Role of surveillance biopsy frequency post intestine transplant: A tertiary care experience

Background: With only 81 intestine transplant (IT) in the U.S. in 2019, the literature on this type of solid organ transplant remains scarce. Frequent surveillance biopsy is required on the first month post IT due to high-risk of acute rejection, however, the frequency of surveillance biopsy 1-month post IT is often determined by the physician and the institutions\u27 preference. Aims: Report IT outcomes and clinical impact of surveillance biopsy at a single tertiary care center. Methods: This is a retrospective review of patients that underwent IT during the time-period between 08/2010 and 03/2020. Primary outcome was the correlation between increased protocol biopsies and mortality. Secondary outcomes included correlation between increased protocol biopsies and hospital re-admissions, length of hospital stay, and rate of biopsy proven rejection detection. Kaplan-Meier curves was used to perform the survival analysis at 6-month, 1-year, and 2-years post-transplant. Results: A total of 35 patients (mean age 47.6 ± 12.9 years, F 22 (63%) underwent IT for: ischemic bowel 11 (31%), Chron\u27s disease 9 (25%), neuroendocrine tumor 6 (17%), trauma 3 (9%) and \u27others\u27 6 (17%), of which 14 (40%) were part of multivisceral organ transplant. During the first-year posttransplant, the median number of biopsies was 12 (IQR 6-30), with evidence of definite acute graft rejection in 40%, 27%, and 41% at the 1-3, 3-6, and 6-12 post IT time intervals, respectively. During the duration of the study, the mortality rate was 18/35 (51%) at a median time of 37 (12-60) months post IT, and a total of 8/35 (23%) patients underwent enterectomy at a median time of 12 (8-36) months post IT (Table 1). In general, there was survival benefit for patients who had a total number of biopsies of ≥ 10 as compared to \u3c 10 biopsies at the time interval of 6-months post IT, (p=0.008) (Table 2). There was a non-significant trend with longer median length of hospital stay in patients with greater number of biopsies. Conclusion: Our results indicate evidence of survival benefit of increased protocol biopsies. Studies with larger sample sizes are required to validate our results

Evaluation of Intestinal Transplantation for Short Bowel Syndrome due to Gun Violence versus Other Causes: A Single Center Experience

Introduction: Short Bowel Syndrome (SBS) due to trauma is a rarely examined problem with a unique solution in Intestine Transplantation. We discuss factors that may have contributed to variations in patient outcome after intestinal transplant surgery secondary to SBS due to gun violence. Methods: A retrospective chart review was conducted for intestinal transplant patients at an urban medical center. Two patients underwent intestinal transplants secondary to SBS after small bowel resections for gunshot related injury (GSW). Trends were noted and compared to trends found among patients comprising the intestinal transplant recipient registry (n=26) at the same medical center. Results: Two patients were transplanted for intestinal failure related to gunshot wound. 24 patients in the non-GSW group were transplanted for other indications including Crohn’s disease (n=6), neuroendocrine tumor (n=5), and anatomic infarction (n=6). The average age for intestine transplant due to GSW was 29.5 years, compared to 47.8 years of non-GSW group. 50% of patients with GSW had rejection within 6 months following intestine transplant versus 36% from the non-GSW group. 50% of the GSW patients were alive one year and 5 years post-transplant. 92% and 71% of the non-GSW patients were alive at one year and 5 years post-transplant respectively. Conclusion: Intestine transplant can be successful in short bowel syndrome due to gunshot wound. Patients should be considered based on co-morbid conditions and risk factors rather than cause of trauma. Further large, multi-center studies are needed to elucidate risk factors related to the success of intestinal transplant for short bowel syndrome due to trauma

Acupuncture in living liver and kidney donors: a feasibility study

OBJECTIVE: The purpose of this study was to test the feasibility of integrating acupuncture into the routine care of living liver and kidney donors during the process of donation and recovery. METHODS: This is a pilot study on the feasibility of a brief acupuncture intervention for living liver and kidney donors. Participants received acupuncture immediately prior to organ donation surgery, every day as inpatients, while recovering from donation, and at a 2-week follow-up. Prior to surgery, questionnaires were completed on acupuncture outcome expectations and the State-Trait Anxiety Inventory. After participating, those who received acupuncture provided feedback. Following the active intervention, a retrospective chart review was conducted, using donors who did not receive acupuncture as a comparison cohort. RESULTS: Forty donor candidates were approached and recruited, 32 consented and ultimately 25 donors participated in the acupuncture intervention (15 of kidney, 10 of liver), 68% female, and 88% Caucasian; only one had prior experience with acupuncture. Participants received an average of 4 sessions while inpatient (range 2-8). Those who expected acupuncture to be more helpful prior to the intervention reported lower inpatient pain scores (P = 0.04). Qualitative feedback from patients was predominantly positive, indicating acupuncture was helpful for relaxation and pain. However, a few patients reported feeling overburdened during postdonation recovery, and that the study was viewed as additional obligation. CONCLUSION: Preliminary findings suggest it is feasible to integrate acupuncture into inpatient recovery for living organ donation. Tailoring interventions to the specific needs of patients is important to address ongoing concerns. Larger studies are needed to further ascertain benefits of peri-operative acupuncture

Acupuncture in living liver and kidney donors: a feasibility study

OBJECTIVE: The purpose of this study was to test the feasibility of integrating acupuncture into the routine care of living liver and kidney donors during the process of donation and recovery. METHODS: This is a pilot study on the feasibility of a brief acupuncture intervention for living liver and kidney donors. Participants received acupuncture immediately prior to organ donation surgery, every day as inpatients, while recovering from donation, and at a 2-week follow-up. Prior to surgery, questionnaires were completed on acupuncture outcome expectations and the State-Trait Anxiety Inventory. After participating, those who received acupuncture provided feedback. Following the active intervention, a retrospective chart review was conducted, using donors who did not receive acupuncture as a comparison cohort. RESULTS: Forty donor candidates were approached and recruited, 32 consented and ultimately 25 donors participated in the acupuncture intervention (15 of kidney, 10 of liver), 68% female, and 88% Caucasian; only one had prior experience with acupuncture. Participants received an average of 4 sessions while inpatient (range 2-8). Those who expected acupuncture to be more helpful prior to the intervention reported lower inpatient pain scores (P = 0.04). Qualitative feedback from patients was predominantly positive, indicating acupuncture was helpful for relaxation and pain. However, a few patients reported feeling overburdened during postdonation recovery, and that the study was viewed as additional obligation. CONCLUSION: Preliminary findings suggest it is feasible to integrate acupuncture into inpatient recovery for living organ donation. Tailoring interventions to the specific needs of patients is important to address ongoing concerns. Larger studies are needed to further ascertain benefits of peri-operative acupuncture

Acupuncture in living liver and kidney donors: a feasibility study

OBJECTIVE: The purpose of this study was to test the feasibility of integrating acupuncture into the routine care of living liver and kidney donors during the process of donation and recovery. METHODS: This is a pilot study on the feasibility of a brief acupuncture intervention for living liver and kidney donors. Participants received acupuncture immediately prior to organ donation surgery, every day as inpatients, while recovering from donation, and at a 2-week follow-up. Prior to surgery, questionnaires were completed on acupuncture outcome expectations and the State-Trait Anxiety Inventory. After participating, those who received acupuncture provided feedback. Following the active intervention, a retrospective chart review was conducted, using donors who did not receive acupuncture as a comparison cohort. RESULTS: Forty donor candidates were approached and recruited, 32 consented and ultimately 25 donors participated in the acupuncture intervention (15 of kidney, 10 of liver), 68% female, and 88% Caucasian; only one had prior experience with acupuncture. Participants received an average of 4 sessions while inpatient (range 2-8). Those who expected acupuncture to be more helpful prior to the intervention reported lower inpatient pain scores (P = 0.04). Qualitative feedback from patients was predominantly positive, indicating acupuncture was helpful for relaxation and pain. However, a few patients reported feeling overburdened during postdonation recovery, and that the study was viewed as additional obligation. CONCLUSION: Preliminary findings suggest it is feasible to integrate acupuncture into inpatient recovery for living organ donation. Tailoring interventions to the specific needs of patients is important to address ongoing concerns. Larger studies are needed to further ascertain benefits of peri-operative acupuncture

Pilot study on acupuncture in living liver and kidney donors

Pain is an important concern in living donation. The purpose of this study was to test feasibility of integrating an acupuncture intervention pre/post-living donation and explore acupuncture\u27s influence on pain in living liver and kidney donors. Methods: Pilot study on feasibility and potential effects of a brief acupuncture intervention on living liver and kidney donors immediately pre-and post-donation. Participants received acupuncture immediately prior to organ donation surgery, every day inpatient for donation and at the 2-week follow-up. Prior to surgery, completed questionnaire on expectation regarding acupuncture and the State-Trait Anxiety Inventory. After participating, provided feedback on acupuncture. Results: Twenty-four donors consented (15 kidneys, 9 liver), 66.7% female, 87.5% Caucasian, only one had prior experience with acupuncture. Mean state anxiety 29.5 (±9.7) and trait anxiety 26.8 (±6.4) were lower than national norms of healthy adults. Participants received an average of 4 acupuncture sessions while inpatient (range 2-8).Those who expected acupuncture to be more helpful prior to the intervention reported lower inpatient pain scores (p=0.04). Qualitative feedback from patients was predominantly positive indicating acupuncture was helpful with relaxation; one patient was able to avoid all narcotic use. However, a few patients reported feeling already overburdened recovering post-donation. Conclusions: Preliminary findings suggest it is feasible to integrate acupuncture into inpatient recovery for living organ donation. Tailoring interventions to the specific needs of patients is important to address ongoing concerns. Given limited sample size, larger studies are needed

An assessment of psychiatric needs pre-and postmultivisceral transplant

Introduction: As intestinal transplant becomes a more viable treatment option, there has been increased interest in quality of life and other psychosocial metrics. Systematic review suggests that quality of life improves post-transplant. However, there is limited data regarding psychosocial issues present at initial evaluation and post-transplant. Given that psychiatric issues are associated with increased mortality in solid organ transplant, this study aims to highlight psychosocial patterns that are present at initial evaluation and post-transplant. Methods: This study was a retrospective chart review of 28 patients who received intestinal transplants between 8/3/10-1/3/17 at an academic hospital in the United States. Psychosocial variables from encounters with health psychology senior staff and trainees were extracted. Descriptive data were evaluated from pre and post-transplant encounters. Results: Pre-transplant, the most common initial diagnosis was adjustment disorder (68%) with more significant pathology occurring in the remaining patients. 3/28 patients had comorbid substance use issues. 12/28 patients were on psychotropic medications during initial evaluation with 50% of those on multiple medications. Figure 1 describes data from initial psychological assessment. Of those eventually transplanted, 8 required further intervention prior to psychosocial clearance. Among the 28 patients, psychology was consulted an average of 2.71 times. Of those that required follow-up, there was an average of 8.25 follow-ups. Most common reasons for consult were; depression, pain, anxiety, eating related issues, mental status concerns, or other. Of the 28 patients, 19 had post-transplant psychiatric diagnoses. Although adjustment disorders were the most prevalent (8/19), more significant pathology was found in remaining patients including opioid abuse (4/19), PTSD (3/19), and pain disorders (3/19). Conclusion: Present analysis suggests that many pre-transplant patients have significant psychopathology. Post-transplant a number of psychosocial issues persist and can emerge on an inpatient and outpatient basis. Development of behavioral health protocols for the most common consultations will be a valuable clinical service. These interventions may improve psychosocial outcomes, decrease patient noncompliance and reduce disease burden and cost. Future prospective studies, extending period of follow up, and assessing a wider range of predictors and outcomes are needed. (Figure Preseted)