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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment, which carries a high risk of complications and mortality, highlighting the necessity of discussions about life threat. This study explores the perspectives of patients, informal caregivers (ICs), and healthcare professionals (HCPs) regarding the timing, content, and challenges of these discussions. Multicenter cross-sectional survey in comprehensive care centers across Germany, involving patients with allo-HSCT, ICs, and HCPs. Questionnaires assessed perceived concerns about life threat, communication needs, and attitudes toward death. Statistical analyses included descriptive statistics, group comparisons, and multivariate logistic regressions. A total of 61 patients, 31 ICs and 125 HCPs participated in this study. Patients and ICs had a high need for discussion about life threat at diagnosis, which was corroborated by HCPs. At further time points in the transplant trajectory, there were more discrepancies between patients‘/ICs‘ and HCPs’ perceptions towards conversations about life threat. While 61.7% of patients preferred having their ICs present during discussions, ICs often felt overlooked, with only 50% finding conversations with HCPs helpful. HCPs’ avoidance of death was associated with a reduced likelihood of reporting a need for conversation in patients in the event of severe complications. These findings highlight a discrepancy between patients’ and ICs’ preferred timing for conversations about life threat and HCPs’ perceptions of when patients actually express such a need. To bridge this gap, earlier and ongoing conversations are essential. Training programs should address HCPs’ discomfort in discussing prognosis and improve interdisciplinary teamwork to standardize end-of-life communication. Trial registration number : DRKS00027290 (German Clinical Trials Register) on 10.01.2022.

To determine which donor characteristics, like previous diseases and surgeries, influence the severity of the DM/endothelial lamella preparation prior to DMEK-surgery. Retrospective cross-sectional single-center study is presented. Eight hundred and forty-six eyes with DMEK-surgery between 01/2018 and 01/2021 performed at the University Hospital Cologne, Germany, were included. Information regarding the donors' previous diseases and surgeries were provided by a large database of a cornea bank (Multi Tissue Bank Mecklenburg-Vorpommern) and merged with the Cologne DMEK database, which contains information regarding preparation characteristics of the surgeon-prepared graft directly preoperatively. Three preparation groups (easy, difficult and very difficult) were correlated to the donors' previous diseases and surgeries. The following characteristics were used for the assignment in one of the three groups: stripping difficulty, rolling and staining behavior, central and peripheral adherences, tissue fragility and DM-splitting. Significant risk factors for DM-splitting were diabetes mellitus (DMel) type II, heart failure, chronic kidney disease and previous cataract surgery (p=0.022, p=0.012; p=0.047 and p<0.001 respectively). Previous DMel (especially type 2) was significantly associated with the occurrence of central adherences (p=0.009). Several cardiovascular diseases (p-values between <0.001 and p=0.038), DMel type II, chronic kidney disease and previous cataract-surgery were associated with peripheral adherences (p=0.004; p=0.020 and p<0.001 respectively). Furthermore, pseudophakic donor eyes presented a higher degree of fragility of the graft (p<0.001). Age was a significant risk factor for difficult preparation (p<0.001). The staining of the graft was poorer in donors with chronic kidney disease (p=0.037). Donor diabetes mellitus type 2, heart failure, previous cataract surgery, chronic kidney disease and age are associated with a difficult DMEK graft preparation. For every one-year increment in donor age, the odds of having very difficult preparation were increased by 3%. Also, chronic kidney disease predisposes to a poor tissue staining with trypan blue during preparation.

Purpose: To determine which donor characteristics, like previous diseases and surgeries, influence the severity of the DM/endothelial lamella preparation prior to DMEK-surgery. Patients and Methods: Retrospective cross-sectional single-center study is presented. Eight hundred and forty-six eyes with DMEK-surgery between 01/2018 and 01/2021 performed at the University Hospital Cologne, Germany, were included. Information regarding the donors' previous diseases and surgeries were provided by a large database of a cornea bank (Multi Tissue Bank Mecklenburg-Vorpommern) and merged with the Cologne DMEK database, which contains information regarding preparation characteristics of the surgeon-prepared graft directly preoperatively. Three preparation groups (easy, difficult and very difficult) were correlated to the donors' previous diseases and surgeries. The following characteristics were used for the assignment in one of the three groups: stripping difficulty, rolling and staining behavior, central and peripheral adherences, tissue fragility and DM-splitting. Results: Significant risk factors for DM-splitting were diabetes mellitus (DMel) type II, heart failure, chronic kidney disease and previous cataract surgery (p=0.022, p=0.012; p=0.047 and p<0.001 respectively). Previous DMel (especially type 2) was significantly associated with the occurrence of central adherences (p=0.009). Several cardiovascular diseases (p-values between <0.001 and p=0.038), DMel type II, chronic kidney disease and previous cataract-surgery were associated with peripheral adherences (p=0.004; p=0.020 and p<0.001 respectively). Furthermore, pseudophakic donor eyes presented a higher degree of fragility of the graft (p<0.001). Age was a significant risk factor for difficult preparation (p<0.001). The staining of the graft was poorer in donors with chronic kidney disease (p=0.037). Conclusion: Donor diabetes mellitus type 2, heart failure, previous cataract surgery, chronic kidney disease and age are associated with a difficult DMEK graft preparation. For every one-year increment in donor age, the odds of having very difficult preparation were increased by 3%. Also, chronic kidney disease predisposes to a poor tissue staining with trypan blue during preparation. Keywords: DMEK, lamellar keratoplasty, donor, graft preparation, risk factors, cornea bank

Patients treated with an allogeneic hematopoietic stem cell transplantation (allo-SCT) face a significant mortality risk, which might trigger existential distress. We aimed to investigate how hematology health care professionals (HCPs) address life-threatening conditions with allo-SCT recipients and their relatives, and what are challenging and supportive aspects. We conducted a multicenter cross-sectional survey, assessing: (1) HCPs’ approaches to address life threat, using a self-developed questionnaire with 19 items categorized in four dimensions (proactive, cautious, reactive, avoiding), (2) challenges/support needs, using self-developed multiple-choice questions, and (3) personal attitudes towards death (Death Acceptance subscale of the Life Attitude Profile-Revised; Death Attitude Profile-Revised). Statistics included association, regression and exploratory factor analysis. We included 104 participants (52 physicians, 45 nurses, 7 psycho-oncologists) from the settings of SCT, general hematology and intensive care. Physicians predominantly addressed life threat proactively, while nurses tended to raise the topic when prompted by patients or a clinical worsening. Overall, 10% of HCPs stated to avoid the topic, even in case of a high risk of death. HCPs’ approaches correlated weakly with their attitudes towards death. A main challenge was to talk with patients/relatives repressing the risk of death (72%). More time resources for these conversations (71%), and mentoring by palliative-care specialists (67%) or psycho-oncologists (65%) were the most frequent support needs. This comprehensive survey reveals strong differences between professions in addressing life threat, and possible influence from personal death attitudes. Further confirmatory research in larger samples is needed to tailor communication trainings on life threat in multi-professional teams. Registration:German Clinical Trials Register, DRKS00027290, date of registration: 2022-01-10.