Mediating role of inner strength in the relationship between medication literacy and medication adherence among kidney transplant patients

Objective:Compared with long-term renal replacement therapy,kidney transplantation is the ideal treatment for end-stage renal disease(ESRD),significantly extending patient life and improving quality of life.Kidney transplant patients need to adhere to lifelong immunosuppressive medication regimens,but their medication adherence is generally poor compared with other organ transplant recipients.Medication adherence is closely related to medication literacy and psychological status,yet related studies are limited.This study aims to investigate the current status of medication adherence,inner strength,and medication literacy in kidney transplant patients,analyze the relationships among these 3 factors,and explore the mediating role of inner strength in the relationship between medication literacy and medication adherence.Methods:A cross-sectional survey was conducted from March to October 2023 involving 421 patients aged≥18 years who visited kidney transplantation outpatient clinics at 4 tertiary hospitals in Hunan Province.The inner strength,medication literacy,and medication adherence of kidney transplant patients were investigated using the Inner Strength Scale(ISS),the Chinese version of the Medication Literacy Assessment in Spanish and English(MedLitRxSE),and the Chinese version of the Morisky Medication Adherence Scale-8(C-MMAS-8),respectively.Univariate analysis was performed to examine the effects of demographic and clinical data on medication adherence.Correlation analysis was conducted to explore the relationships among medication literacy,medication adherence,and inner strength.Significant variables from univariate and correlation analyses were further analyzed using multiple linear regression,and the mediating effect of inner strength was explored.Results:Among the 421 questionnaires collected,408 were valid,with an effective rate of 96.91%.The scores of C-MMAS-8,MedLitRxSE,and ISS were 6.64±1.16,100.63±14.67,and 8.47±4.03,respectively.Among the 408 patients,only 86(21.08%)patients had a high level of medication adherence,whereas 230(56.37%)patients had a medium level of medication adherence,and 92(22.55%)patients had poor medication adherence.Univariate analysis indicated that the kidney transplant patients’age,marital status,education levels,years since their kidney transplant operation,number of hospitalizations after the kidney transplant,and adverse drug reactions showed significant differences in medication adherence(all P<0.05).Correlation analysis showed that inner strength positively correlated with both medication literacy(r=0.183,P<0.001)and medication adherence(r=0.201,P<0.001).Additionally,there was a positive correlation between medication adherence and medication literacy(r=0.236,P<0.001).Inner strength accounted for 13.22%of the total effect in the mediating role between medication literacy and medication adherence.Conclusion:The level of medication adherence among kidney transplant patients needs improvement,and targeted intervention measures are essential.Inner strength mediates the relationship between medication literacy and medication adherence in these patients.Healthcare professionals should focus on enhancing medication literacy and supporting patients’inner strength to improve medication adherence.

Immunosuppressive treatment and radiotherapy in kidney transplant patients:A systematic review

BACKGROUND Immunosuppression(IS)therapy may contribute to cancer development.Some authors have proposed to reduce immunosuppression drugs dose in case of viral infections,in immunosuppression-related diseases,and in patients undergoing radiotherapy.The present analysis reports the results of a systematic review on kidney transplant recipients undergoing immunosuppression and radiotherapy.AIM To define if it is necessary reduce immunosuppression drugs during radiotherapy.METHODS The literature search was based on three electronic databases(Pubmed,Scopus,and Web of Science)using selected keywords linked through the"AND"and"OR"Boolean operators to build specific strings for each electronic search engine.Two researchers independently screened the citations,and disagreement was resolved by discussion or through the intervention of a third author.The review was conducted and reported according to the PRISMA statement.Extracted data were narratively synthesized,and,where possible,frequencies,percentages,and ranges were calculated.RESULTS The literature search resulted in 147 citations.After abstracts screening,21 records were selected for full-text evaluation.Fifteen of these were excluded,leaving six papers considered suitable for analysis.There is still no clear evidence that withdrawing antimetabolites and/or calcineurin inhibitors and/or mammalian target of rapamycin-inhibitors,as opposed to continuing maintenance IS,improves patient survival in kidney transplant recipients with cancer undergoing radiotherapy.Only few retrospective studies on small cancer patient cohorts are available in this setting,but without comparison of different immunosuppression treatments.Even where immunosuppression therapy was described,patient survival seemed to be correlated only with cancer stage and type.CONCLUSION The results of this systematic review do not support the reduction of immunosuppression dose in patients undergoing radiotherapy.

Clinical Study of Different Immunosuppressive Regimens in Liver Transplant Patients

[Objectives]To explore the clinical effect of different immunosuppressive regimens in liver transplant patients.[Methods]The study patients were 147 liver transplant patients who underwent liver transplantation in a hospital and received CNI-based immunosuppression in the first two years after the operation.Both groups were given mycophenolate mofetil+glucocorticoid,and the control group was additional given cyclosporine,and the experimental group was given tacrolimus.Followed up and made a record of the liver and kidney function indicators,blood routine examination,blood sugar,and blood concentration of immunosuppressive drugs in the two groups of patients at 3,6,12,18,and 24 months after the operation,and the clinical pharmacist regularly adjusted the dose of immunosuppressive drugs.The renal function indicators of the two groups were compared:glomerular filtration rate(eGFR)and serum creatinine(Scr)level.[Results]Within 24 months after the operation,the eGFR level in the two groups showed a declining trend,and the Scr level showed a rising trend,indicating a decline in renal function;the renal function of the control group decreased at 3 months after operation,and the difference was significant(P<0.05);the renal function of the experimental group also decreased at 12 months after operation,and the difference was significant(P<0.05).[Conclusions]The TAC based triple immunization regimen can delay the decline of renal function in liver transplant patients,and the efficacy is significantly better than the CsA based triple immunization regimen.

Multidisciplinary Approach to Drug-Drug Interactions between Tacrolimus and Sofosbuvir/Velpatasvir and Glecaprevir/Pibrentasvir in Kidney Transplant Patients during Hepatitis C Treatment:A Case Series Report

The direct acting antivirals(DAAs)are now the standard of care for hepatitis C virus(HCV)treatment with high and effective sustained virologic responserate(SVR)and great safety profile,including solid organ transplant patients.There are increasing reports showing DAAs are effective with high SVR rates and safety profile in kidney transplant recipients.There are reports on drug-drug interaction(DDI)between tacrolimus with DAAs.However,data remain lacking on potential DDIs between tacrolimus and DAA regimens and the management process.This case series reports three kidney transplant patients on tacrolimus who were successfully treated for HCV with multidisciplinary approach,although there was DDI between tacrolimus with sofosbuvir/velpatasvir and glecaprevir/pibrentasvir,which required tacrolimus dose adjustment to maintain therapeutic level during and after DAA treatment.Such DDIs should be aware of and closely monitored by pharmacist and physicians with tacrolimus dose adjustment as needed during and right after DAA treatment in post-kidney transplant patients.

Salvage living-donor liver transplantation to previously hepatectomized hepatocellular carcinoma patients:is it a reasonable strategy?

Salvage liver transplantation (LT) has been performed for recurred hepatocellular carcinoma(HCC) or for deterioration of liver function after resection of HCC. Controversies arise, howeverover the technical feasibility of salvage LT in patientswho underwent liver surgery,

Selection of patients with hepatocellular carcinoma before liver transplantation:need to combine alpha-fetoprotein with morphology?

Liver transplantation is the best treatment for selected patients with unresectable hepatocellular carcinoma (HCC). While candidate selection has been historically based on the restrictive Milan

Liver transplantation benefits selected patients with hilar cholangiocarcinoma and colorectal liver metastases

Hilarcholangiocarcinoma(HCCA)isanaggressivemalignancy with a dismal prognosis. The 5-year survival rate has been reported to range from 39%to 50%if an R0 resection is obtained [1]. Approximately 25%patients with early stage HCCA of all cases can be treated with radical surgical resection [2], while most patients do not have a chance to receive a surgical procedure due to the advanced stage at the time of diagnosis. The poor prognosis is gen-

Allogeneic hematopoietic stem cell transplantation in 24 patients with β-thalassemia major

Objective To investigate the effect of allgeneic hematopoietic stem cell transplantation ( allo - HSCT ) for β - thalassemia major. Methods Twenty - four β - thalassemia major patients with median age of 4 years ( range: 2 -15 years) ,18 boys and 6 girls,received al-

Influence of organic anion transporting potypeptide(SLCO1B1 and SLCO1B3)genetic polymorphisms on mycophenolic acid in Chinese kidney transplantation patients

Objective To analyze the relationship between genetic polymorphisms of organic anion transporting polypeptide ( SLCO1B1 and SLCO1B3) and mycophenolic acid ( MPA) pharmacokinetics in Chinese kidney transplant recipients. Methods Gene mutations ( SLCO1B3 T334G,SLCO1B1 A338G) were detected in 68 recipi-

The Safety of Autologous Peripheral Blood Stem Cell Transplantation by Intracoronory Infusion in Patients with Acute Myocardial Infarction

Objectives Bone-marrow stem-cell transplantation has been shown to improve cardiac function in patients with acute myocardial infarction (AMI) , but the safety of intracoronory infusion of autologous peripheral blood stem-cell (PBSCs) in patients with AMI is unknown. For this reason, we observe the feasibility and safety of PBSCs transplantation by intracoronory infusion in such patients. Methods 41 patients with AMI were allocated to receive granulocyte colony-stimulating factor (G- CSF: Filgrastim,300μg) with the dose of 300μg~ 600μg/day to mobilize the stem cell, and the duration of applying G-CSF was 5 days. On the sixth day, PBSCs were separated by Baxter CS 3000 blood cel 1 separator into suspend liquid 57 ml. Then the suspend liquid was infused into the infarct related artery (IRA) by occluding the over the wire balloon and infusing artery through balloon center lumen. In the process of the intracoronary infusion of PBSCs, the complications should be observed, which were arrhythmias including of bradycardia, sinus arrest or atrial ventricular block, premature ve. ntricular beats ,ven~icular tachycardia, ventricular fibrillation; and hypotention, etc. Results There were total 10 cases with complications during the intracoronary infusion of PBSCs. The incidence of complications was 24.4% (10/41), including bradyca- rdia was 2.4 % (1/41), sinus arrest or atrial ventri- cular block was 4.0% (2/41), ventricular fibrillation was 2.4 % (1/41), hypotention was 14.6 % (6/41). Conclusions In patients with AMI, intracoronary infusion of PBSCs is feasible and safe.

Modified upper abdominal cluster transplantation in patients with end-stage liver diseases associated with insulin dependent type 2 diabetes mellitus

Objective Modified upper abdominal cluster transplantation ( MCT) ,which was inspired by classical cluster transplant technique,has been proven more effective and feasible in the treatment of patients with end stage liver diseases associated with insulin - dependent

Effect of desensitization treatment for highly sensitized uremic patients before kidney transplantation

Objective To explore the feasibility and efficacy of desensitization protocol for highly sensitized renal transplant patients ( HSP ) . Methods Thirty - five HSPs ( HLA class - I panel reactive antibody 2〉50 % ) , including 27 patients with a positive T and/or B cell cy-

Ailogeneic hematopoietic cell transplantation for malignant hematological diseases in patients older than 50 years of age

Objective To investigate the efficiency and safety of allogeneic hematopoietic cell transplantation for malignant hematological diseases in patients older than 50 years of age. Methods From May 2002 to January 2010,35 patients P 】 50 years with malignant hematological diseases received allogeneic hematopoietic

A comparative study of pancreatic endocrine function and related metabolism after long-term survival between the patients with combined kidneypancreas transplantation vs those with combined en bloc ' liver-pancreas transplantation

Objective To compare the effects of combined en bloc liver - pancreas transplantation ( LPT) with portal vein drainage and simultaneous combined kidney - pancreas transplantation ( KPT) with systemic venous drainage on the pancreatic endocrine function and related me-

Steps To ward HIV Cure Two more HIV-infected patients appear to be virus-free after bone-marrow transplants

THIS year＇s International AIDS Society Conference on HIV Pathogenesis, Treatment and Preven-／tion, held in Kuala Lumpur, Malaysia, made major headlines when Timothy Hendch, an American doctor, announced that two more cancer patients may have been cured of HIV after receiving bone-marrow transplants to treat lymphoma. Both patients had been taking retroviral medication, and continued to do so after the transplants as their viral levels sank until doctors were unable to find any traces of HIV in the patients＇ blood.

Insights into hepatitis E virus epidemiology in Croatia

BACKGROUND Hepatitis E virus(HEV)is an emerging virus of global health concern.The seroprevalence rates differ greatly according to geographic region and population group.AIM To analyze the seroprevalence of HEV in exposed(animal-related professions)and nonexposed populations,as well as solid organ and hematopoietic stem cell transplant patients.METHODS Forestry workers(n=93),hunters(n=74),and veterinarians(n=151)represented the exposed population.The general population(n=126)and pregnant women(n=118)constituted the control group.Transplant patients included liver transplant recipients(LTRs)(n=83),kidney transplant recipients(KTRs)(n=43),and hematopoietic stem cell transplant recipients(HSCRs)(n=39).HEV immunoglobulin G antibodies were detected using the enzyme-linked immunosorbent assay and confirmed by the immunoblot test.RESULTS The HEV seroprevalence significantly differed between groups:Veterinarians 15.2%,hunters 14.9%,forestry workers 6.5%,general population 7.1%,and pregnant women 1.7%.In transplant patients,the seropositivity was highest in LTRs(19.3%),while in KTRs and HSCRs,the seroprevalence was similar to the general population(6.9%and 5.1%,respectively).A significant increase in seropositivity with age was observed from 2.9%in individuals less than 30 years to 23.5%in those older than 60 years.Sociodemographic characteristics(sex,educational level,area of residence,and number of household members),eating habits(game meat,offal,and pork products consumption),and environmental and housing conditions(drinking water supply,type of water drainage/sewer,waste disposal,domestic animals)were not associated with HEV seropositivity.However,individuals who reported a pet ownership were more often seropositive compared to those who did not have pet animals(12.5%vs 7.0%).CONCLUSION The results of this study showed that individuals in professional contact with animals and LTRs are at higher risk for HEV infection.In addition,age is a significant risk factor for HEV seropositivity.

Telaprevir/boceprevir era: From bench to bed and back

Hepatitis C virus (HCV) infects approximately 200 million people worldwide. Interferon-based therapies have dominated over the past two decades. However, the overall response rates remain suboptimal. Thanks to the tremendous effort from both academia and industry, two serine protease inhibitors telaprevir and boceprevir for treating chronic hepatitis C have finally reached the clinic. Although these compounds are only approved for combination use with interferon and ribavirin in genotype 1 HCV infected chronic patients, the management of HCV patients however is now evolving incredibly. Here, we overviewed a series of landmark studies, regarding the clinical development of telaprevir and boceprevir. We discussed the mechanism-of-action of telaprevir/boceprevir and their potential application in HCV-positive liver transplantation patients. We further emphasized some emerging concerns with perspective of further development in this field.

THE ROLE OF ETOPOSIDE (VP-16) IN PREPARATORY REGIMENS FOR PATIENTS WITH LEUKEMIA UNDERGOING ALLOGENEIC BONE MARROW TRANSPLANTATION

In 1983,we began a series of five clinical trials with the goal of reducing the relapse rate following