gene. These data indicate first, that OLA antigens are not directly involved in causing scrapie, and second, that the OLA complex is linked to at least one scrapie resistance/susceptibility locus. In practice, it should be possible to select more resistent sheep, using some OLA antigens but an investigation of the OLA genes and the resistance to scrapie in a given breed is necessary before the selection.

Comparison of the segregation of sheep histocompatibility genes OLA - A1, A8, B7, B9, and OLX-5 in eighteen hamster X sheep fibroblast hybrid lines

Four OLA factors of the ovine histocompatibility complex and the OLX -5 factor were recognized in hamster cell X sheep fibroblast hybrids, by means of absorption of OLA reagents with hybrid cells. Segregation of these factors could be studied in eighteen independent hybrids. In the case described, the four OLA factors were distributed into two haplotypes isolated in some hybrids. The heterozygous OLX-5 factor was linked to only one haplotype; nevertheless a dissociation, occurred in one hybrid (relative to five simultaneous transmissions), is in agreement with a previous genetic study showing a loose linkage between the OLA complex and the OLX locus.

[Major OLA histocompatibility complex of sheep. Frequency of factors in sheep affected by trembling (scrapie) or normal sheep]

The OLA histocompatibility complex of sheep was studied in a flock of Ile-de France breed affected with Scrapie. On the whole, gene frequencies of 9 out of 11 factors were increased in the non-affected sheep of this contaminated flock. In these sheep, frequencies of the three following genes appeared to be increased significantly: OLA-A4, OLA-A8, OLA-B6. When these genes were present in the sheep of this flock, the relative risk of Scrapie was estimated at 0.05, 0.10 and 0.25, respectively.

[The sheep OL lymphocyte antigen system: 11 factors detected by microcytotoxicity assays in a prealp flock]

By means of microcytotoxicity techniques and using 9 immune allosera, 11 lymphocyte factors were determined in Prealpe sheep, 10 factors, transmitted by haplotypes, depended genetically on 2 linked locus: OL-A and OL-B. From a sample of 130 haplotypes, 36 OL-A alleles were demonstrated by 6 combinations of 1 to 2 factors and 80 OL-B alleles by 32 combinations of 1 to 5 factors. Genic frequencies were varied and low: inferior to 0,01 for half of the combinations they only once exceeded 0,1. The overall frequency of marked genes was estimated to 0,27 for OL-A and 0,61 for OL-B. The genetic transmission of the 11th factor (frequency: 0,05) depended on a 3rd OL-C locus of the same system.