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Art of the Transplant Infectious Diseases Consult: Storytelling and Science

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Abstract

Purpose of Review

This review sets out to describe the art of the transplant infectious diseases consult for pre-transplant, peri-transplant, and post-transplant patient.

Recent Findings

Emphasis is placed on recent developments in the assessment of antimicrobial allergies, pre-transplant vaccination, management of donor cultures, and antimicrobial stewardship in transplantation. Strategies for effective verbal communication including motivational interviewing and managing cognitive biases, as well as the importance of written communication in the transplant infectious diseases consult, are also highlighted.

Summary

While there may be many variations on this art of the consult, they all revolve around transplant patients’ fascinating and rewarding stories.

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References and Recommended Reading

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  1. Marcon AR, Caulfield T. Donation and transplantation coverage in the Canadian media: a content analysis of story focus over 2 decades. Can J Surg. 2022;65(5):E661–E664. Published 2022 Oct 12. https://doi.org/10.1503/cjs.012721.

  2. Morgan SE, Harrison TR, Chewning L, Davis LS, Dicorcia M. Entertainment (mis)education: the framing of organ donation in entertainment television. Health Commun. 2007;22(2):143–51. https://doi.org/10.1080/10410230701454114.

    Article  PubMed  Google Scholar 

  3. Harbaugh C, Afana M, Burdick S, et al. Portrayal of organ donation and transplantation on American primetime television. Clin Transplant. 2011;25(4):E375–80. https://doi.org/10.1111/j.1399-0012.2011.01427.x.

    Article  PubMed  Google Scholar 

  4. Strassny F, Nerz L, Veidt C, Askonas P, Sorina A, Renard M, et al. The hands of Orlac (Film). Austria: Production company: Pan-Film; 1928.

  5. Kalra GG, Bhugra D. Representation of organ transplantation in cinema and television. Int J Organ Transplant Med. 2011;2(2):93–100.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Lorenz EC, Egginton JS, Stegall MD, et al. Patient experience after kidney transplant: a conceptual framework of treatment burden. J Patient Rep Outcomes. 2019;3(1):8. Published 2019 Jan 30. https://doi.org/10.1186/s41687-019-0095-4.

  7. Lundmark M, Lennerling A, Forsberg A. Developing a grounded theory on adaptation after lung transplantation from intermediate-term patient experiences. Prog Transplant. 2019;29(2):135–43. https://doi.org/10.1177/1526924819835823.

    Article  PubMed  Google Scholar 

  8. Jones J, Damery S, Allen K, Nicholas J, Baharani J, Combes G. ‘You have got a foreign body in there’: renal transplantation, unexpected mild-to-moderate distress and patients’ support needs: a qualitative study. BMJ Open. 2020;10(3):e035627. Published 2020 Mar 31. https://doi.org/10.1136/bmjopen-2019-035627.

  9. McKie P, Webzell I, Tavabie O, Loewenthal D, Heaton N. An exploratory study of the experiences of deceased-donor liver transplant recipients and their need for psychotherapeutic support. J Clin Nurs. 2020;29(15–16):2991–8. https://doi.org/10.1111/jocn.15309.

    Article  PubMed  Google Scholar 

  10. Fishman JA. Infection in organ transplantation. Am J Transplant. 2017;17(4):856–79. https://doi.org/10.1111/ajt.14208.

    Article  CAS  PubMed  Google Scholar 

  11. van Delden C, Stampf S, Hirsch HH, et al. Burden and timeline of infectious diseases in the first year after solid organ transplantation in the Swiss Transplant Cohort Study. Clin Infect Dis. 2020;71(7):e159–e169. https://doi.org/10.1093/cid/ciz1113. This update from the Swiss Transplant Cohort Study offers new insight into the prevalence and timing of infectious diseases complications after transplant. Infections in the first year are common and dominated by bacterial organisms, whereas opportunistic infections are rare in part due to thoughtful prophylaxis.

  12. Fatma C, Cigdem C, Emine C, Omer B. Life experiences of adult heart transplant recipients: a new life, challenges, and coping. Qual Life Res. 2021;30(6):1619–27. https://doi.org/10.1007/s11136-021-02763-y.

    Article  PubMed  Google Scholar 

  13. Tang J, Kerklaan J, Wong G, et al. Perspectives of solid organ transplant recipients on medicine-taking: systematic review of qualitative studies. Am J Transplant. 2021;21(10):3369–3387. https://doi.org/10.1111/ajt.16613. This systematic review integrates findings from multiple qualitative studies of transplant recipient experiences and highlights common post-transplant concerns including susceptibility to infections and adjustment to new illness states replacing the prior state of organ failure.

  14. Memory KE, Wilkinson TJ, Smith AC, Lightfoot CJ. A qualitative exploration of the facilitators and barriers to self-management in kidney transplant recipients. J Nephrol. 2022;35(7):1863–72. https://doi.org/10.1007/s40620-022-01325-w.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mestres-Soler O, Gómez-Ibáñez R, Zuriguel-Pérez E, et al. Expectations of patients awaiting lung transplantation: a qualitative study. Nurs Open. 2023;10(6):3766–73. https://doi.org/10.1002/nop2.1634.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Waldron JL, Trubiano JA. Antibiotic allergy labels in immunocompromised populations. Transpl Infect Dis. 2022;24(5):e13955. https://doi.org/10.1111/tid.13955. This excellent review spans the full spectrum of issues related to antimicrobial allergy label in transplant patients, including common antimicrobial allergy misconceptions and procedures for de-labeling.

  17. Ham YY, Joshi S, Sukerman E. Delabeling penicillin and other antibiotic allergies in solid organ transplantation patients. Transpl Infect Dis. 2022;24(5):e13897. https://doi.org/10.1111/tid.13897.

    Article  PubMed  Google Scholar 

  18. Khumra S, Chan J, Urbancic K, et al. Antibiotic allergy labels in a liver transplant recipient study. Antimicrob Agents Chemother. 2017;61(5):e00078–17. Published 2017 Apr 24. https://doi.org/10.1128/AAC.00078-17.

  19. Walti LN, Mugglin C, Mombelli M, et al. Vaccine-preventable infections among solid organ transplant recipients in Switzerland. JAMA Netw Open. 2023;6(4):e2310687. Published 2023 Apr 3. https://doi.org/10.1001/jamanetworkopen.2023.10687. This update, also from the Swiss Transplant Cohort Study, provides the latest data on vaccine-preventable illnesses after transplantation including prevalence, morbidity, and mortality.

  20. Calmels A, Heng AE, Corbin V, et al. Vaccination coverage reinforced by an infectious disease consultation during pretransplant check-up in patients awaiting kidney transplantation: a randomized study [published online ahead of print, 2023 May 12]. Infect Dis Now. 2023;53(7):104718. https://doi.org/10.1016/j.idnow.2023.104718.

  21. Pineda EMZ, Spinner ML, Pallotta A, Koval C, Bollinger J. Infectious diseases pre-transplant evaluation improves vaccination rates for liver transplant candidates. Transpl Infect Dis. 2019;21(5):e13160. https://doi.org/10.1111/tid.13160.

    Article  PubMed  Google Scholar 

  22. Kasper AK, Pallotta AM, Kovacs CS, Spinner ML. Infectious diseases consult improves vaccination adherence in kidney transplant candidates. Vaccine. 2018;36(34):5112–5. https://doi.org/10.1016/j.vaccine.2018.06.058.

    Article  CAS  PubMed  Google Scholar 

  23. Runyo F, Matignon M, Audureau E, et al. Infectious disease consultation is effective in boosting vaccine coverage in patients awaiting kidney transplantation: a French prospective study. Transpl Infect Dis. 2021;23(4):e13607. https://doi.org/10.1111/tid.13607. This single-center study joins several others in reinforcing the value of infectious diseases consultation for increasing pre-transplant vaccination coverage, but also presents findings related to latent tuberculosis treatment, another important role for pre-transplant infectious diseases consultation.

  24. Harboe ZB, Hald A, Ekenberg C, et al. Implementation of a vaccination clinic for adult solid organ transplant candidates: a single-center experience [published online ahead of print, 2023 Sep 27]. Vaccine. 2023;S0264–410X(23)01106-4. https://doi.org/10.1016/j.vaccine.2023.09.036.

  25. Freeman D, Loe BS, Yu LM, et al. Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): a single-blind, parallel-group, randomised controlled trial. Lancet Public Health. 2021;6(6):e416–27. https://doi.org/10.1016/S2468-2667(21)00096-7.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gagneur A, Battista MC, Boucher FD, et al. Promoting vaccination in maternity wards ─ motivational interview technique reduces hesitancy and enhances intention to vaccinate, results from a multicentre non-controlled pre- and post-intervention RCT-nested study, Quebec, March 2014 to February 2015. Euro Surveill. 2019;24(36):1800641. https://doi.org/10.2807/1560-7917.ES.2019.24.36.1800641.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Rossen I, Hurlstone MJ, Lawrence C. Going with the grain of cognition: applying insights from psychology to build support for childhood vaccination. Front Psychol. 2016;7:1483. Published 2016 Sep 30. https://doi.org/10.3389/fpsyg.2016.01483. This review article summarizes a range of previous findings in the field of vaccine deliberation and persuasion, including an excellent table of cognitive pitfalls that may affect vaccine persuasion. Many of the same findings and pitfalls are relevant for other conversations involving persuasion, such as conversations about antimicrobial use.

  28. Hippen BE, Axelrod DA, Maher K, et al. Survey of current transplant center practices regarding COVID-19 vaccine mandates in the United States. Am J Transplant. 2022;22(6):1705–13. https://doi.org/10.1111/ajt.16995.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Caliskan Y, Hippen BE, Axelrod DA, et al. International practices on COVID-19 vaccine mandates for transplant candidates. Kidney360. 2022;3(10):1754–1762. Published 2022 Aug 15. https://doi.org/10.34067/KID.0004062022.

  30. Edwards AL, Tavakol MM, Mello A, Kerney J, Roberts JP. Pre-transplantation COVID-19 vaccination requirements: a matched case-control study of factors associated with waitlist inactivation [published online ahead of print, 2023 Sep 23]. Am J Transplant. 2023;S1600-6135(23)00697-4. https://doi.org/10.1016/j.ajt.2023.09.009. This single-center study provides an answer to a question posed in the ethics literature about pre-transplant vaccination requirements: what will be the impact of such requirements on equity in access to transplantation?.

  31. Kates OS. Approaches to pretransplant vaccination. Curr Opin Organ Transplant. 2022;27(4):277–84. https://doi.org/10.1097/MOT.0000000000000994.

    Article  PubMed  Google Scholar 

  32. Park J, Saha S, Chee B, Taylor J, Beach MC. Physician use of stigmatizing language in patient medical records. JAMA Netw Open. 2021;4(7):e2117052. https://doi.org/10.1001/jamanetworkopen.2021.17052.

  33. Sun M, Oliwa T, Peek ME, Tung EL. Negative patient descriptors: documenting racial bias in the electronic health record. Health Aff (Millwood). 2022;41(2):203–11. https://doi.org/10.1377/hlthaff.2021.01423.

    Article  PubMed  Google Scholar 

  34. Goddu PA, O'Conor KJ, Lanzkron S, et al. Do words matter? Stigmatizing language and the transmission of bias in the medical record [published correction appears in J Gen Intern Med. 2019 Jan;34(1):164]. J Gen Intern Med. 2018;33(5):685–691. https://doi.org/10.1007/s11606-017-4289-2. This experiment shows the impact that stigmatizing language can have on how patients are perceived and treated by future readers, driving home the importance of language choice in infectious diseases documentation, which is often used as a reference by future readers or copied into others’ notes.

  35. Boutin CA, Pouch SM, Ison MG. Utility of deceased donor cultures in solid organ transplantation in preventing donor-derived bacterial and fungal infectious diseases transmission. Transpl Infect Dis. 2023;25(2):e14032. https://doi.org/10.1111/tid.14032. This is the definitive review of evidence and guidelines for treatment of positive donor culture results and highlights opportunities for decreasing the duration of antimicrobials in the early post-transplant period.

  36. Groff LT, Reed EE, Coe KE, et al. Effectiveness of short vs long-course perioperative antibiotics in lung transplant recipients with donor positive respiratory cultures. Transpl Infect Dis. 2021;23(3):e13518. https://doi.org/10.1111/tid.13518.

    Article  CAS  PubMed  Google Scholar 

  37. Buzo BF, Preiksaitis JK, Halloran K, et al. Association between Mycoplasma and Ureaplasma airway positivity, ammonia levels, and outcomes post-lung transplantation: a prospective surveillance study. Am J Transplant. 2021;21(6):2123–31. https://doi.org/10.1111/ajt.16394.

    Article  CAS  PubMed  Google Scholar 

  38. Roberts SC, Bharat A, Kurihara C, Tomic R, Ison MG. Impact of screening and treatment of Ureaplasma species on hyperammonemia syndrome in lung transplant recipients: a single center experience. Clin Infect Dis. 2021;73(9):e2531–7. https://doi.org/10.1093/cid/ciaa1570.

    Article  PubMed  Google Scholar 

  39. Vijayvargiya P, Esquer Garrigos Z, Kennedy CC, et al. Routine donor and recipient screening for Mycoplasma hominis and Ureaplasma species in lung transplant recipients. Open Forum Infect Dis. 2022;9(11):ofac607. Published 2022 Nov 7. https://doi.org/10.1093/ofid/ofac607.

  40. Guidance for donor and recipient information sharing. Organ Procurement and Transplantation Network. Published/Updated February 17, 2012. https://optn.transplant.hrsa.gov/professionals/by-topic/guidance/guidance-for-donor-and-recipient-information-sharing/. Accessed 1 Sept 2023.

  41. O’Brien GM, Donaghue N, Walker I, Wood CA. Deservingness and gratitude in the context of heart transplantation. Qual Health Res. 2014;24(12):1635–47. https://doi.org/10.1177/1049732314549018.

    Article  PubMed  Google Scholar 

  42. Howick J, Moscrop A, Mebius A, et al. Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis [published correction appears in J R Soc Med. 2018 Oct;111(10):383]. J R Soc Med. 2018;111(7):240–252. https://doi.org/10.1177/0141076818769477.

  43. So M, Hand J, Forrest G, et al. White paper on antimicrobial stewardship in solid organ transplant recipients. Am J Transplant. 2022;22(1):96–112. https://doi.org/10.1111/ajt.16743. This is the definitive review of the current state of antimicrobial stewardship in solid organ transplantation, existing data to support antimicrobial stewardship practices and the limitations of that data in transplantation, as well as priorities for the future.

  44. Imlay H, Spellberg B. Shorter is better: the case for short antibiotic courses for common infections in solid organ transplant recipients. Transpl Infect Dis. 2022;24(5):e13896. https://doi.org/10.1111/tid.13896. This review thoughtfully analyzes the data for shorter courses of antimicrobials predominantly in non-immunocompromised patients and offers insights into how these data can be applied to transplant patients.

  45. Walensky RP, Del Rio C, Armstrong WS. Charting the future of infectious disease: anticipating and addressing the supply and demand mismatch. Clin Infect Dis. 2017;64(10):1299–301. https://doi.org/10.1093/cid/cix173.

    Article  PubMed  Google Scholar 

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Correspondence to Olivia S. Kates MD, MA.

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Kates, O.S. Art of the Transplant Infectious Diseases Consult: Storytelling and Science. Curr Treat Options Infect Dis (2024). https://doi.org/10.1007/s40506-024-00272-3

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