Annotated Abstracts of Journal Articles
2015, 2nd Quarter
Annotations by Paula Zimbrean, MD, FAPM
Also of interest:
This article signals a new direction for transplant psychiatry. Uterine transplants are elective rather than life saving, which changes the framework for transplant mental health providers. In addition, incorporating fertility and peri-pregnancy issues in the posttransplant care poses new challenges for all medical providers involved.
This is a systematic review which provides comprehensive information regarding the presence of posttraumatic stress disorder in organ transplant patients.
Keles M, Avsar U, Avsar Z, et al
Transplant Proc 2015; 47(5):1302-5
ANNOTATION (Paula Zimbrean)
The Finding: There was a significant decrease of smoking rate in kidney transplant donors following the donation.
Strength and Weaknesses: This is a prospective study assessing smoking prevalence in living kidney donors, pre- and post- (12 months) donation surgery. The limitation of this study consists in the fact that assessment of smoking status was based on questionnaire only, without any objective measurements such as cotinine levels.
Relevance: This finding is important because it indicates a significant benefit of being a living organ donor. It also prompts the medical professional working with living kidney donors to consider offering smoking cessation treatment as a part of the assessment and follow up.
Introduction: Smoking increases the risk for cardiovascular disease in kidney donors, as is the case with normal individuals; it may also result in the development and progression of chronic renal failure. The present study aimed to investigate the effect of kidney transplant on smoking habits of kidney donors.
Method: The study included 98 donors in total (54 female, 44 male). A questionnaire was administered to donors about smoking status. Smoking status was asked about before surgery and 12 months postoperatively, and the preoperative and postoperative values were compared. The Fagerstörm test for nicotine dependence was administered to individuals who were still smokers and those who had smoked but quit.
Results: The mean age of the participants was 48.27 ± 10.8 years. The preoperative smoking status was 47% (n = 46), whereas the postoperative rate decreased to 29% (n = 28). This reduction in smoking rate was significant (P = .001). There was no difference in Fagerström levels between donors who continued smoking and those who quit smoking after the surgery (P = .583).
Conclusions: A person who becomes a kidney transplant donor has the chance to quit smoking, which is a cardiovascular risk factor. In addition to the psychosocial benefits of being a donor, it should be noted that it might also provide some medical benefits. However, some patients continue smoking after surgery. Smoking should be questioned in the postoperative follow-ups of donors and the support required for smoking cessation should be provided.
ANNOTATION (Paula Zimbrean)
The Finding: This is a case report of 9 patients with Wilson disease and neuropsychiatric symptoms who showed improvement in their neuropsychiatric status after liver transplantation.
Strengths and Weaknesses: The data was collected prospectively and the study includes a significant number of cases considering the low prevalence of Wilson disease. The limitations of the study are given by the instrument used to measure the neurocognitive symptoms: the Unified Wilson Disease Rating Scale is aimed to be a general measure of all symptoms of Wilson disease and does not differentiate between psychiatric and neurological manifestations.
Relevance: This study contradicts prior case reports which have indicated that liver transplant does not provide benefit for the neuropsychiatric manifestations of Wilson disease.
Objectives: This study sought to evaluate the effect of liver transplantation on the neuropsychological manifestations of Wilson disease.
Materials and Methods: Nine of 42 Wilson disease patients had neuropsychological symptoms before liver transplantation. They were 7 male and 2 female subjects with a median age of 19 years (range 10 to 25). They were analyzed for their preoperative and postoperative hepatic, neurological, and psychological scores described by the Unified Wilson Disease Rating Scale after a mean 36.6 months of follow-up.
Results: Preoperative mean Model for End-Stage Liver Disease and Child-Pugh scores were 18.3 (range 15 to 26) and 8.9 (range 6 to 12), respectively. One patient had acute postoperative ischemic stroke unrelated to Wilson disease and was excluded from the statistical analysis. Preoperative and postoperative hepatic, neurological, and psychological scores of the remaining 8 patients were 7.4 ± 2.3 vs 2.4 ± 1.3 (P = .0005), 17.7 ± 11.7 vs 12.7 ± 12.5 (P = .055), and 9.0 ± 1.7 vs 7.0 ± 2.1 (P = .033).
Conclusions: Liver transplantation for Wilson disease can provide some improvement of the neuropsychological symptoms in addition to the hepatic recovery.