Journal Article Annotations
2017, 1st Quarter

Transplant Psychiatry

Annotations by Paula Zimbrean, MD, FAPM, and Frank Vinitius, MD
April 2017

Development of the Japanese version of the Psychosocial Assessment of Candidates for Transplantation in allogeneic hematopoietic stem cell transplantation
A pilot randomized controlled trial to promote immunosuppressant adherence in adult kidney transplant recipients

Also of interest:

Beckmann M, Paslakis G, Böttcher M, Helander A, Erim Y: Integration of clinical examination, self-report, and hair ethyl glucuronide analysis for evaluation of patients with alcoholic liver disease prior to liver transplantation
Prog Transplant 2016; 26(1):40-46

This study detected a high percentage of ongoing alcohol consumption in a selected group of patients before listing for liver transplantation. One weakness of the study is the cross-sectional design.
The study promotes the discussion how to use hETG in clinical routine. In a further approach, the comparison between the whole group (n=233) and the selected group regarding positive hETG values would be helpful to assess the quality of clinical interview regarding underreporting and denying of alcohol consumption.

PUBLICATION #1 — Transplant Psychiatry

Development of the Japanese version of the Psychosocial Assessment of Candidates for Transplantation in allogeneic hematopoietic stem cell transplantation

Harashima S, Yoneda R, Horie T, et al

Psychosomatics 2017; Jan 19 (Epub ahead of print)

BACKGROUND:
The Psychosocial Assessment of Candidates for Transplantation (PACT) is a validated instrument for evaluating psychosocial risk factors in transplant candidates.

OBJECTIVES:
This study examined reliability and validity of the Japanese version of the PACT (J-PACT).

METHODS:
PACT is a clinician-rated scale consisting of an initial rating, 8 subscales, and a final rating. J-PACT was developed through a translation and back-translation procedure. Seventy adult patients who underwent allogeneic hematopoietic stem cell transplant between April 2009 and December 2013 received retrospective J-PACT ratings based on medical records. Interrater reliability and concurrent validity with Hospital Anxiety and Depression Scale (HADS) and Profile of Mood Status (POMS) scores were assessed.

RESULTS:
Interrater reliability for each J-PACT item was generally high, ranging from 0.53 (drug and alcohol use)-0.93 (support stability). The concurrent validity analyses revealed the following significant relationships (p < 0.05). Higher support stability was associated with lower HADS depression (p = 0.02), POMS anger (p = 0.001), POMS fatigue (p = 0.03), and POMS confusion (p = 0.01) scores. Higher support availability was associated with lower POMS anger scores (p = 0.01). More suitable personality was associated with lower HADS anxiety (p = 0.04) and HADS depression (p = 0.048) scores. Better scores on lifestyle factors and alcohol use were both associated with lower POMS confusion scores (p = 0.01, 0.04, respectively). Better final rating was associated with lower HADS anxiety (p = 0.03) and HADS depression (p = 0.02) scores.

CONCLUSION:
J-PACT was reliable and valid, although further study is needed to confirm these findings.

On PubMed: Psychosomatics 2017; Jan 19 [Epub ahead of print]

Annotation

The finding: This is a validation study for the Japanese version of PACT (Psychosocial Assessment of Candidates for Transplantation), one of the most frequently used instruments to assess the psychosocial risk of transplant candidates. The study was done retrospectively. The investigators evaluated the interrater reliability as well as the correlations between PACT and mood status.

Strengths and weaknesses: Three clinicians were involved in the translation and retrospective application of the scale. Seventy cases were assessed. The most important strength of this study was that no cases were rejected from transplantation; therefore, the validity of PACT was assessed in patients with all ranges of psychosocial risks.

Relevance: This study is important in the context of the ongoing debate about what is the optimal measure for pretransplant psychosocial risk.

PUBLICATION #2 — Transplant Psychiatry

A pilot randomized controlled trial to promote immunosuppressant adherence in adult kidney transplant recipients

Cukor D, Ver Halen N, Pencille M, Tedla F, Salifu M

Nephron 2017; 135(1):6-14

BACKGROUND:
Nonadherence to immunosuppressant medication is a prevalent practice among kidney transplant recipients and has been associated with increased risk for graft failure and economic burden. The aim of this pilot study was to test whether a culturally sensitive cognitive-behavioral adherence promotion program could significantly improve medication adherence to tacrolimus prescription as measured by telephone pill counts among kidney transplant recipients.

METHODS:
Thirty-three adult transplant recipients were less than 98% adherent to tacrolimus prescription based on 3 telephone pill counts and were randomized either to the 2-session cognitive-behavioral adherence promotion program or to standard care. The curriculum was developed from an iterative process with transplant recipients into a 2-session group program that provided psychoeducation, addressed barriers to adherence, fostered motivation to improve adherence behavior, and discussed cultural messages on adherence behavior.

RESULTS:
The intervention group displayed significantly higher levels of adherence when compared to the control group (t = 2.2, p = 0.04) and. similarly, when the amount of change was compared between the groups, the intervention group showed more change than the control condition (F (22,1) = 12.005, p = 0.003). Tacrolimus trough concentration levels were used as a secondary measure of adherence and, while there were no significant between-group differences for mean trough concentration levels, the variability in the trough levels did significantly decrease over time indicating more consistent pill-taking behavior in the intervention group.

CONCLUSIONS:
There is preliminary support for the pilot program as a successful intervention in helping patients with their immunosuppressant medication.

On PubMed: Nephron 2017; 135(1):6-14

Annotation

The finding: Two sessions of cognitive behavioral therapy centered around the behavior of taking medications had a positive effect on improving medication adherence after kidney transplantation.

Strengths and weaknesses: The study is a prospective randomized trial of a brief psychotherapeutic intervention. The main limitations of the study are described by the authors and consists in being localized to one single centre, limited psychological evaluation of subjects, and limited consideration of other psychosocial factors that may interfere with adherence. In addition, the objective measure of adherence was medication levels and there was no discussion about biological factors that can influence those levels (genetic factors or pharmacodynamic interactions).

Relevance: With poor adherence being a main risk factor for posttransplant complications, this study suggests that a short behavioral intervention can have a positive impact.