Long-term Immunosuppression Adherence After Kidney Transplant and Relationship to Allograft Histology

Two Decades of Hand Transplantation: A Systematic Review of Outcomes

ABSTRACT

Hand transplantation for upper extremity amputation provides a unique treatment that restores form and function, which may not be achieved by traditional reconstruction and prosthetics. However, despite enhancing quality of life, hand transplantation remains controversial, because of immunological complications, transplant rejection, and medication effects. This systematic literature review sought to collect information on current experiences and outcomes of hand transplants to determine the efficacy and utility of hand transplants. The databases PubMed, Scopus, and Embase were analyzed with combinations of "hand" or "upper extremity" or "arm" and "transplant" or "allograft," with information collected on recipient characteristics, details of transplant, immunological outcomes, functional outcomes, and complications. Functional outcomes, as measured by Disabilities of Arm, Shoulder and Hand score, were compared between patient groups using Wilcoxon signed-rank test or 1-way analysis of variance test and post hoc Tukey test. Within the 108 articles that fulfilled inclusion and exclusion criteria, there were 96 patients with 148 hand transplants. There were 57 patients who experienced acute rejection and 5 patients with chronic rejection. Disabilities of the Arm, Shoulder and Hand scores significantly decreased after hand transplantation and were significantly lower for distal transplants compared with proximal transplants. There were 3 patients with concurrent face transplantation and 2 patients with simultaneous leg transplants. Sixteen patients experienced amputation of the hand transplant, and there were 5 deaths. This study found that hand transplantation provides significant restoration of function and form, especially for proximal transplants. Reduction in complications, such as rejection and amputation, can be achieved by decreasing medication cost and patient education.

Adherence to Immunosuppressive Medication in Iraqi Kidney Transplant Recipients During the First Year of Transplant. A Single-Center Experience

OBJECTIVES

Our objective was to measure adherence to immunosuppressive medications among Iraqi renal transplant patients at a single center.

MATERIALS AND METHODS

This cross-sectional study was conducted from January to November 2020 in the outpatient unit of the Nephrology and Renal Transplantation Center in Baghdad's Medical City. Seventy-five adult Iraqi renal transplant recipients were recruited. An Arabic version of the Basel Assessment of Adherence to Immunosuppressive Medications (BAASIS) scale was used to evaluate adherence.

RESULTS

The study included 75 adult renal transplant recipients (51 men/24 women) with a mean age of 39.44 ± 12.06 years. The mean time posttransplant was 8.11 ± 3.12 months. In our patient group, 65.33% reported total adherence and 34.6% did not adhere to one (25.3%) or more (9.3%) drug. We observed a statistically significant association between nonadherence and complications (P = .015, chi-square test). Four patients had biopsy-proven acute rejection, and all 4 patients were noncompliant with medications. Binary logistic regression model P values for employment, time after transplant, and complications were .06, .06, and .08, respectively.

CONCLUSIONS

There was a high rate of nonadherence among our sample of Iraqi renal transplant recipients in the first year posttransplant. Time after transplant and transplant complications were related to nonadherence. More extensive multicenter studies are needed to define the actual rate of adherence to immune suppression in Iraq.

Association between Posttransplant Opioid Use and Immunosuppressant Therapy Adherence among Renal Transplant Recipients

INTRODUCTION

Little is known about the effect of posttransplant opioid use on adherence to immunosuppressant therapy (IST) among adult renal transplant recipients (RTRs).

OBJECTIVE

The aim of this study was to examine the relationship between opioid use and IST adherence among adult RTRs during the first year posttransplant.

METHODS

Longitudinal data were analyzed from a retrospective cohort study examining US veterans undergoing renal transplant from October 1, 2007, through March 31, 2015. Data were collected from the US Renal Data System, Centers for Medicare and Medicaid Services Data (Medicare Part D), and Veterans Affairs pharmacy records. Dose of opioid prescriptions was collected and divided based on annual morphine milligram equivalent within a year of transplant. Proportion of days covered of greater than or equal to 80% indicated adherence to tacrolimus. Unadjusted and multivariable-adjusted logistic regression analyses were performed.

RESULTS

A study population of 1,229 RTRs included 258 with no opioid use, while 971 opioid users were identified within the first year after transplantation. Compared to RTRs without opioid usage, RTRs with opioid usage had a lower probability of being adherent to tacrolimus in unadjusted logistic regression (odds ratio [OR] (95% confidence interval [CI]): 0.22 [0.07-0.72]) and adjusted logistic regression (OR [95% CI]: 0.11 [0.03-0.44]). These patterns generally remained consistent in unadjusted and adjusted main and sensitivity analyses.

CONCLUSIONS

Findings indicate RTRs who use prescription opioids during the first year posttransplant, regardless of the dosage/amount, are less likely to be adherent to tacrolimus. Future studies are needed to better understand underlying causes of the association between opioid use and tacrolimus nonadherence.