Journal Article Annotations
2024, 1st Quarter
Annotations by Sarah R. Andrews, MD, Gregory Nikogosyan, DO
April, 2024
The finding:
In this study involving 207 adult recipients of liver transplants at five US transplant centers, researchers found that 23% of recipients reported a high financial burden, defined as spending ≥10% of their annual income on out-of-pocket medical costs. This high financial burden was significantly associated with higher daily activity impairment compared to recipients with a lower financial burden. Adjusted analyses revealed that high financial burden was independently linked to delayed or foregone medical care and the inability to afford daily necessities. Recipients experiencing high financial burden reported lower health-related quality of life (HRQOL) as measured by the EQ-5D-5L compared to those with a low financial burden and the general population. These results highlight the importance of addressing financial burden in liver transplant recipients to improve outcomes and quality of life both before and after transplantation.
Strength and weaknesses:
This study provides valuable insights into the financial burden experienced by liver transplant recipients and the need to screen for out-of-pocket expenses. However, limitations include the cross-sectional design, potential selection bias related to the COVID-19 pandemic, and the lack of clinical outcome data to assess the broader impact of socioeconomic factors on patient outcomes. Despite these limitations, the study highlights the importance of addressing financial challenges in liver transplant recipients to improve their overall well-being and outcomes.
Relevance:
This study is relevant to CL psychiatrists because it sheds light on the significant financial burden faced by adult recipients of liver transplants and its impact on their mental health and well-being. Understanding the association between high financial burden and adverse outcomes such as delayed medical care and lower health-related quality of life can help CL psychiatrists identify and support patients who may be struggling with financial distress. By recognizing and addressing the financial challenges faced by liver transplant recipients, CL psychiatrists can work collaboratively with the medical team to improve patient outcomes and overall mental health during the transplant process and beyond.
The finding:
This review discussed multiple aspects of the assessment and management of cannabis use in liver transplant candidates and recipients. The paper highlights the importance of conducting appropriate assessments and management regardless of the differences in policies between states for liver transplant candidates who use cannabis, given the health consequences of hazardous cannabis use. Additionally, it suggests monitoring cannabis use during screening and in the long-term post-transplant period due to significant drug-drug interactions, especially with immunosuppressants, in preventing graft rejection and other health effects. The final decision on determining high-risk and/or contraindications for liver transplant candidates was left to specialist evaluation and selection conference.
Strength and weaknesses:
The authors addressed multiple stages in the transplant process related to cannabis use. Additionally, they provided significant insights on facilitating appropriate multidisciplinary team discussions and listing conferences to reduce inequity. There was a thorough review of literature challenging more conservative practices while considering state laws and differences among transplant centers. Practical insights into diagnosing hazardous cannabis use and managing perioperative cannabis withdrawal were explored, along with a review of guideline recommendations from various organizations. Unfortunately, the paper did not offer an opinion on which liver candidates using cannabis may be considered high risk for transplant or contraindicated for transplant. Instead, they appropriately deferred this decision to listing selection committees for a final determination.
Relevance:
Given significant differences in listing practices among transplant centers for candidates using cannabis, this article helps identify factors considered by various transplant centers to determine appropriateness for listing and briefly discusses the available evidence, if any. Elements of psychosocial assessment and management throughout the transplant process, as well as biological concerns related to cannabis use, are significant aspects of transplant psychiatry reviewed in this article.