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Kumar RN, Gorsline CA, Rader T, Boucher HW, Malinis M, Koff A, Harris CE. The pre-transplant evaluation: Considerations for trainees and early career transplant infectious diseases clinician. Transpl Infect Dis 2024; 26:e14326. [PMID: 38967408 DOI: 10.1111/tid.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/26/2024] [Accepted: 06/13/2024] [Indexed: 07/06/2024]
Abstract
Transplant infectious disease (TID) clinicians are integral to the pre-transplantation evaluation. Pre-transplant evaluations allow clinicians to assess risk factors for latent infections and relevant exposures to potential pathogens, address immunizations, and optimize patients' health and understanding of life after transplant. However, there is not a standardized approach to the pre-transplant evaluation. This article reviews the details of performing successful pre-transplant evaluations, including updated recommendations on available vaccines and contemporary opinions on marijuana use. This resource can be used for teaching with trainees or for early career TID clinicians.
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Affiliation(s)
- Rebecca N Kumar
- Division of Infectious Disease and Tropical Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Chelsea A Gorsline
- Division of Infectious Disease, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Theodore Rader
- Division of Infectious Diseases and Immunology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Helen W Boucher
- Division of Geographic Medicine and Infectious Diseases, Tuft University School of Medicine, Boston, Massachusetts, USA
| | - Maricar Malinis
- Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA
| | - Alan Koff
- Division of Infectious Diseases, University of California, Davis, Sacramento, California, USA
| | - Courtney E Harris
- Division of Infectious Disease, Medical University of South Carolina, Charleston, South Carolina, USA
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2
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Kriss M, Shingina A, Hamel S, Winder GS. Cannabis use in liver transplant candidates and recipients. Liver Transpl 2024; 30:530-543. [PMID: 38289264 DOI: 10.1097/lvt.0000000000000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/20/2024] [Indexed: 03/24/2024]
Abstract
The increasing legality and acceptance of cannabis sale and consumption across the United States has led to a measurable increase in cannabis use nationwide, including in liver transplant (LT) candidates and recipients. With over 75% of liver transplant recipients transplanted in states with legalized use of medicinal and/or recreational cannabis, liver transplant clinicians must have expertise in the assessment of cannabis use given its potential impact on clinical care. In this review, the authors provide an understanding of nomenclature and tools to assess cannabis use, highlight essential components to guide clinical policy development and implementation, and discuss the potential impacts of cannabis use on patients' transplant course.
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Affiliation(s)
- Michael Kriss
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Colorado Center for Transplantation Care, Research and Education, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alexandra Shingina
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephanie Hamel
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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3
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Yau MTK, Hussaini T, Yoshida EM. Review of liver transplantation candidacy and outcomes among patients who use cannabis: Is it time for a change in policy? CANADIAN LIVER JOURNAL 2023; 6:269-277. [PMID: 37503517 PMCID: PMC10370722 DOI: 10.3138/canlivj-2022-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/15/2022] [Indexed: 07/29/2023]
Abstract
Background Recreational cannabis was legalized in Canada in 2018. A controversial contraindication for liver transplantation is cannabis. There is currently no consensus regarding cannabis use in liver transplant candidates. We aim to investigate liver transplantation candidacy and outcomes among cannabis users. Methods English peer-reviewed studies on PubMed and Google Scholar were searched on September 9, 2022, using keywords including "cannabis," "liver transplantation," and their synonyms. Titles and abstracts were screened, followed by full texts. Reference lists were reviewed. Studies that investigated liver transplantation candidacy and outcomes among cannabis users were included. Results The proportion of patients listed for liver transplantation was significantly less among cannabis users than among non-users. Time to listing was longer for cannabis users than non-users. The incidence of delisting was similar. There is an inconsistency between transplant centres regarding transplantation candidacy for cannabis users. While only 14% of Canadian centres had a policy in place and preferred candidates to abstain or decrease cannabis use before transplantation, a third of Canadian centres rejected cannabis users. Observational studies failed to demonstrate significant differences in patient survival between pre-transplantation cannabis users and non-users. However, self-reported mental health ratings were worse in post-transplantation cannabis users than in non-users and former users. Conclusions Current observational data do not support a link between cannabis use and poor patient survival post-transplantation. However, high-quality prospective studies are needed to better elucidate the impact of cannabis use on liver transplantation outcomes. Liver transplant candidacy should be evaluated through a multidisciplinary and comprehensive approach considering all relevant psychosocial factors.
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Affiliation(s)
| | - Trana Hussaini
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric M Yoshida
- Division of Gastroenterology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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4
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Marijuana use and post-transplant complications and non-compliance in liver transplant patients. Am J Med Sci 2023; 365:115-120. [PMID: 36202161 DOI: 10.1016/j.amjms.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/16/2022] [Accepted: 09/29/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Liver transplant (LT) is a lifesaving treatment for patients with end stage liver disease. Historically, institutions across the United States have deemed active marijuana use as an exclusion criterion for listing. This study aims to investigate LT outcomes in patients with history of marijuana use prior to LT. METHODS We performed a retrospective review of 111 patients who tested positive for marijuana on urine drug screen during initial LT evaluation between February 2016 and January 2021. 100 non-marijuana users who underwent LT were cross matched for control. Patient demographics, substance use history, and transplant decisions were recorded. Post-LT variables were also collected up to 1 year post surgery including postoperative infections, issues with non-compliance, and continued substance use. Chi-square analysis was used to assess the association between pre-transplant marijuana use and post-transplant complications. Logistics regression was implemented to measure associations amongst the entire cohort. RESULTS From 111 marijuana users, 32 (29%) received a transplant. There was no statistical difference in post-LT outcomes between marijuana and non-marijuana users, including incidence of cardiac, respiratory, renal, psychiatric, or neurological complications, as well as readmission rates post-surgery. There were no statistically significant associations between marijuana use with post-transplant bacterial or fungal infections, medication non-compliance, or continued substance use (all p>0.05). Marijuana use was associated with pre-LT tobacco use (p = 0.020). CONCLUSIONS Our data indicates that marijuana is not associated with increased risk of postoperative noncompliance, other organ complications, infections, or death. As a single factor, marijuana may not need to be a contraindication for LT.
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5
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Liu CR, Heid CA, Hauptmann E, Ali M, Pruszynski J, Pillai A, Banga A, Wait MA, Huffman LC, Peltz M, Hackmann AE, Jessen ME, Ring WS, Murala JS. Donor substance use and lung transplantation: A single center experience. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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6
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Winder GS, Mellinger JL. CAQ Corner: Psychosocial and ethical considerations in patient selection for liver transplantation. Liver Transpl 2022; 28:1376-1384. [PMID: 35377543 DOI: 10.1002/lt.26470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Gerald Scott Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica L Mellinger
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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7
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Jowsey-Gregoire S, Jannetto PJ, Jesse MT, Fleming J, Winder GS, Balliet W, Kuntz K, Vasquez A, Weinland S, Hussain F, Weinrieb R, Fireman M, Nickels MW, Peipert JD, Thomas C, Zimbrean PC. Substance use screening in transplant populations: Recommendations from a consensus workgroup. Transplant Rev (Orlando) 2022; 36:100694. [DOI: 10.1016/j.trre.2022.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/20/2022] [Indexed: 02/07/2023]
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8
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Cannon RM. Double Standards and Double Jeopardy: The Unintended Consequence of Policy Regarding Substance Use in Potential Kidney Transplant Candidates. Transplantation 2022; 106:e200-e201. [PMID: 35135971 DOI: 10.1097/tp.0000000000004055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Robert M Cannon
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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9
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Shenoy A, Winder GS. Cannabinoids in Colorado: Liver Transplantation Recipients Follow National Trends. Liver Transpl 2021; 27:1529-1531. [PMID: 34387024 DOI: 10.1002/lt.26261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Akhil Shenoy
- Department of Psychiatry, Columbia University, New York, NY
| | - Gerald Scott Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, MI.,Department of Surgery, University of Michigan, Ann Arbor, MI.,Department of Neurology, University of Michigan, Ann Arbor, MI
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10
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Mohottige D, McElroy LM, Boulware LE. A Cascade of Structural Barriers Contributing to Racial Kidney Transplant Inequities. Adv Chronic Kidney Dis 2021; 28:517-527. [PMID: 35367020 PMCID: PMC11200179 DOI: 10.1053/j.ackd.2021.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/17/2021] [Accepted: 10/27/2021] [Indexed: 11/11/2022]
Abstract
Stark racial disparities in access to and receipt of kidney transplantation, especially living donor and pre-emptive transplantation, have persisted despite decades of investigation and intervention. The causes of these disparities are complex, are inter-related, and result from a cascade of structural barriers to transplantation which disproportionately impact minoritized individuals and communities. Structural barriers contributing to racial transplant inequities have been acknowledged but are often not fully explored with regard to transplant equity. We describe longstanding racial disparities in transplantation, and we discuss contributing structural barriers which occur along the transplant pathway including pretransplant health care, evaluation, referral processes, and the evaluation of transplant candidates. We also consider the role of multilevel socio-contextual influences on these processes. We believe focused efforts which apply an equity lens to key transplant processes and systems are required to achieve greater structural competency and, ultimately, racial transplant equity.
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Affiliation(s)
- Dinushika Mohottige
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC.
| | - Lisa M McElroy
- Division of Abdominal Transplant, Department of Surgery, Duke University School of Medicine, Durham, NC; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - L Ebony Boulware
- Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
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11
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Xiao N, Chai H, Omoloja A. Substance use among adolescents and young adults with chronic kidney disease or kidney failure. Pediatr Nephrol 2021; 36:3585-3593. [PMID: 33686466 DOI: 10.1007/s00467-021-05001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/31/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
Substance use, a significant public health issue, is well described in the adult chronic kidney disease (CKD) population. Knowledge about substance use in the adolescent and young adult (AYA) CKD population such as prevalence, impact on kidney function, medication adherence, and psychosocial well-being remain largely unknown. Awareness of and inquiring about substance use is paramount to providing evidence-based care and preparation to transition to adult-focused health services. The authors in this review identify commonly used substances (alcohol, tobacco, marijuana, etc.) and how they impact kidney function and care of the AYA with CKD or kidney failure. Recommendations for screening and intervention strategies are provided.
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Affiliation(s)
- Nianzhou Xiao
- Department of Nephrology, Valley Children's Healthcare, Madera, CA, USA
| | - Hua Chai
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Abiodun Omoloja
- Department of Pediatrics, Wright State University, Dayton, OH, USA.
- Division of Nephrology, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA.
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12
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Greenberg R, Goldberg A, Anthony S, Buchman DZ, Delaney S, Gruben V, Holdsworth S, Le Foll B, Leung M, Lien D, Lynch MJ, Selzner N, Chandler JA, Fortin MC. Canadian Society of Transplantation White Paper: Ethical and Legal Considerations for Alcohol and Cannabis Use in Solid Organ Listing and Allocation. Transplantation 2021; 105:1957-1964. [PMID: 33587429 PMCID: PMC8376271 DOI: 10.1097/tp.0000000000003618] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
Alcohol and cannabis use as a contraindication to organ transplantation is a controversial issue. Until recently, patients in Canada with alcohol-associated liver disease were required to demonstrate abstinence for 6 mo to receive a liver transplant. There is no equivalent rule that is applied consistently for cannabis use. There is some evidence that alcohol and cannabis use disorder pretransplant could be associated with worse outcomes posttransplantation. However, early liver transplantation for patients with alcohol-associated liver disease in France and in the United States has led to challenges of the 6-mo abstinence rule in Canada in the media. It has also resulted in several legal challenges arguing that the rule violates human rights laws regarding discrimination in the provision of medical services and that the rule is also unconstitutional (this challenge is still before the court). Recent legalization of cannabis use for adults in Canada has led to questions about the appropriateness of limiting transplant access based on cannabis use. The ethics committee of the Canadian Society of Transplantation was asked to provide an ethical analysis of cannabis and alcohol abstinence policies. Our conclusions were as follows: neither cannabis use nor the 6-mo abstinence rule for alcohol use should be an absolute contraindication to transplantation, and transplant could be offered to selected patients, further research should be conducted to ensure evidence-based policies; and the transplant community has a duty not to perpetuate stigma associated with alcohol and cannabis use disorders.
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Affiliation(s)
- Rebecca Greenberg
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Aviva Goldberg
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Samantha Anthony
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada
| | - Daniel Z. Buchman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | | | - Vanessa Gruben
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Sandra Holdsworth
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Bernard Le Foll
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Dale Lien
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Marie-Josee Lynch
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Research Institute, Toronto, ON, Canada
| | - Nazia Selzner
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Toronto General Research Institute, Toronto, ON, Canada
| | - Jennifer A. Chandler
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Chantal Fortin
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Centre de recherche du CHUM, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, QC, Canada
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13
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Testino G, Balbinot P, Pellicano R. Substances use disorders and liver injury: a concise review. Minerva Gastroenterol (Torino) 2021; 68:269-276. [PMID: 33971710 DOI: 10.23736/s2724-5985.21.02885-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Substance use disorders (SUDs) are often associated with alcohol use disorders (AUDs) and psychiatric comorbidities. In addition, they are often subjected to polytherapy. For these reasons SUDs patients are at greater risk of developing liver disease. In this concise review, liver damage from amphetamines, cannabinoids, cocaine and opioids is analyzed and the need to identify a possible associated alcohol use disorder is also suggested. Early identification of liver fibrosis is required in SUDs patients. Fibrosis is the most significant predictor of both prognosis and long-term survival. Its identification helps to promote the abstention from substances and alcohol. Active use of heroin, cocaine and synthetic substances is an absolute controindication for liver transplantation. In cases of remission and adherence to a significant care path, the patient is reevaluated. An addiction specialist should be present within the transplant team. If this is not present, a close collaboration with an addiction unit is mandatory.
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Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o San Martino Hospital, Genoa, Italy -
| | - Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o San Martino Hospital, Genoa, Italy
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14
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Likhitsup A, Saeed N, Winder GS, Hassan A, Sonnenday CJ, Fontana RJ. Marijuana use among adult liver transplant candidates and recipients. Clin Transplant 2021; 35:e14312. [PMID: 33829569 DOI: 10.1111/ctr.14312] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/22/2021] [Accepted: 04/02/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Data regarding marijuana (MJ) use among liver transplant (LT) candidates are limited. We set out to determine the incidence and pre- and post-LT outcomes of adult LT candidates with a self-reported history of MJ use. METHODS Baseline clinical characteristics, waitlist, and post-LT outcomes of adult LT candidates from January 2010 to March 2017 were compared. RESULTS Among 2690 LT candidates, 630(23%) and 298(11%) reported a history of MJ use and use within the past 12 months, respectively. Although the proportion of MJ users increased over time(β = .76, p = .03), the proportion listed and transplanted did not change. Listing for LT increased with male (OR 1.24, 95% CI 11.01-1.52), MELD score (OR 1.08, 95% CI 1.01-1.15), HCC (OR 1.83, 95% CI 1.39-2.41) but decreased among MJ users (OR 0.67, 95% CI 0.50-0.91, p = .01). The median time to listing was longer among MJ users compared to non-users (115 vs. 87 days, p < .0005). Post-LT survival was similar in 83 MJ users and 306 non-users. CONCLUSION The proportion of MJ users among LT candidates is increasing. MJ users have a greater burden of psychosocial issues which may contribute to longer evaluations and lower rate of LT listing. Post-LT survival was not impacted by self-reported MJ use history.
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Affiliation(s)
- Alisa Likhitsup
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Naba Saeed
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Gerald Scott Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Ammar Hassan
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | | | - Robert J Fontana
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
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15
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García-Alanís M, Toapanta-Yanchapaxi L, Vilatobá M, Cruz-Martínez R, Contreras AG, López-Yáñez S, Flores-García N, Marquéz-Guillén E, García-Juárez I. Psychosocial evaluation for liver transplantation: A brief guide for gastroenterologists. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 86:172-187. [PMID: 33771379 DOI: 10.1016/j.rgmx.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/09/2020] [Accepted: 12/27/2020] [Indexed: 06/12/2023]
Abstract
Liver transplantation is a lifesaving treatment that improves survival and quality of life. The procedure requires adequate transplant candidate selection carried out by a multidisciplinary team. Psychosocial evaluation is a necessary part of recipient selection and its primary aims are to identify problems and psychosocial needs of the patient and his/her family, to improve transplantation outcomes. Different psychosocial conditions are considered risk factors for morbidity and mortality after transplantation. The presence of those factors per se is not an absolute contraindication, thus adequate evaluation promotes equal access to healthcare, improves results, and optimizes resources. The present review provides an overview of and guidelines for the most important psychosocial issues during the pretransplantation phase.
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Affiliation(s)
- M García-Alanís
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México.
| | - L Toapanta-Yanchapaxi
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - M Vilatobá
- Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - R Cruz-Martínez
- Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - A G Contreras
- Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - S López-Yáñez
- Departamento de Trabajo Social, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - N Flores-García
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - E Marquéz-Guillén
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
| | - I García-Juárez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
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16
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García-Alanís M, Toapanta-Yanchapaxi L, Vilatobá M, Cruz-Martínez R, Contreras A, López-Yáñez S, Flores-García N, Marquéz-Guillén E, García-Juárez I. Psychosocial evaluation for liver transplantation: A brief guide for gastroenterologists. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021. [DOI: 10.1016/j.rgmxen.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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17
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Loiselle MM, Gulin S, Rose T, Burker E, Bolger L, Smith P. The relationship between marijuana use and psychosocial variables in living kidney donor candidates. Clin Transplant 2021; 35:e14248. [PMID: 33555627 DOI: 10.1111/ctr.14248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/26/2021] [Accepted: 02/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We investigate whether marijuana use in living kidney donor candidates is associated with psychosocial risk factors that place donors at higher risk for adverse outcomes and the unique associations between marijuana use and donor candidacy. METHODS Medical records of 757 living kidney donor candidates were reviewed. Patients were grouped into marijuana users/abstainers; demographic, psychiatric, and substance use variables were compared. Multivariate logistic regression assessed the independent association of marijuana use on committee approval for donation. RESULTS Marijuana use was associated with lack of health insurance, legal history, lower education level, active and history of substance use disorder, active psychiatric disorder, history of multiple psychiatric diagnoses, and history of suicidality. Marijuana users were also more likely to be young, male, unmarried, and less likely to be approved for donation by the multidisciplinary selection committee. This latter association persisted in multivariate models. CONCLUSIONS This is the first study to show that marijuana use is associated with psychosocial factors that could impact behavioral adherence following kidney donation, while reducing chances of committee approval for kidney donation. Special attention to potential overlay between psychosocial risk factors and marijuana use should be considered when evaluating kidney donors, particularly in context of increasingly legal use.
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Affiliation(s)
- Marci M Loiselle
- Department of Psychiatry and Behavioral Sciences, Division of Behavioral Medicine, Duke University Medical Center, Durham, NC, USA
| | - Shaina Gulin
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Terra Rose
- Department of Allied Health Sciences and Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Eileen Burker
- Department of Allied Health Sciences and Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Lauren Bolger
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Patrick Smith
- Department of Psychiatry and Behavioral Sciences, Division of Behavioral Medicine, Duke University Medical Center, Durham, NC, USA
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Guorgui J, Ito T, Markovic D, Aziz A, Younan S, Severance A, Lu M, Lee J, DiNorcia J, Agopian VG, Farmer DG, Busuttil RW, Kaldas FM. The impact of marijuana use on liver transplant recipients: A 900 patient single center experience. Clin Transplant 2021; 35:e14215. [PMID: 33406299 DOI: 10.1111/ctr.14215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/16/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Increased societal prevalence of marijuana continues to challenge liver transplant (LT) programs. This study aimed to examine the potential effects of marijuana use on outcomes. METHODS This retrospective study included recipients who underwent LT between 1/2012 and 6/2018. According to pre-LT marijuana use, patients were classified into recent (≤6 months of LT), former (chronic use but not ≤6 months), or non-users. Additionally, the impact of post-LT marijuana use on survival was assessed. RESULTS Of 926 eligible patients, 184 were pre-LT marijuana users (42 recent; 142 former) (median follow-up: 30.3 months). Pre-users were more likely to be male, White, and have histories of tobacco, alcohol, and illicit drug use. Additionally, recent users were of higher acuity, with higher MELD and requiring ICU admission. Patient survival at 1-year was 89% in non-users, 94% (HR: 0.494, 95% CI: 0.239-1.022 vs. non-users) in former users, and 83% (HR: 1.516, 95% CI: 0.701-3.282) in recent users. Post-operative complications in pre-LT users and the survival analysis for post-LT marijuana users vs. non-users did not show significance. CONCLUSIONS Our results demonstrated that marijuana use did not have an adverse impact on post-LT outcomes; however, further studies utilizing larger cohorts are warranted.
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Affiliation(s)
- Jacob Guorgui
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Takahiro Ito
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Daniela Markovic
- Department of Medicine Statics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Antony Aziz
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Stephanie Younan
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alyscia Severance
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michelle Lu
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jane Lee
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph DiNorcia
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vatche G Agopian
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Douglas G Farmer
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ronald W Busuttil
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Fady M Kaldas
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Cannabis use and bariatric surgery psychology practice: survey and insights. Surg Obes Relat Dis 2020; 17:701-710. [PMID: 33551252 DOI: 10.1016/j.soard.2020.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/16/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cannabis is second only to alcohol as a substance of abuse and dependence in the United States. While there is extensive research examining alcohol use and bariatric surgery, there is currently little research and there are no published guidelines specific to cannabis use and bariatric surgery. OBJECTIVES To identify major themes and general guidelines applied by bariatric surgery psychology clinicians. SETTING This practice survey was disseminated to bariatric surgery psychologists at various U.S. academic medical centers, hospitals, and private practices. METHODS An electronic, 35-question survey was sent to 47 bariatric surgery psychologists to collect information on current clinical practice guidelines regarding cannabis use before and after bariatric surgery. RESULTS The survey questionnaire was completed by 34 (72.34%) bariatric surgery psychologists. The major identified themes included: (1) the lack of a standardized assessment of cannabis use; (2) a requirement for 3 months of abstinence from cannabis before bariatric surgery; (3) recommended lifetime abstinence from cannabis after bariatric surgery; and (4) discussion of cannabis use risks following bariatric surgery, including appetite stimulation, addiction potential, and possible negative impacts on judgment. CONCLUSION Cannabis use will likely further increase in the United States. This survey highlighted common bariatric surgery psychology practices in the absence of extensive research and published guidelines. These findings suggest a preliminary framework with which to address cannabis use in patients seeking bariatric surgery. It is recommended that professional organizations and societies build on these initial survey findings to develop guidelines for more consistent, evidence-based practice regarding cannabis use and bariatric surgery.
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Famiglietti A, Memoli JW, Khaitan PG. Therapeutic Application of Cannabis in Medicine and Its Relevance to Thoracic Surgery. Ann Thorac Surg 2020; 112:665-671. [PMID: 33248994 DOI: 10.1016/j.athoracsur.2020.08.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/12/2020] [Accepted: 08/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cannabis is the most commonly used illicit substance in the United States. As cannabis use rises in popularity and its legalization continues to expand, the scientific community must address the controversy between beneficial and adverse effects of cannabis consumption. METHODS We performed a comprehensive literature review to study the medicinal and pathologic effects of cannabis use, with emphasis on its association with cancer pathophysiology and thoracic surgery. RESULTS We found evidence that cannabis products often contain carcinogenic materials and that their use is associated with the development of certain head and neck cancers, but not lung cancer. Indeed, several in vitro and in vivo studies have demonstrated that cannabis may have a therapeutic role in cancer given the antiproliferative effects of its active compounds such as δ-9-tetrahydrocannabinol. Cannabis-derived products have also been shown to be effective treatments for chronic pain, neuropathy, spasticity, and as antiemetics. CONCLUSIONS We acknowledge that additional studies are required to elucidate the long-term effects of cannabis products and that many potential biases and limitations exist in the literature due to self-reporting and limited survey studies. Appropriate stewardship over cannabis use among our patient population will likely determine its full implications in both oncologic and perioperative outcomes.
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Affiliation(s)
- Amber Famiglietti
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Jessica Wang Memoli
- Division of Interventional Pulmonology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Puja Gaur Khaitan
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC; Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC.
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21
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Almogi-Hazan O, Or R. Cannabis, the Endocannabinoid System and Immunity-the Journey from the Bedside to the Bench and Back. Int J Mol Sci 2020; 21:ijms21124448. [PMID: 32585801 PMCID: PMC7352399 DOI: 10.3390/ijms21124448] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
The Cannabis plant contains numerous components, including cannabinoids and other active molecules. The phyto-cannabinoid activity is mediated by the endocannabinoid system. Cannabinoids affect the nervous system and play significant roles in the regulation of the immune system. While Cannabis is not yet registered as a drug, the potential of cannabinoid-based medicines for the treatment of various conditions has led many countries to authorize their clinical use. However, the data from basic and medical research dedicated to medical Cannabis is currently limited. A variety of pathological conditions involve dysregulation of the immune system. For example, in cancer, immune surveillance and cancer immuno-editing result in immune tolerance. On the other hand, in autoimmune diseases increased immune activity causes tissue damage. Immuno-modulating therapies can regulate the immune system and therefore the immune-regulatory properties of cannabinoids, suggest their use in the therapy of immune related disorders. In this contemporary review, we discuss the roles of the endocannabinoid system in immunity and explore the emerging data about the effects of cannabinoids on the immune response in different pathologies. In addition, we discuss the complexities of using cannabinoid-based treatments in each of these conditions.
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Shockcor N, Adnan SM, Siegel A, Wise E, Zafar SN, Kligman M. Marijuana use does not affect the outcomes of bariatric surgery. Surg Endosc 2020; 35:1264-1268. [DOI: 10.1007/s00464-020-07497-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/02/2020] [Indexed: 01/10/2023]
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23
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Phillips KA, Thrush PT, Lal AK, Kindel SJ, Castleberry C, Sparks J, Daly KP, Johnson JN. Marijuana in pediatric and adult congenital heart disease heart transplant listing: A survey of provider practices and attitudes. Pediatr Transplant 2020; 24:e13640. [PMID: 31960528 DOI: 10.1111/petr.13640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
Abstract
Despite increasing legalization and use of marijuana, there is no consensus among pediatric heart transplant institutions or providers regarding users' eligibility for cardiac transplant. We sent a survey to pediatric and ACHD transplant providers (physicians, surgeons, transplant coordinators, and pharmacists) assessing their current institution's policies and their personal opinions about marijuana use in patients being considered for heart transplantation. Of the respondents, 84% practice in the United States and Canada. Most providers (80%) care for both pediatric and ACHD patients. Respondents included cardiologists (77%) and surgeons (11%), with the remaining being coordinators and pharmacists. Most providers (73%) reported their institution had no policy regarding marijuana use in heart transplant candidates. Only 20% of respondents' institutions consider mode of consumption, with 87% and 53% approving of oral and transdermal routes, respectively, and only 7% approving of vaporized or smoked routes. While 73% of providers would consider illegal marijuana use an absolute/relative contraindication to heart transplant listing, the number decreases to 57% for legal recreational users and 21% for legal medical users. Most providers personally believe marijuana to be physically and mentally/emotionally harmful to pediatric patients (67% and 72%, respectively). Many institutions lack a policy regarding marijuana use in pediatric and ACHD heart transplant candidates, and there is considerable disagreement among providers on the best practice. With increasing legalization and use of marijuana, each institution will have to address this issue thoughtfully to continue to provide high-quality, consistent, and equitable care for pediatric and ACHD heart transplant candidates.
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Affiliation(s)
| | - Philip T Thrush
- Department of Pediatrics/Division of Cardiology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Ashwin K Lal
- Department of Pediatrics/Division of Cardiology, University of Utah, Salt Lake City, Utah
| | - Steven J Kindel
- Department of Pediatrics/Division of Cardiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Chesney Castleberry
- Department of Pediatrics/Division of Cardiology, St. Louis Children's Hospital, St. Louis, Missouri
| | - Joshua Sparks
- Department of Pediatrics/Division of Cardiology, Norton Children's Hospital, Louisville, Kentucky
| | - Kevin P Daly
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jonathan N Johnson
- Department of Pediatrics/Division of Cardiology, Mayo Clinic, Rochester, Minnesota
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24
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The impact of recreational cannabinoids on peri-operative outcomes. J Plast Reconstr Aesthet Surg 2020; 73:184-199. [DOI: 10.1016/j.bjps.2019.05.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 11/21/2022]
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25
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26
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Moadel D, Chism K. Medical Marijuana-Induced Tacrolimus Toxicity. PSYCHOSOMATICS 2019; 60:603-605. [DOI: 10.1016/j.psym.2019.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 12/01/2022]
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27
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Zhu J, Peltekian KM. Cannabis and the liver: Things you wanted to know but were afraid to ask. CANADIAN LIVER JOURNAL 2019; 2:51-57. [PMID: 35990221 PMCID: PMC9202751 DOI: 10.3138/canlivj.2018-0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 12/10/2018] [Indexed: 07/29/2023]
Abstract
Many Canadians use cannabis for medicinal and recreational purposes. We describe the current understandings of how cannabis is metabolized in the liver and its potential interactions with other common drugs. We also summarize how cannabis may exert various effects in chronic liver diseases (CLDs), especially in chronic hepatitis C virus (HCV) and fatty liver disease.
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Affiliation(s)
- Julie Zhu
- Correspondence: Julie Zhu, Victoria Building, QEII Health Sciences Centre, 1276 South Park Street; Halifax, Nova Scotia B3H 2Y9, Canada. Telephone: 902-473-5841. Fax: 902-473-2783. E-mail:
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Ryan JE, Noeder M, Burke C, Stubblefield SC, Sulieman S, Miller EG. Denying renal transplantation to an adolescent medical cannabis user: An ethical case study. Pediatr Transplant 2019; 23:e13467. [PMID: 31124250 PMCID: PMC6671627 DOI: 10.1111/petr.13467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/26/2018] [Accepted: 03/30/2019] [Indexed: 11/28/2022]
Abstract
Medical cannabis is now legal in over half of the United States. As more patients adopt this unconventional therapy, it is inevitable that potential transplant recipients will disclose their cannabis use during transplant evaluation. Transplant teams are tasked with the decision to utilize a pressure resource, often with little guidance from international and national professional organizations. Many healthcare providers remain uniformed or misinformed about the risks of cannabis use and organ transplantation. In order to illustrate the multifaceted and complex evaluation of transplant patients using medical cannabis, this article presents the case of a 20-year-old woman recommended for renal transplant who was originally denied active listing due to her medical cannabis use. A review of the literature explores the perceived and actual risks of cannabis use in the immunocompromised patient. Furthermore, a discussion of the ethics of medical cannabis use and organ transplantation is included with recommendations for multidisciplinary transplant teams.
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Affiliation(s)
- Jennie E. Ryan
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan,Nemours/AI duPont Hospital for Children, Wilmington, Delaware
| | - Maia Noeder
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware
| | - Christine Burke
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware
| | - Samuel C. Stubblefield
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Salwa Sulieman
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elissa G. Miller
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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29
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Bui QM, Allen LA, LeMond L, Brambatti M, Adler E. Psychosocial Evaluation of Candidates for Heart Transplant and Ventricular Assist Devices: Beyond the Current Consensus. Circ Heart Fail 2019; 12:e006058. [DOI: 10.1161/circheartfailure.119.006058] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Advanced heart failure therapies, including heart transplantation and durable mechanical circulatory support, are available to a limited number of patients because of the scarcity of donors, expense, and large burden of care. The importance of psychological and social determinants of health, including cognitive status, health literacy, psychopathology, social support, medical adherence, and substance abuse, are emphasized in advanced heart failure and further amplified in the context of mechanical circulatory support and heart transplantation. The psychosocial assessment of advanced heart failure therapy candidates remains largely subjective, requiring a multidisciplinary evaluation, which may include psychiatrists, social workers, case managers, financial coordinators, pharmacists, and clinicians. Objective tools—including the Stanford Integrated Psychosocial Assessment for Transplantation, Psychosocial Assessment of Candidates for Transplantation, and Transplant Evaluation Rating Scale—were developed and validated in limited populations to help standardize the evaluation process. Small, retrospective studies have inconsistently shown that these tools may predict clinical outcomes in the transplant population, with higher-risk scores associated with readmissions, rejection episodes, and infections. However, it has been more difficult to show that these tools can predict mortality, and their applicability to the mechanical circulatory support population is less studied. The International Society for Heart and Lung Transplantation released a consensus statement in 2018 to promote consistency of psychosocial evaluation across advanced heart failure programs, but it lacks specific recommendations given the current state of evidence. This state-of-the-art review expands on the current consensus by critically reviewing current studies supporting available objective assessment tools, proposing a psychosocial evaluation framework that uses a multidisciplinary approach and offering future directions for research.
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Affiliation(s)
- Quan M. Bui
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
| | - Larry A. Allen
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora (L.A.A.)
| | - Lisa LeMond
- Department of Cardiology, Mayo Clinic Arizona, Phoenix (L.L.)
| | - Michela Brambatti
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
| | - Eric Adler
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
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MacGowan GA, Dark JH, Corris PA, Nair AR. Effects of drug abuse, smoking and alcohol on donor hearts and lungs. Transpl Int 2019; 32:1019-1027. [PMID: 31172575 DOI: 10.1111/tri.13468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/04/2019] [Accepted: 05/31/2019] [Indexed: 12/16/2022]
Abstract
Potential heart and lung donors with a history of illicit drugs and/or smoking and alcohol are frequently offered, though there is no clear guidance on when it is safe to use these organs. A review of the literature on effects of drugs, alcohol and smoking on donor outcomes, and the effects of these on the intact heart and lung was undertaken. There has been a marked increase in deaths from opioid abuse in many developed countries, though recent evidence suggests that outcomes after cardiothoracic transplantation are equivalent to nonopioid donor causes of death. For donor smoking, there is an increased risk with lung transplantation; however, that risk is less when compared to further waiting on the transplant list for a nonsmoking alternative. Heavy alcohol consumption does not adversely affect heart transplantation, and there is no clear evidence of adverse outcomes after lung transplantation. There are no overall effects of cannabis or cocaine on survival after heart or lung transplantation. In all these cases, careful donor assessment can establish if a particular organ can be used. In most cases, use of drugs requires careful assessment, but is not in of itself a contraindication to cardiothoracic transplantation.
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Affiliation(s)
- Guy A MacGowan
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - John H Dark
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Paul A Corris
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Arun R Nair
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Department of Respiratory Medicine, Freeman Hospital, Newcastle upon Tyne, UK
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31
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Ruckle D, Keheila M, West B, Baron P, Villicana R, Mattison B, Thomas A, Thomas J, De Vera M, Kore A, Wai P, Baldwin DD. Should donors who have used marijuana be considered candidates for living kidney donation? Clin Kidney J 2019; 12:437-442. [PMID: 31198546 PMCID: PMC6543962 DOI: 10.1093/ckj/sfy107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The use of marijuana in the USA has been steadily increasing over the last 10 years. This study is the first to investigate the effect of marijuana use by live kidney donors upon outcomes in both donors and recipients. METHODS Living kidney donor transplants performed between January 2000 and May 2016 in a single academic institution were retrospectively reviewed. Donor and recipient groups were each divided into two groups by donor marijuana usage. Outcomes in donor and recipient groups were compared using t-test, Chi-square and mixed linear analysis (P < 0.05 considered significant). RESULTS This was 294 living renal donor medical records were reviewed including 31 marijuana-using donors (MUD) and 263 non-MUDs (NMUD). It was 230 living kidney recipient records were reviewed including 27 marijuana kidney recipients (MKRs) and 203 non-MKRs (NMKR). There was no difference in donor or recipient perioperative characteristics or postoperative outcomes based upon donor marijuana use (P > 0.05 for all comparisons). There was no difference in renal function between NMUD and MUD groups and no long-term difference in kidney allograft function between NMKR and MKR groups. CONCLUSIONS Considering individuals with a history of marijuana use for living kidney donation could increase the donor pool and yield acceptable outcomes.
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Affiliation(s)
- David Ruckle
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Mohamed Keheila
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Benjamin West
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Pedro Baron
- Department of Transplant and Transplant Nephrology, Loma Linda University Health, Loma Linda, CA, USA
| | - Rafael Villicana
- Department of Transplant and Transplant Nephrology, Loma Linda University Health, Loma Linda, CA, USA
| | - Braden Mattison
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Alex Thomas
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Jerry Thomas
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Michael De Vera
- Department of Transplant and Transplant Nephrology, Loma Linda University Health, Loma Linda, CA, USA
| | - Arputharaj Kore
- Department of Transplant and Transplant Nephrology, Loma Linda University Health, Loma Linda, CA, USA
| | - Philip Wai
- Department of Transplant and Transplant Nephrology, Loma Linda University Health, Loma Linda, CA, USA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
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Serrano Rodriguez P, Strassle PD, Barritt AS, Watkins R, Gerber DA, Hayashi PH, Desai CS. Marijuana Consumption in Liver Transplant Recipients. Liver Transpl 2019; 25:734-740. [PMID: 30693668 DOI: 10.1002/lt.25417] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/20/2019] [Indexed: 02/07/2023]
Abstract
Marijuana is legalized for either medical or recreational use in over half of the states in the United States and in Canada, but many transplant centers will not list patients who are using marijuana. However, the effect of marijuana on transplant outcomes remains unclear. Thus, we performed a retrospective analysis of all adult (≥18 years old) liver transplant patients treated at our center between 2007 and 2017. Patients were grouped according to their marijuana use and tobacco smoking status. We also evaluated tobacco smoking status for the comparative evaluation. Posttransplant morbidity, mortality, and graft survival were evaluated. In total, 316 patients were included: 171 (54%) patients were tobacco smokers (70 current; 101 former), 81 (26%) patients were marijuana smokers (13 current; 68 former), and 64 (20#x0025;) patients were both marijuana and tobacco smokers. A total of 136 (43%) reported never smoking marijuana or tobacco. After adjustment, current tobacco users were over 3 times as likely to die within 5 years compared with never users (hazard ratio [HR], 3.25; 95% confidence interval [CI], 1.63-6.46; P < 0.001), but no difference was seen between current/former and never marijuana users (HR, 0.52; 95% CI, 0.26-1.04; P = 0.06). No significant differences in inpatient respiratory complications, reintubation, or >24-hour intubation was seen. Overall, pretransplant marijuana use, past or current, does not appear to impact liver transplant outcomes, though tobacco smoking remains detrimental.
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Affiliation(s)
- Pablo Serrano Rodriguez
- Department of Surgery, Division of Abdominal Transplant Surgery, University of North Carolina, Chapel Hill, NC
| | - Paula Diane Strassle
- Department of Surgery, Division of Abdominal Transplant Surgery, University of North Carolina, Chapel Hill, NC
| | | | - Randall Watkins
- UNC Health Care, University of North Carolina, Chapel Hill, NC
| | - David A Gerber
- Department of Surgery, Division of Abdominal Transplant Surgery, University of North Carolina, Chapel Hill, NC
| | - Paul Hideyo Hayashi
- Liver Center, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Chirag Sureshchandra Desai
- Department of Surgery, Division of Abdominal Transplant Surgery, University of North Carolina, Chapel Hill, NC
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33
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Neuberger J. Liver Transplantation and Marijuana Use: Needing a Joint Approach. Liver Transpl 2019; 25:688-689. [PMID: 30913351 DOI: 10.1002/lt.25456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/22/2019] [Indexed: 02/07/2023]
Affiliation(s)
- James Neuberger
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
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34
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Marijuana use and candidacy for heart transplantation. J Heart Lung Transplant 2019; 38:589-592. [PMID: 31128599 DOI: 10.1016/j.healun.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/24/2019] [Accepted: 03/29/2019] [Indexed: 12/18/2022] Open
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Levi ME, Montague BT, Thurstone C, Kumar D, Huprikar SS, Kotton CN. Marijuana use in transplantation: A call for clarity. Clin Transplant 2019; 33:e13456. [PMID: 30506888 DOI: 10.1111/ctr.13456] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/31/2018] [Accepted: 11/26/2018] [Indexed: 12/22/2022]
Abstract
Transplant centers have varying policies for marijuana (MJ) use in donors, transplant candidates, and recipients. Rationales for these differences range from concerns for fungal complications, impaired adherence, and drug interactions. This paper reviews the current status of MJ policies and practices in transplant centers and results of a survey sent to the American Society of Transplantation (AST) membership by the Executive Committee of the AST Infectious Diseases Community of Practice.The purpose of the survey was to compare policies and concerns of MJ use to actual observed complications. Of the 3321 surveys sent, 225 members (8%) responded. Transplant centers varied in their approval processes, differing even in organ types within the same institutions. Furthermore, there was discordance among transplant centers in their perceived risks of marijuana use as opposed to complications actually observed. An increasing number of states continue to legalize medical and recreational MJ resulting in widespread availability. Further research is needed to assess the validity of concerns for complications of MJ use in potential donors and recipients. Ultimately, standardized guidelines should be established based on studies and evidence-based criteria to assist transplant programs in their policies around the use of cannabis in their donors and recipients.
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Affiliation(s)
- Marilyn E Levi
- Department of Internal Medicine/Division of Infectious Diseases, University of Colorado, Aurora, Colorado
| | - Brian T Montague
- Department of Internal Medicine/Division of Infectious Diseases, University of Colorado, Aurora, Colorado
| | - Christian Thurstone
- Department of Psychiatry, Denver Health and Hospital Authority and University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Deepali Kumar
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Shirish S Huprikar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Camille N Kotton
- Transplant and Immunocompromised Host Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Andrews CN, Devlin SM, Le Foll B, Fischer B, Tse F, Storr M, Congly SE. Canadian Association of Gastroenterology Position Statement: Use of Cannabis in Gastroenterological and Hepatic Disorders. J Can Assoc Gastroenterol 2018; 2:37-43. [PMID: 31294362 PMCID: PMC6507278 DOI: 10.1093/jcag/gwy064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/17/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Christopher N Andrews
- Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Correspondence: Christopher N Andrews, MD, MSc, FRCPC, Clinical Professor, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, 6th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada. E-mail
| | - Shane M Devlin
- Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Acute Care Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Benedikt Fischer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Frances Tse
- Department of Gastroenterology and Hepatology, McMaster University, Hamilton, Ontario, Canada
| | - Martin Storr
- Department of Medicine, University of Munich and Center of Endoscopy, Starnberg, Germany
| | - Stephen E Congly
- Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Abstract
The recent legalization of recreational marijuana use in some parts of the world, the discovery of new indications for the clinical application of cannabis, and the acceptance of the use of cannabis in practice has been paralleled by extensive research on the active components of cannabis and the endocannabinoid system within the human body. In this review, we evaluate the available evidence on cannabis and its constituents and the application of this evidence in clinical practice, focusing particularly on the liver and liver diseases. Constituents of cannabis, such as cannabidiol and Δ-tetrahydrocannabinol, have shown anti-inflammatory, antioxidant, and hepatoprotective effects both in in vitro and clinical studies, and appear to have potential in the symptom management and treatment of various liver diseases that were previously considered difficult to manage conservatively. In addition, the manipulation of the inherent endocannabinoid response system has found favor in many clinical fields and has generated considerable research and clinical interest. Moreover, evidence with regard to the adverse effects of marijuana use in liver diseases is weak, which has led to raise a question on the prior rules, with regard to a denial of liver transplantation to marijuana users. All in all, the recent trends in research, clinical experiences, as well as the legislature, has opened up new avenues towards the widespread clinical application of cannabis and its derivatives as well as modifiers of the components of the endocannabinoid system. More research is required to fully exploit these new evidences.
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates for Long-term Mechanical Circulatory Support. PSYCHOSOMATICS 2018; 59:415-440. [DOI: 10.1016/j.psym.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/09/2018] [Indexed: 12/28/2022]
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support. J Heart Lung Transplant 2018; 37:803-823. [PMID: 29709440 DOI: 10.1016/j.healun.2018.03.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals.
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Affiliation(s)
- Mary Amanda Dew
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Andrea F DiMartini
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Kathleen L Grady
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Annemarie Kaan
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Susan E Abbey
- University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Zeeshan Butt
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Sabina De Geest
- Katholieke Universiteit Leuven, Leuven, Belgium; University of Basel, Basel, Switzerland
| | | | | | - Laurie McDonald
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Linda Ohler
- George Washington University, Washington, DC, USA
| | - Liz Painter
- Auckland City Hospital, Auckland, New Zealand
| | | | - Desiree Robson
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | | | - Jonathan P Singer
- University of California at San Francisco, San Francisco, California, USA
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Dew MA, Posluszny DM, DiMartini AF, Myaskovsky L, Steel JL, DeVito Dabbs AJ. Posttransplant Medical Adherence: What Have We Learned and Can We Do Better? CURRENT TRANSPLANTATION REPORTS 2018; 5:174-188. [PMID: 30416933 DOI: 10.1007/s40472-018-0195-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose of review Non-adherence to the medical regimen after kidney transplantation can contribute to poor clinical outcomes, and strategies to maximize adherence are sought by care providers and patients alike. We assessed recent evidence on prevalence, risk factors, and clinical outcomes associated with non-adherence to the medical regimen after kidney transplantation. We summarized recent clinical trials testing interventions to improve adherence and generated recommendations for future research and clinical practice. Recent findings A large evidence base documents rates of non-adherence to each of the multiple components of the regimen, including medication-taking, lifestyle activities, clinical care requirements, and substance use restrictions. Some risk factors for non-adherence are well known but the full range of risk factors remains unclear. Non-adherence to immunosuppressants and to other components of the regimen increases morbidity and mortality risks. Recent interventions, including education and counseling; electronic health strategies; and medication dose modifications, show promise for reducing immunosuppressant non-adherence. However, most of these interventions would be difficult to deploy in everyday clinical practice. Systematic dissemination of efficacious interventions into clinical practice has not been undertaken. Summary Rates and risk factors for non-adherence to the medical regimen have been examined and there is evidence that non-adherence may be ameliorated by a range of interventions. Although gaps in the evidence base remain, it would be timely to devote greater efforts to dissemination of findings. Thus, efforts are needed to assist transplant programs in using existing evidence to better identify patients who are non-adherent and to design and implement strategies to reduce or prevent non-adherence.
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Affiliation(s)
- Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.,Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and the Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Donna M Posluszny
- Department of Medicine and University of Pittsburgh Medical Center Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea F DiMartini
- Departments of Psychiatry and Surgery and the Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Larissa Myaskovsky
- Department of Internal Medicine, Nephrology Division, and the Center for Healthcare Equity in Kidney Disease, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Jennifer L Steel
- Departments of Surgery, Psychiatry, and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Annette J DeVito Dabbs
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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