Therapeutic education as a tool to improve patient‐reported and clinical outcomes after renal transplantation: results of the EPHEGREN multicenter retrospective cohort study

Abstract

Summary Patients are not always aware of the inconveniences associated with renal transplantation, which they compare with a « rebirth », and from which they expect complete recovery. Therapeutic education is proposed to prepare patients for their life after transplantation. This study evaluated the impact of pretransplant therapeutic education on patient‐reported outcomes and rejection‐free survival over the first year. We collected data from 383 renal transplant patients followed‐up in seven centers. Patients who benefited from therapeutic education before transplantation (N = 182) were compared with patients who did not (N = 139) for quality‐of‐life, adherence and adverse events using the Pearson’s chi‐square test, one‐way ANOVA or t‐test. The association between therapeutic education and time to acute rejection was investigated using Cox models. The patients who benefited from therapeutic education reported adverse events less frequently (e.g., tremor: 9% vs. 32.4%, P = 0.01) and better quality‐of‐life (MCS‐QOL: 50.7 ± 8.1 vs. 47.7 ± 9.5, P = 0.02; PCS‐QOL: 49.1 ± 7.1 vs. 46.0 ± 9.2, P = 0.013). No difference was found on adherence. Rejection‐free survival was slightly better in the therapeutic education group (HR = 0.44, 95% CI = [0.19–1.01]). This multicenter retrospective cohort study suggests that integrating therapeutic education to care pathways entails clinical benefit, in terms of quality‐of‐life, self‐reported adverse events and rejection‐free survival. Randomized clinical trials are necessary to confirm this.

The Cost-effectiveness of Valganciclovir Prophylaxis Versus Preemptive Therapy in CMV R+ Kidney Transplant Recipients Over the First Year Posttransplantation

“…EPHEGREN (Etude Pharmaco-économique EN Greffe Rénale) is a pharmacological and clinical cohort of adult kidney transplant recipients enrolled between 2013 and 2017, 25 , 26 who provided written informed consent to participate and followed up in seven French centers (University Hospitals of Amiens, Bordeaux, Limoges, Poitiers, Rouen, Toulouse, and Tours). It was sponsored by the University Hospital of Limoges, complied with the legal requirements of the Declaration of Helsinki and received approval from the regional Ethics Committee (nr.130-2013-30, November 20, 2013) and authorization from the National Committee for Informatics and Liberties (912242 ACT, 2012).…”

French Recommendations for a National Competency Framework of Therapeutic Patient Education in Solid Organ Transplantation

“…By improving transplant patients' autonomy, TPE aims to optimize successful outcomes, including improved quality of life, better coping with side effects or decreased risk of graft loss. [3][4][5][6][7] In this scientific and regulatory context, French transplantation centers should offer a TPE program to all patients.…”

“…2 The biomedical model has focused on pathologies and treatments, in a disease management mode targeting mainly the improvement of compliance. 1,3 A humanistic biopsychosocial model has recently emerged in France, leading to education approaches centered on the development of psychosocial and adaptation competencies.…”

Exploring Transplant Medication-Taking Behaviours in Older Adult Kidney Transplant Recipients: A Qualitative Study of Semi-Structured Interviews

“…Medication-taking behaviours can be considered unique to individuals [15]. In best practice, health care systems' decisions about individual patients need to be made using a structured, evidence-based baseline approach [17][18][19][20]. Over time, this approach should be further tailored based on individual experience and active feedback mechanisms [21,22].…”