Transplant Infectious Disease最新文献

{"title":"Cytomegalovirus Infections Following Pediatric Hematopoietic Stem Cell Transplantation: An 18-Year Single-Center Experience.","authors":"Doğacan Sarısoy, Elif Ünal İnce, Dilber Talia İleri, Ergin Çiftçi, Zeynep Ceren Karahan, Hasan Fatih Çakmaklı, Gül Arga, Tuğba Akkaya Hocagil, Candan İslamoğlu, Halil Özdemir, Mehmet Ertem","doi":"10.1111/tid.70332","DOIUrl":"https://doi.org/10.1111/tid.70332","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study was to evaluate the risk factors for CMV reactivation and the effects of CMV on HSCT outcomes in patients managed using a standard prophylaxis and preemptive treatment approach in settings where letermovir prophylaxis could not be used.</p><p><strong>Methods: </strong>Patients who underwent HSCT between January 2006 and December 2023 in our pediatric hematology department were included in this retrospective study.</p><p><strong>Results: </strong>Among 217 patients included, 96 (44.4%) underwent HSCT for malignant diseases. The donor was a matched-sibling for 65.4%, and 86.1% had myeloablative conditioning regimen. All patients received acyclovir prophylaxis (1500 mg/m²/day) for the first 30 days. The prevalences of acute and chronic GVHD were 28.1% and 18%, respectively. In a median (IQR) follow-up of 49 (26.5-93.3) months, 60 (27.6%) patients experienced a total of 92 CMV reactivations. Patient group that experienced CMV reactivations was characterized by higher rates of malignant diseases, higher rates of mismatched donors, lower rates of bone marrow as stem cell source, higher acute and chronic GVHD prevalences, and higher grades of acute GVHD. In the group that did not experience CMV reactivation, 2-year overall survival rates were higher and treatment-related mortality rates were lower. This association remained consistent when evaluated among non-malignant patients. However, no significant difference was observed in the malignant diseases.</p><p><strong>Conclusion: </strong>After an effective prophylaxis, CMV DNA monitoring combined with preemptive treatment have an important role in CMV management. However, the survival rates among patients experiencing CMV reactivation remain lower.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70332"},"PeriodicalIF":2.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylaxis Durations and Risks of Cytomegalovirus Infection and Disease in Solid Organ Transplant Recipients: An International, Multicenter Cohort Study.","authors":"Anja Lindis Dahl, Oriol Manuel, Michael Koller, Joanne Reekie, Erich Tusch, Kasper Moestrup, Michael Perch, Kasper Rossing, Nicolai Schultz, Soren Schwartz Sorensen, Kristian Schønning, Jens Lundgren, Nicolas Johannes Mueller, Marie Helleberg","doi":"10.1111/tid.70321","DOIUrl":"10.1111/tid.70321","url":null,"abstract":"<p><strong>Background: </strong>The optimal duration of cytomegalovirus (CMV) prophylaxis in solid organ transplant recipients (SOTr) remains undetermined. We evaluated real-life preventive strategies on the incidence of CMV disease in an international SOTr cohort.</p><p><strong>Methods: </strong>All CMV IgG donor (D)+/recipient (R)- or R+ SOTr in Zürich, Lausanne, and Copenhagen (2008-2022) were followed 12-month post-transplantation. Multivariable Poisson regression examined associations between antiviral prophylaxis duration and risk of CMV infection and CMV disease at time of infection diagnosis.</p><p><strong>Results: </strong>We included 3203 non-lung (2057 kidney, 815 liver, 331 heart) and 620 lung transplant recipients. Strategies for CMV prophylaxis durations varied from none to ≥ 12 months. For D+/R- non-lung SOTr, no prophylaxis with preemptive therapy only versus 3 months of prophylaxis was associated with higher risk of CMV infection and disease (adjusted incidence rate ratio [aIRR] [95% CI] 2.46 [1.69-3.57], and 2.82 [1.18-6.68]). Risk did not differ between 3 and 6 months of prophylaxis. For D+/R- lung transplant recipients, 3 versus 6 months of prophylaxis was associated with higher risk of CMV infection and high CMV DNAemia (2.74 [1.36-5.52] and 8.10 [1.89-41.90]), but not significantly higher risk of CMV disease. Irrespective of antiviral prophylaxis duration, incidence of CMV disease was lower among R+ compared to D+/R- SOTr.</p><p><strong>Conclusions: </strong>In a setting with CMV surveillance after prophylaxis, 3 months of antiviral prophylaxis seems adequate to prevent CMV disease in D+/R- non-lung SOTr, whereas lung transplant recipients may benefit from longer duration of prophylaxis. Risk of CMV disease was low among R+ SOTr, irrespective of antiviral prophylaxis.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70321"},"PeriodicalIF":2.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumocystis jirovecii Pneumonia Outbreaks in Solid Organ Transplant Recipients: A Systematic Review of Epidemiology, Transmission Dynamics, and Outbreak Investigations.","authors":"Francesca Gioia, Sarah Almansour, Ani Orchanian-Cheff, Jay A Fishman, Seyed M Hosseini-Moghaddam","doi":"10.1111/tid.70333","DOIUrl":"https://doi.org/10.1111/tid.70333","url":null,"abstract":"<p><strong>Background: </strong>Although Pneumocystis jirovecii pneumonia (PJP) outbreaks continue to occur in solid organ transplantation (SOT) recipients, no systematic review has synthesized the available evidence to provide an aggregated understanding of their epidemiology and transmission.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, Cochrane, and manual sources through May 1, 2024 for studies of PJP outbreaks in adult SOT recipients. Data on patient characteristics, immunosuppression, diagnostics, outcomes, outbreak investigations, and control measures were extracted. The primary outcome was all-cause mortality, and the secondary outcome was characterization of outbreak investigation.</p><p><strong>Results: </strong>Twenty-nine outbreaks involving 360 SOT recipients (median age, 51.8 years [range, 22-70.5 years]; 32.6% female) were identified. Late-onset PJP (> 1 year posttransplant) occurred in 92.6% of outbreaks, which lasted a median of 365 days (range, 90-1260 days); kidney transplant recipients accounted for 77.8% of cases. Across 22 studies, the crude aggregate mortality was 19.0% (51 of 268 patients), while 27 of 64 patients (42.2%) required dialysis in six studies. Most patients were not on prophylaxis at diagnosis; breakthrough infections were rare (< 5%). Molecular typing was performed in most studies (21/28, 75%) among which single or predominant genotypes were identified in 19/20 (95%), supporting clonal transmission. Control measures included extended prophylaxis and surveillance, although their individual effectiveness could not be determined.</p><p><strong>Conclusion: </strong>Transplant centers remain susceptible to prolonged PJP outbreaks associated with substantial mortality. Nosocomial airborne transmission is likely. Most outbreaks occurred after prophylaxis discontinuation, but optimal control measures and prophylaxis duration remain uncertain. Standardized investigations incorporating molecular epidemiology will guide outbreak control and prevention.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70333"},"PeriodicalIF":2.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Pyloric Enteral Immunoglobulin for Treatment of Chronic Norovirus Diarrhea in Solid Organ Transplant Recipients: A Single Center Retrospective Study.","authors":"Fahad Buskandar, Andrew H Karaba, Brandon Trollinger, Robin K Avery","doi":"10.1111/tid.70330","DOIUrl":"https://doi.org/10.1111/tid.70330","url":null,"abstract":"<p><strong>Background: </strong>Norovirus can cause devastating, chronic diarrhea in immunocompromised individuals. There is no approved therapy for this infection. Case series have described oral immunoglobulin (Ig) as a treatment option, but destruction by gastric enzymes may affect efficacy. This study reviews clinical outcomes and safety of enteral Ig given via post-pyloric nasoduodenal tube in solid organ transplant recipients (SOTRs) with chronic norovirus-related diarrhea.</p><p><strong>Methods: </strong>All cases of chronic norovirus-related diarrhea in SOTRs managed with enteral Ig at our center were retrospectively reviewed. Enteral Ig was prepared from the intravenous Ig (IVIg) product and dosed at 50 mg/kg/dose every 6 h for 48 h. The primary outcome was resolution of diarrhea at 100 days; the secondary outcome was recurrence of norovirus-related diarrhea within 1 year.</p><p><strong>Results: </strong>Seven SOTRs (five kidney, one kidney/pancreas, and one double lung recipient) with chronic norovirus-related diarrhea who received enteral Ig were identified. All patients had previously failed treatment with nitazoxanide, 28% had failed prior IVIg, and 80% had mycophenolate held without improvement. Diarrhea resolved in all patients following enteral Ig without documented recurrence, with median time to resolution of 21 days (IQR: 10-50). Adverse events included nausea and vomiting in one patient.</p><p><strong>Conclusion: </strong>Our small size and single-center study suggests that enteral Ig given via a nasoduodenal tube may be further evaluated as a potential approach for chronic norovirus infection in SOTRs. Large randomized controlled trials with symptom diaries to assess time to resolution more accurately, and serial stool nucleic acid testing, will be needed for confirmation.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70330"},"PeriodicalIF":2.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letermovir in Refractory and Resistant CMV After Lung Transplantation: Therapeutic Potential and Emergence of Resistance.","authors":"Tobias Veit, Stefan Trost, Teresa Kauke, Nina Engels, Gabriela Leuschner, Michael Gerckens, Carlo Mümmler, Sebastian Michel, Michael Zoller, Valeria Hackemann, Jürgen Behr, Nikolaus Kneidinger","doi":"10.1111/tid.70324","DOIUrl":"https://doi.org/10.1111/tid.70324","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) infection remains a major challenge in lung transplant (LTx) recipients, particularly in antiviral-resistant or refractory (R/R) cases. Letermovir, effective for prophylaxis, has been used off-label as salvage therapy for R/R CMV infection; however, data on treatment-emergent resistance in LTx recipients remain limited.</p><p><strong>Methods: </strong>We retrospectively analyzed 61 consecutive LTx recipients treated with letermovir for R/R CMV infection between March 2018 and August 2024.</p><p><strong>Results: </strong>Overall, 21 patients (35%) developed R/R CMV under therapy and were genotypically tested; in 19 (31.1%), UL56 mutations conferring letermovir resistance were detected after a median of 96 [51-395] days. In contrast, 40 patients (65.6%) showed a > 1 log decline in viral load within 14.5 [5-31] days and viral clearance after 34 [6-126] days. Patients who developed resistance had significantly higher viral loads at initiation (35.100 [13.900-228.000] vs. 7.805 [1.173-30.350] IU/mL; p = 0.018) and less frequent positive CMV-specific immune responses (7.1% vs. 38.7%; p = 0.038). Time to 1 log decline was shorter in patients without resistance (16 [5-31] vs. 34 [17-58] days; p < 0.001). Multivariable regression identified slow viral load decline (OR 0.721; p < 0.001) and higher baseline viral load (OR 1.110; p = 0.044) as independent risk factors.</p><p><strong>Conclusion: </strong>Letermovir use for active R/R CMV infection was associated with treatment-emergent resistance in approximately one-third of patients, particularly in those with high baseline viral loads and delayed virological response. These findings support cautious use of letermovir for treatment, preferably in selected patients with low viral loads or limited alternative therapeutic options, with close virological monitoring and early resistance testing.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70324"},"PeriodicalIF":2.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CMV in Solid Organ Transplantation: A Persistent and Costly Burden.","authors":"Carlos A Q Santos","doi":"10.1111/tid.70334","DOIUrl":"https://doi.org/10.1111/tid.70334","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70334"},"PeriodicalIF":2.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attack of Rare Molds: Challenges of Infection With Thermothelomyces thermophilus in an Immunocompromised Host.","authors":"Sandus Khan, Allen Zou, Aanchal Gupta","doi":"10.1111/tid.70328","DOIUrl":"https://doi.org/10.1111/tid.70328","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70328"},"PeriodicalIF":2.5,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytomegalovirus Vaccines in Transplantation: History, Hurdles, and Hope.","authors":"Matthew L Goodwin, Ajit P Limaye, Madeleine R Heldman","doi":"10.1111/tid.70329","DOIUrl":"10.1111/tid.70329","url":null,"abstract":"<p><p>Cytomegalovirus (CMV) remains one of the most common and consequential pathogens in solid organ transplant (SOT) and allogeneic hematopoietic cell transplant (HCT) despite current prevention strategies. Even a partially effective CMV vaccine could reduce morbidity and mortality associated with CMV in SOT recipients (SOTr) and HCT recipients (HCTr), as well as decrease costs, toxicities, and the risk of antiviral resistance. Despite progress since the first CMV vaccine (Towne) was developed in the 1970s, no CMV vaccine has achieved regulatory approval. Differences in CMV epidemiology, host risk factors, and immune reconstitution between SOTr and HCTr, and heterogeneity in CMV vaccination goals across transplant populations, complicate the development of CMV vaccine candidates in transplantation. Incompletely defined immune correlates of protection and logistical barriers inherent to CMV vaccine clinical trial execution, such as unpredictable timing of transplantation and variable access to central laboratory monitoring, create additional challenges. This review describes the potential benefits of a CMV vaccine in HCTr and SOTr, summarizes prior trials of CMV vaccines in transplantation and the lessons learned, and provides a framework for overcoming historical barriers with innovative trial designs and validated biologic endpoints in the modern era of CMV prophylaxis to advance CMV vaccine candidates through clinical stages of development.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70329"},"PeriodicalIF":2.5,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Disseminated Encephalitozoon cuniculi in a Lung Transplant Recipient: Microsporidiosis in the Era of Molecular Diagnostics.","authors":"Lee S Gottesdiener, Clare DeLaurentis, Marcus R Pereira","doi":"10.1111/tid.70325","DOIUrl":"https://doi.org/10.1111/tid.70325","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70325"},"PeriodicalIF":2.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the Donor Pool: Successful Single Lung Transplant of a Hepatitis C Seropositive Donor to a Recipient With HIV and Pulmonary Fibrosis.","authors":"Harris Z Whiteson, Sangita Goel, Melissa Lesko, Bonnie E Lonze, Sapna A Mehta","doi":"10.1111/tid.70327","DOIUrl":"https://doi.org/10.1111/tid.70327","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70327"},"PeriodicalIF":2.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}