Camille Boissière’s research while affiliated with Centre Hospitalier Universitaire de Rennes and other places

Context: Poor medication management can lead to adverse outcomes for transplant patients, including acute rejection and graft loss. In recent years, mobile applications have been proposed as innovative tools to improve patient treatment management. Objective: This review aimed to systematically evaluate the available research evidence on the relationship between mobile applications and treatment management in transplant patients. Methods: The following databases were systematically searched for relevant publications on April 8, 2022, using the PRISMA method: PubMed, Embase, and Google Scholar. The Cochrane risk of bias tool was used to assess the included studies. Observational or interventional studies focusing on the use of mobile applications in adult solid organ transplant patients were included for analysis. Results: A total of 28 articles met the inclusion criteria. The overall methodological quality of the evidence was assessed as low. Most studies were monocentric (n = 23, 82%). The majority of follow-ups focused on kidney transplants (n = 12, 42.9%) with small sample sizes (54%, n < 99), including participants < 60 years old (n = 26, 93%) with follow-up ≤ 6 months (61%). Medication adherence rates showed significant improvements in seven out of 13 trials compared to standard care or placebo. Several features were reported to be most effective in improving patient treatment management, such as self-registration and monitoring, medication reminders based on alerts, and caregiver monitoring to check patients' health indicators or medication adherence. Conclusion: Mobile applications tended to improve medication management in transplant patients compared to standard care. However, due to the heterogeneity of the objectives of the analyzed studies, which do not allow for meta-analysis, further high-level evidence studies evaluating the effects of mobile applications in this area are needed to support effective interventions.

Objectives Therapeutic patient education (TPE) plays a critical role in the management of kidney transplant recipients. However, discrepancies exist in the guidance provided regarding the usage of immunosuppressants across different kidney transplant centres in France. Methods To assess the current landscape of TPE practices in this patient population, an online questionnaire consisting of 51 questions was distributed to 32 French renal transplantation centres. Results The participation rate in our survey was 96.9%, (31 of the 32 centres contacted). The respondents had diverse professions: they were nurses (15/31), physicians (9/31) and pharmacists (7/31). Virtually all institutions have implemented TPE initiatives, with an implementation rate of 93.5% (29/31). The topic of anti-rejection medication was consistently addressed, with only one centre not providing support at the conclusion of these sessions. However, the content of the sessions varied significantly from one centre to another, particularly regarding the proper management of anti-rejection medications. Only 19.4% (6/31) of the centres provided the correct recommendation regarding fasting when taking tacrolimus. Dietary guidance was a topic covered in 89.7% (26/29) of the centres, but significant divergences were also observed. TPE teams primarily consisted of nurses, with pharmacists present in only 51.6% (16/31) of the centres. We also observed limited involvement of patient partners, with just 9.7% (3/31) of the centres including them in their programme. Conclusion These findings highlight considerable variability in the approach towards TPE among kidney transplant centres. Addressing counselling variability and increasing pharmacist and patient partner involvement is an essential step to improving the quality and effectiveness of TPE. By establishing a standardised and comprehensive approach to patient education, healthcare providers can ensure that kidney transplant recipients receive information that will ultimately help them improve their health and well-being.

Background Needleless connectors (NCs) can be disinfected using antiseptic barrier caps (ABCs) to reduce the risk of catheter-related bloodstream infections. However, recent evidence suggests that isopropanol can leak from the ABC into the NC, posing concern about their safe use. We sought to determine in vitro which ABC and NC parameters influence the leakage of isopropanol through the infusion circuit. Methods We assessed 13 NCs and 4 ABCs available in the European market. In vitro circuits consisting of an isopropanol cap, a NC, and an 11-cm catheter line were created. The circuits were left in place for 1 to 7 days at room temperature to assess the kinetics of isopropanol leakage. Isopropanol content in ABC and in circuit flushing solutions (5 mL NaCl 0.9%) after exposure to the cap were measured using gas chromatography with a flame ionization detector. Results The leakage of isopropanol from the cap to the NC was dependent on the NC, but not the cap. The NC mechanism did not predict the leakage of isopropanol. The Q-Syte NC exhibited the most isopropanol leakage (7.01±1.03 mg and 28.32±2.62 mg at 24 hours and 7 days, respectively), whereas the Caresite NC had the lowest isopropanol leakage at 7 days (1.69±0.01 mg). Conclusion The use of isopropanol ABCs can cause isopropanol leakage into the catheter circuit according to NC parameters. Caution should be exercised when using these devices, especially in the pediatric and neonatal population.

Tacrolimus is a widely used immunosuppressant for the prevention of rejection after transplantation. In vitro studies suggest that interactions exist between spices and tacrolimus. We present the case of a renal transplant patient aged around 70 years who was treated with prednisone, mycophenolate-mofetil and tacrolimus. The patient had a pre-transplant dietary habit of consuming foods spiced with turmeric, curry and ginger. The following protocol was implemented in parallel with close monitoring of plasma tacrolimus concentrations: administration of 10 g/day of turmeric for 4 days, then 10 g/day of curry for 4 days and then 10 g/day of ginger for 4 days. No change in tacrolimus plasma concentrations during and after the implementation of the protocol was observed. The impact of turmeric, curry and ginger on plasma tacrolimus concentrations seems negligible in vivo although further studies are needed. A shared decision to test the impact of spice consumption in a patient with dietary habits involving these spices seems reasonable.

Introduction L’éducation thérapeutique du patient (ETP) est un élément clé dans la prise en charge des patients transplantés rénaux. Récemment, des divergences entre les pratiques d’ETP ont été constatés entre plusieurs centres de transplantation rénale. Description L’objectif de ce travail est de réaliser un état des lieux des différentes pratiques d’ETP des centres français de transplantation rénale. Méthodes Un questionnaire de 56 questions a été envoyé aux 10 centres ayant la plus forte activité de transplantation rénale. Les informations collectées concernaient l’existence d’une activité d’ETP (programme ARS ou non) et de conciliation médicamenteuse associée, le nombre de séances d’ETP réalisées ainsi que les contenus des sessions sur les thématiques des médicaments (immunosuppresseurs, anti-infectieux et vaccins), des signes de rejet, de l’hygiène de vie et des loisirs. Les informations ont été colligées dans un fichier Excel pour analyse. Résultats Sur les 7 centres ayant répondus, 6 pratiquent des séances d’ETP validés par l’ARS bien que les programmes soient différents et 4 pratiquent une activité de conciliation médicamenteuse. Dans chaque centre, le nombre de séances d’ETP varient en pré-greffe (0–3) et en post-greffe (4 ou plus). Concernant les médicaments, les divergences concernent majoritairement les modalités de prise du tacrolimus (Fig. 1) et la prescription systématique d’anti-infectieux. La reconnaissance des signes de rejet est évoquée dans l’ensemble des centres et les conseils donnés en cas de fièvre sont unanimes. Cependant, les recommandations concernant l’hygiène de vie et les loisirs varient selon les centres (3 centres proscrivant notamment la baignade post-greffe). Conclusion Des divergences dans les pratiques d’ETP ont été observées notamment sur les conseils de prise des immunosuppresseurs. En perspective, un projet d’homogénéisation pourrait être conduit en collaboration avec l’agence de Biomédecine afin de proposer un support d’ETP commun aux différents centres.