Transplant Team Research Articles

First Report With Medium-term Follow-up of Intestinal Transplantation for Advanced and Recurrent Nonresectable Pseudomyxoma Peritonei.

To report our experience with the combination of radical surgical excision and intestinal transplantation in patients with recurrent pseudomyxoma peritonei (PMP) not amenable to further cytoreductive surgery (CRS). CRS and heated intraoperative peritoneal chemotherapy are effective treatments for many patients with PMP. In patients with extensive small bowel involvement or nonresectable recurrence, disease progression results in small bowel obstruction, nutritional failure, and fistulation, with resulting abdominal wall failure. Between 2013 and 2022, patients with PMP who had a nutritional failure and were not suitable for further CRS underwent radical debulking and intestinal transplantation at our centre. Fifteen patients underwent radical exenteration of affected intra-abdominal organs and transplantation adapted according to the individual case. Eight patients had isolated small bowel transplantation and 7 patients underwent modified multivisceral transplantation. In addition, in 7 patients with significant abdominal wall tumor involvement, a full-thickness vascularized abdominal wall transplant was performed. Two of the 15 patients died within 90 days due to surgically related complications. Actuarial 1-year and 5-year patient survivals were 79% and 55%, respectively. The majority of the patients had significant improvement in quality of life after transplantation. Progression/recurrence of disease was detected in 91% of patients followed up for more than 6 months. Intestinal/multivisceral transplantation enables a more radical approach to the management of PMP than can be achieved with conventional surgical methods and is suitable for patients for whom there is no conventional surgical option. This complex surgical intervention requires the combined skills of both peritoneal malignancy and transplant teams.

Remote ex vivo lung perfusion at a centralized evaluation facility.

In the US, only 23% of lungs offered for transplantation are transplanted. Ex vivo lung perfusion (EVLP) allows for evaluation of additional donor lungs; its adoption has been limited by resources and expertise. Dedicated facilities with a centralized lung evaluation system (CLES) could expand access to EVLP. In this unblinded, nonrandomized, traditional feasibility study, 7 US transplant centers referred lungs declined for standard transplantation to a dedicated EVLP facility, which utilized a CLES. EVLP was remotely monitored by the transplant teams. CLES lungs were matched with contemporaneous conventional static cold-preserved controls at each center. A total of 115 recipients were enrolled, and 66 received allografts from 63 donors after EVLP at the dedicated CLES facility. Forty-nine contemporaneous patients served as controls. Primary graft dysfunction grade 3 at 72 hours (PGD3-72 hours) was higher in the CLES group with 16 (24%) vs 2 (4%) in the control (common RD 95% CI, 0.07-0.32; p=0.0009). All recipients survived to 30 days and 1-year survival was similar for both groups (92% controls vs 89% CLES; common RD 95% CI, -0.14-0.08; p=0.58). Total preservation time, hospital and ICU lengths of stay, and time to first extubation were longer in the CLES group. Remote ex vivo perfusion of lung allografts declined for conventional transplantation at a dedicated CLES facility is feasible and resulted in additional transplants. Recipients of allografts assessed with a CLES had a higher rate of PGD3-72 hours, but similar 30-day and 1-year outcomes compared to conventional lung recipients. (NCT02234128).

Recalibrating Transplant Eligibility Criteria: Ensuring Equitable Access to Organ Transplantation for Intellectually Disabled Persons

The American with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act have made little progress towards preventing disability-based discrimination within the organ transplant evaluation process. Intellectual and developmental disabilities (I/DD) pose a unique problem for transplant teams and transplant physicians because I/DDs can simultaneously be a legitimate contraindication for transplantation and a mechanism for invidious discrimination against intellectually disabled persons. A culprit for ongoing disability-based discrimination is a transplant center's authority to develop its own eligibility criteria. While medical criteria for eligibility are generally well-settled, psychosocial criteria - an amorphous constellation of risk factors for post-transplant success - can serve as a facially neutral disguise for social worth determinations of individuals with I/DDs. Consequently, individuals with I/DDs are unjustifiably denied eligibility for organ transplantation and transplant-related services.This Article begins by identifying the pitfalls of current federal antidiscrimination legislation. It then discusses the foreseen benefits and drawbacks of House Resolution (H.R.) 8981, a recently proposed federal bill, that expressly prohibits disability-based discrimination within the organ transplant evaluation process. The Article ends by offering potential solutions for professional organizations and transplant centers that aim to provide for equitable access to organ transplantation and transplant-related services for intellectually disabled individuals.

Experience with the transition process of adolescents with chronic diseases from pediatric to adult care in a general hospital.

The continuity of care from pediatrics to adult medicine is key to optimal health care. To describe the experience of the transition process of adolescent patients with chronic diseases from pediatric to adult care in a general hospital. Cross-sectional study of patients aged 16-24 years with a history of liver transplantation, kidney transplantation, endocrine, metabolic, rheumatic diseases, and myelomeningocele seen at a tertiary care teaching general hospital between 2015 and 2019 during the transition process. The process of health care and transition success were assessed. The Transition Readiness Assessment Questionnaire (TRAQ) was used. A total of 372 patients were included. The myelomeningocele clinic, the kidney transplant and the liver transplant teams were the most common specialties. Thirty-seven percent of participants were involved in the transition process. The mean duration of follow-up by pediatrics until transition initiation was 9 years. The mean age at the beginning of transition was 19 years, and the mean age at the end, 21 years. The joint clinic transition strategy was the most frequent, used in 96% of cases. The median value of the ordinal TRAQ was 4; of these, 32% had already seen adult care physicians. A successful transition was achieved by 32.7%. The continuity of care during transition is a process that took almost 2 years; more than one third of the patients had a successful transition.

"Creating Blue Skies Overhead for All" Introduction of the 2022 Recipient of the Medawar Prize of the Transplantation Society: Professor Jeremy Chapman.

"Creating Blue Skies Overhead for All" Introduction of the 2022 Recipient of the Medawar Prize of the Transplantation Society: Professor Jeremy Chapman.

Hematopoietic Stem Cell Transplantation Activity in China 2020–2021 During the SARS-CoV-2 Pandemic: A Report From the Chinese Blood and Marrow Transplantation Registry Group

Between 2020 and 2021, 31,525 hematopoietic stem cell transplantations (HSCTs) were reported to the Chinese Blood and Marrow Transplantation Registry Group throughout mainland China. In this report, we describe the activity and current trends for HSCT in China during the SARS-CoV-2 pandemic. In 2020, a total of 13,415 cases of HSCT were reported from 166 transplantation teams, and 75% (10,042 cases) were allogeneic HSCTs. In 2021, a total of 18,110 cases of HSCT were reported from 174 transplantation teams, and 70% (12,744 cases) were allogeneic HSCTs. Haploidentical donor (HID) transplantation accounted for 63% (7977 cases) of allogeneic HSCTs in 2021. The most common indications for allogeneic HSCT for malignant disease were acute myeloid leukemia (37%) and acute lymphoblastic leukemia (23%), and the largest proportion of nonmalignant disease comprised aplastic anemia (13%). The peripheral blood stem cell source accounted for 41% of HIDs and 75% of matched sibling donors. The BuCy-based regimen (57%) was the most popular conditioning regimen for allogeneic HSCT, followed by the BuFlu-based regimen (28%) and total body irradiation-based regimen (11%). This survey provides comprehensive information about the current activities and might benefit clinical physicians' decision planning for HSCT.

Can You Spare 100 Days? The Allogeneic Hematopoietic Cell Transplant Caregiver Requirement

Allogeneic hematopoietic cell transplantation (alloHCT) is a potentially curative treatment for patients diagnosed with blood cancers (e.g., acute myeloid leukemia), and blood disorders (e.g., sickle cell disease). It is a resource intensive treatment that generally requires a long hospital stay and recovery period. Patients are often required to have a caregiver to proceed with alloHCT, and if continuous caregiver support is not available, alloHCT likely will not be a treatment option. Few studies have described caregiver requirements or looked at the effect of these requirements on access to alloHCT. To learn more about caregiver requirements and perspectives on those requirements, we conducted web-based focus groups with alloHCT social workers who worked with adult patients at United States (US) transplant centers (TCs) from May-July 2022. Web-based interviews with adult alloHCT recipients, caregivers of adult alloHCT recipients, and physicians/advanced practice professionals (APPs) will also be conducted. Twenty-two social workers from TCs across the US (Midwest [n=8]; West [n=5]; Northeast: [n=5]; South, [n=4]) and with varying alloHCT volumes (median: 97 alloHCTs performed per year [range: 25-487]). All of the social workers noted their TC required a caregiver to proceed to alloHCT. However, there was variation across TCs around the length of time a recipient was required to have a caregiver. Other variations included the distance/time needed to stay near the center post-alloHCT and COVID-19 vaccination requirements for patients/caregivers. The majority of participants noted variance among the transplant team in allowing exceptions for caregiver requirements. The majority of participants noted their TC either did not allow patients to hire caregivers from an agency or discouraged this practice; and if it was allowed, noted it rarely occurs due to the large cost. Some of the participants noted that the requirements were developed by quality or legal teams with input from the transplant team, but some of the participants did not know where the requirements originated. All participants noted it would be helpful to have a 'gold standard’ of requirements across TCs, though there was discussion about what these standards would include, and the importance of flexibility to account for different patient and TC needs. Participants noted the number of patients that do not proceed to an alloHCT due to lack of a caregiver is generally 1-2/year; one participant noted, "I do have worries that patients aren't being referred who don't have caregivers, and we just don't know about them and they're falling through the cracks.” Social workers were also asked to identify patient barriers to meeting the caregiver requirement; common barriers included patients feeling they did not have anyone to ask to be a caregiver, the need for housing/relocation close to the TC, and financial barriers. They also noted the impact of the COVID-19 pandemic (e.g., vaccination requirements of the TC or lodging options, and increased telework which allowed for more flexibility for caregivers). Finding a caregiver is one of many barriers patients face in getting to transplant. In analysis of the first of four populations interviewed in this study, social workers reported variation in caregiver requirements across TCs. This study focused on those who received a transplant, but further research is necessary to learn about barriers faced by patients who are unable to get to alloHCT. Results from this and the other cohorts will describe current practices and help inform the development of new programs at the National Marrow Donor Program/Be The Match focused on reducing caregiver-related barriers to alloHCT.

Preexisting Coronary Artery Disease in Liver Transplant Candidates: Risk Factor or Risk Marker?

Preexisting Coronary Artery Disease in Liver Transplant Candidates: Risk Factor or Risk Marker?

Updated diagnosis and graft involvement for visceral leishmaniasis in kidney transplant recipients: a case report and literature review

PurposeVisceral leishmaniasis (VL) has become a rising concern to transplantation teams, being associated with graft dysfunction and reduced survival of renal transplant recipients. Here, we describe a case of VL occurring in a kidney transplant (KT) recipient in Italy, a country in which Leishmania infantum is endemic and we reviewed the literature on the clinical course and diagnosis of VL in KT recipients residing or travelling to southern Europe.ResultsThe VL case was diagnosed 18 months after transplant and 28 days after the onset of symptoms by quantitative PCR (qPCR) on peripheral blood. A graft biopsy showed renal involvement, and PCR performed on graft tissue displayed the presence of Leishmania DNA. The retrospective confirmation of Leishmania-positive serology in a serum sample collected before transplantation, as well as the absence of anti-Leishmania IgG in the graft donor strongly suggest that reactivation of a latent parasitic infection caused VL in the current case.ConclusionVL is often underdiagnosed in transplant recipients, despite the presence of latent Leishmania infection being reported in endemic countries. This case report, as well as the literature review on leishmaniasis in KT recipients, underline the importance of rapid VL diagnosis to promptly undergo treatment. Serology is scarcely sensitive in immunocompromised patients, thus molecular tests in peripheral blood should be implemented and standardized for both VL identification and follow-up.

Impact of psychosocial factors on medication level variability index and outcomes in pediatric liver transplant recipients.

Caregivers play an important role in maintaining a functioning graft after pediatric liver transplantation. Therefore, the psychosocial factors of both patients and caregivers can have a critical impact on transplant outcomes. Appropriate assessment and recognition of these factors pre-transplantation may allow transplant teams to better define the needs of pediatric organ recipients and develop specific countermeasures, which may then contribute toward improving transplant outcomes. We studied 136 pediatric LT recipients followed at Texas Children's Hospital. Licensed social workers conducted comprehensive pre-transplant assessments on each patient, consisting of 22 psychosocial variables that were thought to impact adherence, which were reviewed during our study period. Non-adherence was determined using the MLVI for up to 4 years after transplantation. Biopsy-confirmed rejection episodes were assessed in the first 3 years after liver transplantation. Factors significantly associated with non-adherence (defined as MLVI >2) included parental age and parental education level at assessment, type of insurance, and household income. The number of ACR episodes trended higher in patients with non-adherence, and these patients had a higher number of moderate to severe rejection episodes but this trend was not statistically significant. Psychosocial characteristics such as parental age, education level, insurance, and household income may contribute significantly to suboptimal adherence to medications after transplantation. Identification of these psychosocial factors and early intervention is essential to the success and equitable care of our pediatric LT recipients.

RF06 | PSAT153 Osteoporosis Screening of Liver Transplant Patients in a Tertiary Urban Medical Center

Abstract Background Liver transplantation is an established treatment for patients with end-stage liver disease. In 2021 more than 8,400 liver transplants were performed in the United States. Although successful transplantation can reverse many complications of end organ failure, disturbance of bone and mineral metabolism may persist, which can contribute substantially to morbidity and mortality. It is important to assess whether liver transplant patients are getting bone density screening and treatment. Objective Our goal is to assess current practice in bone density screening in patients who have undergone liver transplant at our medical center, to identify if these patients are being screened for metabolic bone disease before and after transplant, and to improve management of such patients by initiating a provider work flow that is based on available data and evidence. Study Design: The first phase was a survey of the liver transplant team to assess the current protocol for screening. The second phase involved retrospective chart review of patients at our institution who had a liver transplant between October 2008 and April 2021. The findings will be used to create an institutional protocol for osteoporosis screening and management. Results Survey results: 62.5% of liver transplant providers knew that guidelines or a protocol are being used to screen liver transplant recipients for osteoporosis. 75% said that dual-energy x-ray absorptiometry (DXA) scans are always obtained before liver transplantation, while 25% said they are sometimes obtained. There were mixed results regarding monitoring post transplant. All respondents agreed that creating a protocol for osteoporosis screening would improve outcomes of bone health in transplant patients. Chart review results: We reviewed 243 liver transplant recipients between October 2008 and April 2021. After excluding duplicate transplants and those less than 18 years old, 234 patients were included in analysis. 59% of patients were men with a median age of 63.5. The most common etiologies of pre-transplant liver disease were Hepatocellular Carcinoma (29%), Hepatitis C (17%), alcoholic cirrhosis (16%) and NASH (5%). 72% of transplant patients had a DXA before transplant and 28% did not. Of those with a pre-transplant DXA, 28% had normal bone density, 50% had osteopenia, and 20% had osteoporosis. The remainder did not have data available. Among those with a diagnosis of osteoporosis pre-transplant, 41% received treatment while 56% did not receive any bone-specific therapy. Discussion The majority of providers in our liver transplant team are aware of the need for bone health screening and treatment in liver transplant candidates. Most patients received a DXA prior to transplant however less than half of the patients with osteoporosis were started on treatment. Our study shows the need for developing an institutional work flow to optimize bone health in patients undergoing liver transplant. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Saturday, June 11, 2022 1:06 p.m. - 1:11 p.m.

Care of the organ transplant receiver: Review

Organ transplantation is the process of replacing damaged/inoperative organs with healthy ones. Many parameters are considered in the decision-making process for this procedure. At first, compatibility parameters of the recipient individual and the donor should be evaluated. All laboratory values and tissue compatibility tests should be compared. The organ transplant coordinator shares the patient’s compliance information with the team. The recipient patient is informed of the match, and the process begins. Preparing the recipient for transplantation is as difficult as finding the appropriate organ. During the first stages, the individual is evaluated and meets with the entire transplant team. Everyone on the transplant team explains their roles and responsibilities. The patient can ask questions. Information is given about complications and negative care processes encountered after transplantation. Patients most often experience differences of opinion in religious and cultural dimensions. On the one hand, he/she wants to live; on the other hand, he/she thinks transplantation is a “sin”. These confusing thoughts can increase and be replaced by psychosocial issues. The transplant nurse initiates the patient’s rehabilitation process. This process is based on an immunosuppressive treatment plan to strengthen the patient’s immunity before transplantation. The transplantation plan provides guidance on transplant day, donor patient preparation, and organ safety. This review serves as a guide for recipient individual. This review study consists of specific sub-titles related to the subject.

The altruistic elderly, a valuable but unrecognised kidney donor group. A case report of an 85-year-old unspecified kidney donor

BackgroundKidney transplantation is the definitive treatment for end stage renal disease (ESRD), offering improved quality of life and survival benefit over remaining on dialysis. There is, however, a prevailing significant mismatch between patients awaiting transplantation and available donor kidneys. Over time, initial stringent donor criteria have broadened and organs from extended criteria donors (ECDs) and older donors are now being accepted for transplantation. The spectrum of living donors has also undergone a change from close family members to an increasingly non-related, non-directed altruistic donors, newly classified as ‘unspecified’ donors. Unspecified elderly donors could be a potential untapped resource to expanding the kidney donor pool globally.Case PresentationWe present a case of an 85 year and 8 months old individual, who donated to an unrelated non-directed matched recipient in the national deceased donor transplant waiting list with excellent donor and recipient outcomes at 7 years.ConclusionTo our knowledge she is one of the oldest reported unspecified living kidney donors in the world to date. This case illustrates that elderly donors in good health can come forward to donate, knowing that it is safe and valuable. Once the immediate perioperative challenges after kidney donation are managed, elderly donors rarely encounter long term sequelae. We therefore report this case to increase awareness and refocus attention of transplant teams on elderly donors as a potential untapped group to help address the organ shortage problem in renal transplantation.

Feasibility of using a patient-reported outcome measure into clinical practice following pediatric liver transplantation: The Starzl Network experience.

Patient-reported outcome measures (PROMs) are not routinely used in clinical care by pediatric liver transplant (LT) teams. The Starzl Network for Excellence in Pediatric Transplantation (SNEPT) assessed feasibility of using a disease-specific Quality of Life (QoL) questionnaire in the ambulatory setting at 10 SNEPT sites. A mixed methods feasibility project assessing administration processes, barriers, and user experiences with the Pediatric Liver Transplant Quality of Life (PeLTQL) tool. Iterative processes sought stakeholder feedback across four phases (Pilot, Extended Pilot, Development of a Mobile App PeLTQL version, and Pilot App use). A total of 149 patient-parent dyads completed the PeLTQL during LT clinic follow-up. Clinicians, parents, and patients evaluated and reported on feasibility of operationalization. Only two of 10 SNEPT sites continued PeLTQL administration after the initial two pilot phases. Reasons include limited clinical time and available personnel aggravated by the COVID-19 pandemic. In response, a mobile application version of the PeLTQL was initiated. Providing PeLTQL responses electronically was "very easy" or "easy" as reported by 96% (22/23) parents. Administration of a PROM into post-pediatric LT clinical care was feasible, but ongoing utilization stalled. Use of a mobile app towards facilitating completion of the PeLTQL outside of clinic hours may address the time and work-flow barriers identified.

S1437 Harnessing EHR to Improve Care of Patients With Cirrhosis

Introduction: There is an increasing prevalence of patients with decompensated cirrhosis. These patients have a high rate of admission, with over one third readmitted within thirty days. Ultimately, the burden of this chronic illness impedes patients’ quality of life and has an enormous economic impact on the healthcare system. Due to their complex care it is challenging to transition care from inpatient to outpatient management, and if they are being managed by a non-hepatology service, it is likely that not all treatment guidelines are followed. Recent evidence suggests utilization of electronic health records (EHR) leads to improved guideline directed care and coordination. The aim of this project was to utilize the electronic health record (EHR) to improve the coordination, efficiency, and quality of inpatient cirrhosis management. Methods: This project took place in a single tertiary liver transplant center. A group of stakeholders was formed from internal medicine residents, the hepatology and transplant team, and informatics team. Based on patients being managed, ideas were generated that were subsequently plotted on an impact effort matrix. This helped the team determine direction of EHR intervention. Results: The “Liver Accordion” (Figure) was designed to eliminate steps of the workflow and compile necessary temporal information related to patients with cirrhosis or those transplanted for cirrhosis in one view. For example, a patient with a history of decompensated cirrhosis with history of hepatic encephalopathy and an acute kidney injury. The flow sheet would compile the number of recorded bowel movements and the amount of lactulose ordered and received, amount of albumin given, and if their beta blocker and diuretics were held. It also aims to coordinate inpatient care cognizant of their overall care by pulling information regarding patient’s last hepatology appointment, endoscopy screening, or hepatocellular carcinoma screening in a separate tab linked below. Conclusion: The objective of our solution was to develop and implement a temporal data view in the institution’s EHR to allow clinicians to quickly formulate a clinical picture of the patient and thereby track and manage patient’s disease. This will improve care coordination and workflow. Moreover, if adopted by hospitalist teams not trained in managing cirrhosis, patients will not miss recommended treatment. This project offers a novel EHR tool that can be easily adopted and implemented to change clinical practice.Figure 1.: Example of Liver Accordion in a patient being managed for hepatic encephalopathy

IS POST-COVID LUNG FIBROSIS A PROGRESSIVE FIBROSING ILD?

IS POST-COVID LUNG FIBROSIS A PROGRESSIVE FIBROSING ILD?

Alcohol consumption, alcohol use disorder and organ transplantation.

In the present experience we have evaluated the link alcohol consumption/alcohol use disorder (AUD) and organ transplantation (OT) in order to provide adequate suggestions. The data used for the preparation of these recommendations are based on a detailed analysis of the scientific literature published before August 31, 2022 (Web of Science, Scopus, Google Scholar). Furthermore, in the process of developing this work, we consulted the guidelines/position papers of the scientific societies. With regard to the liver transplantation, there are position papers/guidelines that clearly define indications and contraindications for including the AUD patient in the transplant list. One of the major difficulties in this area is psychosocial assessment which can be influenced by stigma. To solve this problem, it is necessary to use objective tools. However, this assessment should be carried out after providing the patient and family adequate tools to be able to create or recreate reliable socio-family support. This behavior should also be used in the case of other OTs. For the latter, however, adequate guidelines must be created which at the moment do not exist or if there are, as in the case of heart transplantation, they are not sufficient. Even in the absence of obvious alcohol addiction, it is recommended to use alcohol use disorder identification test and to include the addiction specialist in the multidisciplinary transplant team. Besides, providing family members with the tools necessary to better support the patient is essential. They are patients with alcohol use disorder/ possible presence of psychopathological manifestations and alcohol-related pathology (cirrhosis, cardiomyopathy, liver-kidney disfunction, etc.). A cardiovascular and oncologic surveillance post-OT is recommended. For the selection of patients to be included in the list for non-LT (heart, lung, kidney, multivisceral, etc.) it is mandatory to include the diagnosis and treatment of AUDs in the guidelines. What has already been indicated for LT may be useful. Timing of alcoholic abstention in relation to clinical severity, optimal psychosocial activity, anticraving therapy in relation to the type of underlying disease and clinical severity. Close collaboration between scientific societies is required to better manage AUD patients who need OT.

Laparoscopic nephrectomy with mini-incision kidney auto- transplantation in severe ureteral strictures: report of three cases and review of the literature

Severe and long ureteral injuries are difficult to be managed. In presence of a complex injury of the upper ureter, nephrectomy, bowel interposition, and kidney autotransplantation (KAT) are usually proposed. Kidney autotransplantation (KAT) represents a complex surgical procedure with a high risk of complications that could preserve renal function. We update our experience with renal autotransplantation for severe iatrogenic ureteral injuries. Three patients with complex ureteral injuries were referred for definitive management by KAT. Transperitoneal laparoscopic nephrectomy (LN) and open mini-incision KAT (mKAT) to the ipsilateral pelvis were attempted. After bench preparation of the graft, ureteral and vessel length and quality was adequate for autotransplantation in all cases. There were no intra- and postoperative complications and all grafts functioned immediately and at medium-term follow-up of 6 months. KAT gives excellent post-operative results without significant deterioration in renal function at medium-term follow-up. It represents a safe alternative method for the management of complex ureteric strictures when conventional surgical techniques have failed or are not suitable. Intensive collaboration with all transplant teams is crucial to ensure the high quality of the graft and to improve surgical and functional outcomes. Keywords: Ureteral stricture, autotransplantation, kidney, surgery

Patient and care provider inclusion in the development of an educational graphic novel for heart transplanted teenagers.

Teenagers experience high rates of rejection and organ failure after heart transplantation due to non-adherence to medications, poor transition into adult care, and difficulties communicating with adults including healthcare providers. This project aimed to creatively bridge this gap-including teenage patients, their parents, and healthcare providers in the development of a new resource meant to motivate teenage heart-transplant-patients to take interest and ownership of their long-term health. Four teenage heart-transplanted patients, four parents, and three healthcare providers provided insight into relevant content for an educational resource through semi-standardized questionnaires and interviews. Their input guided the style and substance of the resource developed under the supervision of Fine Arts professors and the pediatric heart transplant team. Parents and healthcare providers were concerned about teenagers' health choices and lack of perspective while patients were more bothered by parental nagging and being careful about infections than worrying about post-transplant risks. The resource that was developed therefore used subtlety within a narrative medium: a graphic novel that involved mutant worms, secret plots, and daring escapes, to address identified medical concerns and encouragements without triggering teenage resistance to instruction. The discrepancies between the priorities of healthcare providers, parents, and teenage heart-transplant-patients illustrate the significance of basing resource-development on input from the target population. We developed the first graphic novel written for teenage heart-transplant-patients with patient input and interdisciplinary cooperation, using the subtlety of a narrative medium as a model for integrating medical content within an appealing, motivational, patient-centered, and age-appropriate resource.

Recommendations for the Evaluation and Acceptance of Solid Organ Transplantation Candidates in the Covid-19 Context

Abstract: To date, much has been discussed about performing transplants in candidates who test positive for viral testing (e.g., antigen and molecular testing) or recent exposure/condition compatible with Covid-19. Unfortunately, the literature does not yet provide conclusive guidance, and the risk of complications, graft loss, and death must be considered. This paper discusses these points and provides some premises to inform and assist the transplant team’s decision.