Updates in Transplant Psychiatry

Abstract: Solid organ transplantation (SOT) is a fast-evolving field which obliges C-L psychiatrists working with transplant teams to be informed of the field’s latest medical and psychosocial developments. This course aims to bring psychiatrists up-to-date practical information in a concise and interactive format, focusing on updates in important nomenclature, living donation, relevant toxicology, early liver transplantation (eLT) for alcohol-associated liver disease (ALD), and vascularized composite allotransplantation (VCA).

Dr. Sher will discuss recent significant changes in SOT listing procedures which can affect patient outcomes and wait times. A C-L psychiatrist’s awareness of such logistical adjustments helps her properly counsel and support her candidates.

Dr. Mutalik will provide an update on the psychosocial assessment in directed and non-directed organ donation, touching upon psychiatric conditions and prevalent substance use related conditions. She will discuss medical updates in living donor evaluations, such as APOL1 testing. She will also discuss proactive efforts at soliciting living donors such as RENEWAL and DOVE and will review various frameworks to understand the psychology of altruism. She will explore ethical issues in organ donation, such as the principle of double equipoise.

While ALD has become the most common indication for LT in the United States, substance use influences all organ systems pertinent to SOT. Dr. Fipps will show how toxicology plays a vital role in comprehensive psychosocial candidacy evaluation: diagnostic evaluation of substance use disorders (SUD), monitoring abstinence/adherence, identifying relapses, and influencing treatment of chronic and relapsing SUD. End-stage disease creates toxicological challenges (e.g. urine testing) and newer screening tools can be used for more accurate results.

eLT is an increasingly accepted life-saving therapy for severe acute alcohol-associated hepatitis (SAH). Yet concerns remain about alcohol relapse post-transplantation and its impact on graft survival. Dr Hussain will discuss these opportunities and challenges: alcohol use patterns post-transplant and predictors of relapse, the importance of thoroughly evaluating candidates pre-transplant, and emerging interventions for managing recurring alcohol use disorder.

VCA is an extension of SOT offering unique treatments for restoring function and aesthetics (i.e., more focus on quality of life and function rather than life prolongation) to patients suffering with non-salvageable injuries including severe burns or limb amputation. Dr. Winder will provide background on these diverse procedures and focus on psychosocial elements which are unique to VCA: psychological adaptation to physical disfigurement, coping with social ostracism, adapting to prosthesis function, dealing with media attention, partner’s personal experience with function restoration, and reestablishing sexual and reproductive function.

Each presenter will speak for 30 minutes, followed by engaging in interactive case where participants will break up in small groups to work through a challenging case incorporating above discussed material. The audience will reconvene to discuss their answers and deepen the discussion.