Transplant Infectious Disease最新文献

{"title":"Evaluation of Discrepant Infectious Disease Results in Deceased Organ Donors: Insights from a Retrospective Analysis of Post-Policy Testing.","authors":"Sara Dionne, Hillary Akana, Chris Curran, Sean Van Slyck","doi":"10.1111/tid.70055","DOIUrl":"https://doi.org/10.1111/tid.70055","url":null,"abstract":"<p><strong>Background: </strong>In 2021, a new policy was implemented by the Organ Procurement Transplant Network requiring Organ Procurement Organizations to draw a repeat blood sample for deceased organ donors if donation had not proceeded within 96-h after the initial blood sample for screening was obtained. We performed an analysis of over 2600 deceased donor test results, comparing initial results to repeated blood draw results for human immunodeficiency virus, Hepatitis B virus, and Hepatitis C virus serology and nucleic acid test (NAT) tests. This study reviews result discrepancies and explores investigations behind peculiar results.</p><p><strong>Methods: </strong>Infectious disease results from deceased organ donors were analyzed retrospectively for this study. Donor specimens were collected throughout the United States and tested at eleven laboratories. Food & Drug Administration-approved donor screening tests were used to determine donor eligibility.</p><p><strong>Results: </strong>There was a 1.69% discrepancy rate comparing results from repeat blood draw specimens to original specimen results. Of these discrepancies, 0.75% of the donors had results (enzyme-linked immunoassay and/or NAT) that changed from non-reactive to reactive. 0.68% of donors had results that changed from reactive to non-reactive. 0.26% of results changed from Ultrio repeatedly reactive, non-discriminated to either non-reactive or reactive.</p><p><strong>Conclusion: </strong>This study represents that there is more than a 1% chance that discrepant results will be obtained. Despite the low incidence of discrepancies, these rare occurrences can complicate clinical decision-making, requiring case-by-case assessments. We present several cases in which variability in results can make clinical decisions complex with limited information and the inability to perform timely confirmatory testing using tests not required by Organ Procurement Transplant Network regulations.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70055"},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094994","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":"Vaccine Adjuvants in the Immunocompromised Host: Science, Safety, and Efficacy.","authors":"Haya Hayek, Lana Hasan, Justin Z Amarin, Yasmeen Z Qwaider, Olla Hamdan, Wanderson Rezende, Kevin C Dee, James D Chappell, Natasha B Halasa","doi":"10.1111/tid.70053","DOIUrl":"https://doi.org/10.1111/tid.70053","url":null,"abstract":"<p><p>Vaccine adjuvants are essential for enhancing immune responses to vaccines, particularly in immunocompromised populations who typically demonstrate suboptimal responses to standard vaccination. This narrative review evaluates the safety and efficacy of approved and candidate adjuvants in immunocompromised hosts, with emphasis on solid organ and hematopoietic cell transplant recipients. We examine conventional aluminum-based adjuvants alongside modern adjuvant systems such as AS01_B, MF59, and AS04, analyzing their mechanisms of action and clinical applications. The review synthesizes current evidence on the safety profiles of approved adjuvanted vaccines in immunocompromised individuals and explores emerging adjuvant candidates, including saponin complexes and toll-like receptor agonists. By examining factors that influence adjuvant immunogenicity and safety in these vulnerable populations, we identify critical knowledge gaps and future research priorities. This comprehensive analysis provides clinicians and researchers with an updated perspective on the rapidly evolving landscape of vaccine adjuvants and their specific applications in immunocompromised hosts.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70053"},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094996","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":"Does Switching From Trimethoprim/Sulfamethoxazole to Atovaquone Result in Less Hyperkalemia? A Single-Center Retrospective Analysis in Heart Transplant Patients.","authors":"Marko Novakovic, Daryl Nnani, Enklajd Marsela, Sasa Vukelic, Yogita Rochlani, Omar Saeed, Shivank Madan, Daniel Sims, Jooyoung Shin, Sandhya Murthy, Abdulhamid Bazarbachi, Patricia Chavez, Christiana Gjelaj, Ulrich Jorde, Snehal R Patel","doi":"10.1111/tid.70043","DOIUrl":"https://doi.org/10.1111/tid.70043","url":null,"abstract":"<p><strong>Background: </strong>Trimethoprim/sulfamethoxazole (TMP/SMX) is commonly used after orthotopic heart transplant (OHT) for opportunistic infection (OI) prophylaxis, but its contribution to hyperkalemia is uncertain. Whether switching to atovaquone (ATQ), which has a narrower antimicrobial spectrum, affects infection risk and improves hyperkalemia has not been investigated. This study evaluated whether transitioning from TMP/SMX to ATQ in the setting of post-OHT hyperkalemia is beneficial in lowering risk of recurrent hyperkalemia while maintaining OI prophylaxis efficacy.</p><p><strong>Methods: </strong>A single-center retrospective review of OHT patients (January 2011-April 2022) compared those maintained on TMP/SMX with those switched to ATQ due to side effects, specifically hyperkalemia. The primary endpoint was the resolution of hyperkalemia, and the secondary endpoint was the combined infection rate.</p><p><strong>Results: </strong>Among 321 OHT recipients, 76% were switched to ATQ. Patients switched to ATQ had higher rates of severe and recurrent hyperkalemia and experienced numerically higher overall infection rates compared to TMP/SMX patients (27% vs. 52%; p < 0.001). However, in a Poisson regression model adjusted for immortal time bias, the incidence rate ratio (IRR) for infections with ATQ versus TMP/SMX was 1.32 (95% CI: 0.93-1.86; p = 0.119). Multivariable analyses excluding chronic kidney disease patients confirmed TMP/SMX's association with lower hyperkalemia rates (initial/recurrent). Age and diabetes independently predicted initial hyperkalemia.</p><p><strong>Conclusions: </strong>Transitioning from TMP/SMX to ATQ did not decrease hyperkalemia rates and was associated with a numerically higher incidence of infections, though this difference was not statistically significant. Hyperkalemia is likely multifactorial and often unresolved by switching from TMP/SMX.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70043"},"PeriodicalIF":2.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050000","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":"Outcomes of Invasive Aspergillosis in Liver Transplant Recipients From an Institution Using Targeted Antifungal Prophylaxis and an Antifungal Stewardship Program.","authors":"Brennan Collis, Karen Urbancic, Jack Whitelaw, Gemma Reynolds, Sara Vogrin, Hossein Jahanabadi, Dinesh Pandey, Marie Sinclair, Avik Majumdar, Adam Testro, Jason A Trubiano, Olivia C Smibert","doi":"10.1111/tid.70046","DOIUrl":"https://doi.org/10.1111/tid.70046","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests liver transplant recipients (LiTRs) with invasive aspergillosis (IA) have lower rates of dissemination and mortality compared to historical data. However, contemporary data from other centers remain scarce. We aimed to evaluate modern IA outcomes at our institution, where targeted perioperative echinocandin prophylaxis and an active antifungal stewardship program (AFSP) have been implemented.</p><p><strong>Methods: </strong>This is a single-center retrospective analysis of patients who underwent liver transplantation between January 1, 2017 and June 30, 2022. During the study period, targeted anidulafungin perioperative prophylaxis was administered to patients considered high-risk for invasive fungal infection (IFI), and a multidisciplinary AFSP assisted with IFI diagnosis and management. Patients with proven and probable IA diagnosed post-operatively were identified using internationally accepted definitions. The primary outcomes were IA dissemination and 1-year all-cause mortality rates. Data were extracted from the electronic medical record and descriptive summary statistics were performed.</p><p><strong>Results: </strong>Six patients (6/377, 1.6%) met the inclusion criteria. Patients with IA were significantly more likely to be colonized with multidrug-resistant Gram-negative organisms compared to those without IA (50.0% vs. 12.1%, p = 0.006). The median time to IA diagnosis was 22 days post-transplant (IQR 5-109). No cases of dissemination were observed. One-year all-cause mortality was 16.7%.</p><p><strong>Conclusion: </strong>Consistent with contemporary data, LiTRs had lower IA dissemination and mortality rates compared to earlier studies. These improved outcomes likely reflect a combination of modern advancements in liver transplantation, and we highlight two potentially modifiable interventions; targeted echinocandin prophylaxis and an AFSP. Further studies are needed to support their broader implementation.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70046"},"PeriodicalIF":2.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029045","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":"Odynophagia Unveiling Tonsillar Histoplasmosis in a Renal Transplant Recipient.","authors":"Dinesh Pandian, Jasmine Sethi, Yogesh Khandagale, Dipanwita Biswas, Suvradeep Mitra, Amisha Jamwal, Raja Ramachandran, Shivakumar Patil","doi":"10.1111/tid.70050","DOIUrl":"https://doi.org/10.1111/tid.70050","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70050"},"PeriodicalIF":2.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041114","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":"\"Reevaluating Diagnostic Criteria and Prophylactic Strategies for Aspergillus in Lung Transplant Recipients\".","authors":"Asad Iqbal, Aftab Ahmad, Syed Shayan Ahmad, Kashif Rasool, Syed Sardar Shah","doi":"10.1111/tid.70052","DOIUrl":"https://doi.org/10.1111/tid.70052","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70052"},"PeriodicalIF":2.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015016","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":"Reply to: Critique on \"Infection-Associated Immune Reconstitution Inflammatory Syndrome in Hematopoietic Cell Transplantation\".","authors":"Mansi Chaturvedi, Brian Epling, Maura Manion, Jennifer Cuellar-Rodriguez","doi":"10.1111/tid.70033","DOIUrl":"https://doi.org/10.1111/tid.70033","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70033"},"PeriodicalIF":2.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025295","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":"Effect of Antibiotics With Anaerobic Coverage on Graft-Versus-Host Disease in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis.","authors":"Hiroshi Ito, Yui Okamura, Yuna Tomura, Jura Oshida, Minori Fujita, Daiki Kobayashi","doi":"10.1111/tid.70049","DOIUrl":"https://doi.org/10.1111/tid.70049","url":null,"abstract":"<p><strong>Background: </strong>Broad-spectrum antibiotics are standard for febrile neutropenia (FN) in allogeneic hematopoietic stem cell transplantation (HSCT) but may disrupt gut microbiota, increasing the risk of graft-versus-host disease (GVHD). However, current evidence on the effects of anaerobic versus limited anaerobic antibiotic coverage on GVHD-related outcomes remains inconclusive.</p><p><strong>Methods: </strong>We systematically searched for studies assessing overall survival, acute GVHD incidence, and GVHD-related mortality in patients with allogeneic HSCT receiving antibiotics with anaerobic versus limited anaerobic coverage. A random-effects meta-analysis calculated risk ratios (RRs) and 95% confidence intervals (CIs) after assessing bias risk.</p><p><strong>Results: </strong>Six of the 323 screened studies met the inclusion criteria, encompassing 2169 patients: five studies included adult populations, and one included a pediatric population. Meta-analysis revealed no significant difference in 1-year overall survival between the anaerobic and the limited anaerobic coverage groups (RR: 1.01; 95% CI: 0.92-1.12). Acute GVHD incidence was significantly higher in the anaerobic coverage group than in the limited anaerobic coverage group (RR: 1.33; 95% CI: 1.17-1.51). GVHD-related mortality tended to be higher in the anaerobic coverage group than in the limited coverage group (RR: 1.65; 95% CI: 0.94-2.91). Of the six studies, three had a high risk of bias. Moderate heterogeneity was observed between citations regarding GVHD-related mortality (I² = 63%).</p><p><strong>Conclusion: </strong>Antibiotics with anaerobic coverage appear to increase acute GVHD incidence in patients who received an allogeneic HSCT compared to antibiotics with limited anaerobic coverage. However, the strength of this conclusion is limited by the quality of available evidence. Further well-designed research is necessary to clarify the impact of anaerobic antibiotic coverage on GVHD-related outcomes.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70049"},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055285","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":"Can Quantitative Polymerase Chain Reaction in Tissue Improve Cytomegalovirus Management? Balancing Diagnostic Sensitivity and the Risk of Overtreatment.","authors":"Eleftheria Kampouri, Oriol Manuel","doi":"10.1111/tid.70045","DOIUrl":"https://doi.org/10.1111/tid.70045","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70045"},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043725","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":"Incidence and Timing of Epstein-Barr Virus Whole Blood DNAemia in Epstein-Barr Virus-Mismatched Adult and Pediatric Solid Organ Transplant Recipients.","authors":"Catherine Burton, Curtis Mabilangan, Jutta Preiksaitis","doi":"10.1111/tid.70042","DOIUrl":"https://doi.org/10.1111/tid.70042","url":null,"abstract":"<p><strong>Background: </strong>Epstein-Barr virus (EBV) viral load (VL) monitoring is recommended post-transplant for EBV-mismatched (donor EBV seropositive/recipient EBV seronegative) solid organ transplant (SOT) recipients as a component of post-transplant lymphoproliferative disorder (PTLD) prevention, but the optimal frequency and timing of EBV VL monitoring remains unknown.</p><p><strong>Methods: </strong>In this retrospective cohort study, we investigated the incidence and timing of whole blood EBV DNAemia in EBV-mismatched adult and pediatric SOT recipients, who had EBV VL monitoring as part of a pre-emptive approach to PTLD prevention to optimize monitoring algorithms. We explored associations between donor-acquired EBV DNAemia (DA-EBV), defined as EBV DNAemia within 1 year post-transplant, and donor and recipient characteristics, and determined the proportion who developed PTLD.</p><p><strong>Results: </strong>We analyzed 257 D⁺/R^- recipients (kidney n = 64, heart n = 75, liver n = 93, lung n = 25); 126/257 (49.0%) developed DA-EBV at a median of 83 days (Q1-Q3: 50-130 days) post-transplant. Incidence of DA-EBV varied by organ and was highest in liver (62.4%) and lowest in heart recipients (28.0%). PTLD was diagnosed in 38/257 (14.8%) EBV-mismatched recipients, 25/162 (15.4%) children, and 13/95 (13.7%) adults. DA-EBV was uncommon in recipients less than 6 months old (3/29, 10.3%) and among recipients less than 12 months with donors less than 12 months (2/29, 6.9%); possible mechanisms of protection other than recipient passive maternal antibody and false-positive donor serostatus are discussed.</p><p><strong>Conclusion: </strong>Monitoring for DA-EBV should be focused on months 2-6 post-transplant. Less frequent whole blood EBV VL monitoring is likely a safe option in recipients less than 6 months old and recipients 6-12 months old with donors less than 12 months old.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70042"},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028690","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}