Christine M Durand, Samantha E Halpern, Mary G Bowring, Gilad A Bismut, Oyinkansola T Kusemiju, Brianna Doby, Reinaldo E Fernandez, Charles S Kirby, Darin Ostrander, Peter G Stock, Shikha Mehta, Nicole A Turgeon, David Wojciechowski, Shirish Huprikar, Sander Florman, Shane Ottmann, Niraj M Desai, Andrew Cameron, Allan B Massie, Aaron A R Tobian, Andrew D Redd, Dorry L Segev
Organs from deceased donors with suspected false-positive HIV screening tests were generally discarded due to the chance that the test was truly positive. However, the HIV Organ Policy Equity (HOPE) Act now facilitates use of such organs for transplantation to HIV-infected (HIV+) individuals. In the HOPE in Action trial, donors without a known HIV infection who unexpectedly tested positive for anti-HIV antibody (Ab) or HIV nucleic acid test (NAT) were classified as suspected false-positive donors. Between March 2016 and March 2018, 10 suspected false-positive donors had organs recovered for transplant for 21 HIV + recipients (14 single-kidney, 1 double-kidney, 5 liver, 1 simultaneous liver-kidney)...
October 2018: American Journal of Transplantation
Thomas G Cotter, Sonali Paul, Burhaneddin Sandıkçı, Thomas Couri, Adam S Bodzin, Ester C Little, Vinay Sundaram, Michael Charlton
Direct-acting antiviral (DAA) therapy has altered the frequency and outcome of liver transplantation (LT) for hepatitis C virus (HCV). The high efficacy and tolerability of DAA therapy has also created a rationale for utilizing HCV-viremic (HCV-RNA-positive) donors, including into HCV-negative recipients. We examined trends in frequency of organ utilization and graft survival in recipients of HCV-viremic donors (HCV-RNA positive as measured by nucleic acid testing [NAT]). Data were collected from the Scientific Registry of Transplant Recipients (SRTR) on adult patients who underwent a primary, single-organ, deceased donor LT from January 1, 2008 to January 31, 2018...
June 2019: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Kelly H Schlendorf, Sandip Zalawadiya, Ashish S Shah, Mark Wigger, Chan Y Chung, Sarah Smith, Matthew Danter, Chun W Choi, Mary E Keebler, D Marshall Brinkley, Suzanne Brown Sacks, Henry Ooi, Roman Perri, Joseph A Awad, Samuel Lewis, Rachel Hayes, Heather O'Dell, Callie Darragh, Alicia Carver, Cori Edmonds, Shelley Ruzevich-Scholl, JoAnn Lindenfeld
BACKGROUND: Given the shortage of suitable donor hearts for cardiac transplantation, and the favorable safety and efficacy of current agents used to treat hepatitis C virus (HCV), our institution recently piloted transplantation of select patients using HCV-positive donors. METHODS: Between September 2016 and March 2017, 12 HCV-naive patients and 1 patient with a history of treated HCV underwent heart transplantation (HT) using hearts from HCV-positive donors after informed consent...
June 2018: Journal of Heart and Lung Transplantation
Ann E Woolley, Steve K Singh, Hilary J Goldberg, Hari R Mallidi, Michael M Givertz, Mandeep R Mehra, Antonio Coppolino, Amanda E Kusztos, Megan E Johnson, Kaiwen Chen, Esther A Haddad, John Fanikos, David P Harrington, Phillip C Camp, Lindsey R Baden
BACKGROUND: Hearts and lungs from donors with hepatitis C viremia are typically not transplanted. The advent of direct-acting antiviral agents to treat hepatitis C virus (HCV) infection has raised the possibility of substantially increasing the donor organ pool by enabling the transplantation of hearts and lungs from HCV-infected donors into recipients who do not have HCV infection. METHODS: We conducted a trial involving transplantation of hearts and lungs from donors who had hepatitis C viremia, irrespective of HCV genotype, to adults without HCV infection...
April 25, 2019: New England Journal of Medicine
Samir J Patel, Richard J Knight, Samantha A Kuten, Edward A Graviss, Duc T Nguyen, Linda W Moore, William L Musick, Ahmed Osama Gaber
In kidney transplantation, BK virus infection has historically resulted in high rates of graft dysfunction and graft loss. Unlike other opportunistic infections, no therapies have been shown to prevent BK. The purpose of the current study was to evaluate the safety and efficacy of ciprofloxacin for the prevention of BK viremia in kidney transplant recipients. Two hundred kidney transplant recipients were enrolled in a prospective, randomized, double-blind, placebo-controlled trial comparing a 3-month course of ciprofloxacin (n = 133) vs placebo (n = 67) for the prevention of BK viremia...
June 2019: American Journal of Transplantation
Genovefa A Papanicolaou, Fernanda P Silveira, Amelia A Langston, Marcus R Pereira, Robin K Avery, Marc Uknis, Anna Wijatyk, Jingyang Wu, Michael Boeckh, Francisco M Marty, Stephen Villano
BACKGROUND: Cytomegalovirus (CMV) infections that are refractory or resistant (RR) to available antivirals ([val]ganciclovir, foscarnet, cidofovir) are associated with higher mortality in transplant patients. Maribavir is active against RR CMV strains. METHODS: Hematopoietic-cell or solid-organ transplant recipients ≥12 years old with RR CMV infections and plasma CMV deoxyribonucleic acid (DNA) ≥1000 copies/mL were randomized (1:1:1) to twice-daily dose-blinded maribavir 400, 800, or 1200 mg for up to 24 weeks...
April 8, 2019: Clinical Infectious Diseases
Deepali Kumar, Peter Chin-Hong, Liise Kayler, David Wojciechowski, Ajit P Limaye, A Osama Gaber, Simon Ball, Aneesh K Mehta, Matthew Cooper, Ted Blanchard, James MacDougall, Camille N Kotton
T cell immunity is essential for the control of cytomegalovirus (CMV) infection after transplantation. We evaluated a CMV-specific peptide-based enzyme-linked immunosorbent spot (ELISPOT) assay to determine whether assay results could predict subsequent CMV events. Adult kidney transplant recipients at 43 centers underwent ELISPOT testing to enumerate interferon gamma (IFN-γ) binding spot-forming units (sfu) after stimulation of cells with an overlapping peptide pool of CMV phosphoprotein 65 (pp65) and immediate early-1 (IE-1) protein at the end of antiviral prophylaxis (EOP) and various time points thereafter...
September 2019: American Journal of Transplantation
Laure F Pittet, Charlotte M Verolet, Valérie A McLin, Barbara E Wildhaber, Maria Rodriguez, Pascal Cherpillod, Laurent Kaiser, Claire-Anne Siegrist, Klara M Posfay-Barbe
Live-attenuated vaccines are currently contraindicated in solid-organ transplant recipients. However, the risk of vaccine-preventable infections is lifelong, and can be particularly severe after transplantation. In this prospective interventional national cohort study, 44 pediatric liver transplant recipients with measles IgG antibodies <150 IU/L (below seroprotection threshold) received measles-mumps-rubella vaccine (MMR) at a median of 6.3 years posttransplantation (interquartile range, 4.0 to 10.9). A maximum of two additional doses were administered in nonresponders or when seroprotection was lost...
March 2019: American Journal of Transplantation
Peter Vink, Josep Maria Ramon Torrell, Ana Sanchez Fructuoso, Sung-Joo Kim, Sang-Il Kim, Jeff Zaltzman, Fernanda Ortiz, Josep Maria Campistol Plana, Ana Maria Fernandez Rodriguez, Henar Rebollo Rodrigo, Magda Campins Marti, Rafael Perez, Francisco Manuel González Roncero, Deepali Kumar, Yang-Jen Chiang, Karen Doucette, Lissa Pipeleers, Maria Luisa Agüera Morales, Maria Luisa Rodriguez-Ferrero, Antonio Secchi, Shelly A McNeil, Laura Campora, Emmanuel Di Paolo, Mohamed El Idrissi, Marta López-Fauqued, Bruno Salaun, Thomas C Heineman, Lidia Oostvogels
BACKGROUND: The incidence of herpes zoster is up to 9 times higher in immunosuppressed solid organ transplant recipients than in the general population. We investigated the immunogenicity and safety of an adjuvanted recombinant zoster vaccine (RZV) in renal transplant (RT) recipients ≥18 years of age receiving daily immunosuppressive therapy. METHODS: In this phase 3, randomized (1:1), observer-blind, multicenter trial, RT recipients were enrolled and received 2 doses of RZV or placebo 1-2 months (M) apart 4-18M posttransplant...
January 2, 2020: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Deepali Kumar, Victor H Ferreira, Emily Blumberg, Fernanda Silveira, Elisa Cordero, Pilar Perez-Romero, Teresa Aydillo, Lara Danziger-Isakov, Ajit P Limaye, Jordi Carratala, Patricia Munoz, Miguel Montejo, Francisco Lopez-Medrano, Maria Carmen Farinas, Joan Gavalda, Asuncion Moreno, Marilyn Levi, Jesus Fortun, Julian Torre-Cisneros, Janet A Englund, Yoichiro Natori, Shahid Husain, Gail Reid, Tanvi S Sharma, Atul Humar
Background: Seasonal influenza infection may cause significant morbidity and mortality in transplant recipients. The purpose of this study was to assess the epidemiology of symptomatic influenza infection posttransplant and determine risk factors for severe disease. Methods: Twenty centers in the United States, Canada, and Spain prospectively enrolled solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT) recipients with microbiologically confirmed influenza over 5 consecutive years (2010-2015)...
October 15, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Mario Fernández-Ruiz, Estela Giménez, David Lora, José María Aguado, Manuel Pascual, Oriol Manuel
Mannose-binding lectin (MBL) is a soluble pattern recognition molecule involved in complement activation. Single nucleotide polymorphisms (SNPs) in the MBL2 gene have been associated with susceptibility to infection, although data in solid organ transplant recipients remains inconclusive. This meta-analysis was primarily aimed at investigating the association between posttransplant bacterial and fungal infection and variant alleles of MBL2 gene SNPs in the promoter/5' untranslated region and exon 1. Cytomegalovirus (CMV) infection and/or disease were considered secondary outcomes...
April 2019: American Journal of Transplantation
Susanna Kinnunen, Pauli Karhapää, Auni Juutilainen, Patrik Finne, Ilkka Helanterä
BACKGROUND AND OBJECTIVES: Infections are the most common noncardiovascular causes of death after kidney transplantation. We analyzed the current infection-related mortality among kidney transplant recipients in a nationwide cohort in Finland. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Altogether, 3249 adult recipients of a first kidney transplant from 1990 to 2012 were included. Infectious causes of death were analyzed, and the mortality rates for infections were compared between two eras (1990-1999 and 2000-2012)...
May 7, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Cody Schott, S Samuel Weigt, Benjamin A Turturice, Ahmed Metwally, John Belperio, Patricia W Finn, David L Perkins
BACKGROUND: Lung transplantation outcomes remain complicated by bronchiolitis obliterans syndrome (BOS), a major cause of mortality and retransplantation for patients. A variety of factors linking inflammation and BOS have emerged, meriting further exploration of the microbiome as a source of inflammation. In this analysis, we determined features of the pulmonary microbiome associated with BOS susceptibility. METHODS: Bronchoalveolar lavage (BAL) samples were collected from 25 patients during standard of care bronchoscopies before BOS onset...
September 2018: Journal of Heart and Lung Transplantation
Pieter P Lestrade, Robbert G Bentvelsen, Alexander F A D Schauwvlieghe, Steven Schalekamp, Walter J F M van der Velden, Ed J Kuiper, Judith van Paassen, Ben van der Hoven, Henrich A van der Lee, Willem J G Melchers, Anton F de Haan, Hans L van der Hoeven, Bart J A Rijnders, Martha T van der Beek, Paul E Verweij
BACKGROUND: Triazole resistance is an increasing problem in invasive aspergillosis (IA). Small case series show mortality rates of 50%-100% in patients infected with a triazole-resistant Aspergillus fumigatus, but a direct comparison with triazole-susceptible IA is lacking. METHODS: A 5-year retrospective cohort study (2011-2015) was conducted to compare mortality in patients with voriconazole-susceptible and voriconazole-resistant IA. Aspergillus fumigatus culture-positive patients were investigated to identify patients with proven, probable, and putative IA...
April 24, 2019: Clinical Infectious Diseases
Karlyn D Beer, Eileen C Farnon, Seema Jain, Carol Jamerson, Sarah Lineberger, Jeffrey Miller, Elizabeth L Berkow, Shawn R Lockhart, Tom Chiller, Brendan R Jackson
The environmental mold Aspergillus fumigatus is the primary cause of invasive aspergillosis. In patients with high-risk conditions, including stem cell and organ transplant recipients, mortality exceeds 50%. Triazole antifungals have greatly improved survival (1); however, triazole-resistant A. fumigatus infections are increasingly reported worldwide and are associated with increased treatment failure and mortality (2). Of particular concern are resistant A. fumigatus isolates carrying either TR34 /L98H or TR46 /Y121F/T289A genetic resistance markers, which have been associated with environmental triazole fungicide use rather than previous patient exposure to antifungals (3,4)...
September 28, 2018: MMWR. Morbidity and Mortality Weekly Report
David Andes, Laura Kovanda, A Desai, Therese Kitt, M Zhao, Thomas J Walsh
Clinical use of voriconazole, posaconazole, and itraconazole revealed the need for therapeutic drug monitoring (TDM) of plasma concentrations of these antifungal agents. This need for TDM was not evident from clinical trials. In order to establish whether this requirement also applies to isavuconazole, we examined the plasma concentrations of 283 samples from patients receiving isavuconazole in clinical practice and compared the values with those from clinical trials. The concentration distributions from real-world use and clinical trials were nearly identical (>1 μg/ml in 90% of patients)...
July 2018: Antimicrobial Agents and Chemotherapy
John Richard Lee, Matthew Magruder, Lisa Zhang, Lars F Westblade, Michael J Satlin, Amy Robertson, Emmanuel Edusei, Carl Crawford, Lilan Ling, Ying Taur, Jonas Schluter, Michelle Lubetzky, Darshana Dadhania, Eric Pamer, Manikkam Suthanthiran
Posttransplant diarrhea is associated with kidney allograft failure and death, but its etiology remains unknown in the majority of cases. Because altered gut microbial ecology is a potential basis for diarrhea, we investigated whether posttransplant diarrhea is associated with gut dysbiosis. We enrolled 71 kidney allograft recipients for serial fecal specimen collections in the first 3 months of transplantation and profiled the gut microbiota using 16S ribosomal RNA (rRNA) gene V4-V5 deep sequencing. The Shannon diversity index was significantly lower in 28 diarrheal fecal specimens from 25 recipients with posttransplant diarrhea than in 112 fecal specimens from 46 recipients without posttransplant diarrhea...
February 2019: American Journal of Transplantation
Bart Jan Kullberg, Claudio Viscoli, Peter G Pappas, Jose Vazquez, Luis Ostrosky-Zeichner, Coleman Rotstein, Jack D Sobel, Raoul Herbrecht, Galia Rahav, Sutep Jaruratanasirikul, Ploenchan Chetchotisakd, Eric Van Wijngaerden, Jan De Waele, Christopher Lademacher, Marc Engelhardt, Laura Kovanda, Rodney Croos-Dabrera, Christine Fredericks, George R Thompson
BACKGROUND: Isavuconazole was compared to caspofungin followed by oral voriconazole in a Phase 3, randomized, double-blind, multinational clinical trial for the primary treatment of patients with candidemia or invasive candidiasis. METHODS: Adult patients were randomized 1:1 to isavuconazole (200 mg intravenous [IV] three-times-daily [TID] for 2 days, followed by 200 mg IV once-daily [OD]) or caspofungin (70 mg IV OD on day 1, followed by 50 mg IV OD [70 mg in patients > 80 kg]) for a maximum of 56 days...
May 30, 2019: Clinical Infectious Diseases
Alicia M Alcamo, Lauren J Alessi, S Noona Vehovic, Neha Bansal, Geoffrey J Bond, Joseph A Carcillo, Michael Green, Marian G Michaels, Rajesh K Aneja
OBJECTIVES: To describe characteristics of liver transplant patients with severe sepsis in the PICU. DESIGN: Retrospective descriptive analysis. SETTING: Tertiary children's hospital PICU. PATIENTS: Liver transplant recipients admitted January 2010 to July 2016 for pediatric severe sepsis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Between January 2010 and July 2016, 173 liver transplants were performed, and 36 of these patients (21%) were admitted with severe sepsis (54 episodes total)...
July 2019: Pediatric Critical Care Medicine
G Errico, C Gagliotti, M Monaco, L Masiero, P Gaibani, S Ambretti, M P Landini, S D'Arezzo, A Di Caro, S G Parisi, G Palù, F Vespasiano, F Morsillo, M L Moro, F Procaccio, A Ricci, P A Grossi, A Pantosti, A Nanni Costa
OBJECTIVES: A prospective cohort study was conducted in Italy in order to describe the microbiologic aspects of colonization/infection by carbapenemase-producing Enterobacteriaceae (CPE) in donors and recipients of lung and liver transplants and the possible CPE transmission from donors to recipients. METHODS: Between 15 January 2014 and 14 January 2015, all recipients of solid organ transplants (SOT) at ten lung and eight liver transplantation centres and the corresponding donors were enrolled...
February 2019: Clinical Microbiology and Infection
2019-06-03 11:24:44
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