Transplant Infectious Disease最新文献

{"title":"Aspergillus After Lung Transplantation: Prophylaxis, Risk Factors, and the Impact on Chronic Lung Allograft Dysfunction.","authors":"Johanna P van Gemert, Ger Jan Fleurke, Onno W Akkerman, C Tji Gan, Willie N Steenhuis, Huib A M Kerstjens, Erik A M Verschuuren, Douwe F Postma","doi":"10.1111/tid.70020","DOIUrl":"https://doi.org/10.1111/tid.70020","url":null,"abstract":"<p><strong>Background: </strong>Invasive pulmonary aspergillosis (IA) poses significant challenges for lung transplant (LTx) patients, with unclear risk factors and preventive strategies. The effectiveness of nebulized amphotericin B (AmB) or statins for IA prevention and the effect of IA on chronic lung allograft dysfunction (CLAD) and mortality remain questionable.</p><p><strong>Methods: </strong>Data were collected from all LTx patients transplanted between December 1, 2013 and January 1, 2022 at the University Medical Center Groningen. IA, was defined according to published criteria. Prespecified risk factors were compared between patients with and without IA post-LTx and were entered in a logistic regression model. Two additional logistic regression models were built with factors that might be associated with statin or AmB prophylaxis and IA. A matched case-control study was conducted for the association between statins and IA, with matching based on follow-up time.</p><p><strong>Results: </strong>Aspergillus was cultured in 110 /274 (40%) patients post-LTx and 89/110 (81%) were classified as probable IA. MMF use, airway stenosis, Aspergillus cultured pre-LTx, CLAD, and acute rejection (AR), were significantly associated with IA. Statin use was associated with a lower incidence of IA, while AmB prophylaxis showed no significant effect. A significant statin effect could not be confirmed by the case control analysis. There was no significant difference in all-cause mortality between patients with and without IA (34% vs. 29%).</p><p><strong>Conclusions: </strong>The high incidence of IA post-LTx necessitates more effective strategies. Key targets for intervention include prior positive cultures, airway stenosis, AR, and the use of MMF. The role of statins remains unclear and requires further research.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70020"},"PeriodicalIF":2.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658193","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":"Disseminated Histoplasmosis Manifesting as Oral Lesions in a Kidney Transplant Patient.","authors":"Sebastian Hinojosa, Kaitlyn Reasoner, Trey Richardson, Levan Gakhokidze, Alissa Ice, Mozibur Rahman, Richard W LaRue, Heidi Schaefer, Anthony Langone","doi":"10.1111/tid.70018","DOIUrl":"https://doi.org/10.1111/tid.70018","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70018"},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574175","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":"Limited Risk of Microbial Contamination During Hypothermic and Normothermic Machine Perfusion of Donor Kidneys.","authors":"Julia S Slagter, Carolina A M Schurink, Ga-Lai M Chong, Marlies E J Reinders, Robert J Porte, Robert C Minnee","doi":"10.1111/tid.70019","DOIUrl":"https://doi.org/10.1111/tid.70019","url":null,"abstract":"<p><strong>Background: </strong>Both hypothermic machine perfusion (HMP) and normothermic machine perfusion (NMP) are increasingly used for preservation of deceased donor kidneys. However, especially NMP can pose as a risk for microbial contamination of the kidney graft as the 37°C perfusate can act as a breeding ground for microbial contaminants.</p><p><strong>Methods: </strong>In this study, we investigated the cultures of HMP and NMP perfusates of deceased donor kidneys.</p><p><strong>Results: </strong>Between January 2021 and April 2024, a total of 99 perfusates were examined (73 HMP and 26 NMP perfusates)-. We found that contamination of HMP perfusate was common, occurring in 21 of 73 cultures (29%). Most bacteria originated from the skin. Microbial contamination during NMP was rare, occurring only in 2 of 26 cultures (8%). Microbial contamination during machine perfusion did not lead to infectious complications in the recipients.</p><p><strong>Conclusion: </strong>Machine perfusion poses a very limited risk of infection in kidney transplant recipients.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70019"},"PeriodicalIF":2.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568396","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":"Risk of Cytomegalovirus Viremia Following Transplantation of Hepatitis C-Viremic Donor Kidneys Into Uninfected Recipients: A Multi-Center Retrospective Cohort Study.","authors":"Vishnu S Potluri, David Goldberg, Siqi Zhang, Douglas E Schaubel, Miklos Z Molnar, Rachel Forbes, Megan E Sise, James L Rogers, Vasanthi Balaraman, Anshul Bhalla, David Shaffer, Beatrice P Concepcion, Raymond T Chung, Ian A Strohbehn, Shristi Mapchan, Vikas Vujjini, Akhila Sangadi, Eric Martin, Roy D Bloom, Alyssa Ammazzalorso, Emily A Blumberg, Peter P Reese","doi":"10.1111/tid.70011","DOIUrl":"10.1111/tid.70011","url":null,"abstract":"<p><strong>Background: </strong>Several studies have suggested an increased risk of cytomegalovirus (CMV) viremia among Hepatitis C virus (HCV)-uninfected recipients of kidney transplants from HCV-RNA+ deceased donors (HCV D+/R-), but these studies featured small sample sizes and limited ability to address confounding variables.</p><p><strong>Methods: </strong>We assembled a retrospective cohort of adult kidney transplant recipients at five US centers between 4/1/2015 and 12/31/2020 to determine the association between HCV D+/R- transplants and the outcomes of CMV viremia (> 1000 IU/mL), death-censored graft failure, and mortality in the first posttransplant year compared to HCV D-/R- transplants. We generated highly similar matched cohorts of HCV D+/R- and HCV D-/R- recipients based on attributes that affect the risk of CMV viremia. We matched exactly on center, CMV donor/recipient serostatus, and antibody induction therapy.</p><p><strong>Results: </strong>The cohort comprised 275 HCV D+/R- recipients with a mean age of 52.5 years (SD = 10.7); 19% were CMV D+/R-, and 74% received anti-thymocyte globulin induction. With variable ratio matching, 267 HCV D+/R- recipients were matched to 996 HCV D-/R- recipients. CMV viremia occurred in 15% of HCV D+/R- and 11% of HCV D-R- recipients. In Cox regression, transplantation with an HCV-RNA+ donor kidney was not associated with a significantly higher risk of CMV viremia (HR 1.3, 95% CI 0.89-1.92) or death-censored graft loss (HR 0.61, 95% CI 0.31-1.2).</p><p><strong>Conclusion: </strong>The risk of CMV viremia was not significantly increased among HCV D+/R- kidney recipients. Future studies should examine associations between donor-derived HCV infection and clinical outcomes of CMV syndrome and disease.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70011"},"PeriodicalIF":2.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568397","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":"Association of Posttransplant Circulating 25-Hydroxyvitamin D and Late-Onset Infections Among Kidney Transplant Recipients: The Wisconsin Allograft Recipient Database (WisARD).","authors":"Zhongyu Yuan, Michal L Melamed, Sandesh Parajuli, Didier Mandelbrot, Brad C Astor","doi":"10.1111/tid.70016","DOIUrl":"https://doi.org/10.1111/tid.70016","url":null,"abstract":"<p><strong>Introduction: </strong>Late-onset infection occurring more than 6 months after transplantation is a major threat to the long-term survival of kidney transplant recipients (KTRs). Accumulating evidence indicates a potential role for vitamin D in host resistance to infections. While vitamin D inadequacy is common among KTRs, the association of posttransplant circulating 25-hydroxyvitamin D [25(OH)D] and late-onset infection remains uncertain.</p><p><strong>Methods: </strong>We analyzed data from adult kidney-only transplant recipients at our center from 2005 to 2020 who had at least one valid posttransplant circulating 25(OH)D measurement from 5 to 13 months posttransplant. Survival analyses were conducted using marginal proportional rates models with late-onset infection within 1 year following the 25(OH)D measurement as the event of interest. Additional analyses used time-varying 25(OH)D measurements.</p><p><strong>Results: </strong>Of 2207 KTRs included, 642 recipients had a total of 1448 late-onset infection episodes. Each 5 ng/mL lower serum 25(OH)D was associated with a 5% higher risk of late-onset infection (adjusted rate ratio [aRR] = 1.05; 95% confidence interval [CI]: 1.03, 1.07; p < 0.01). Vitamin D deficiency (≤ 20 ng/mL) was associated with a 1.22-fold higher incidence of late-onset infection (aRR = 1.22; 95% CI: 1.03-1.43; p = 0.02) compared with vitamin D sufficiency (≥30 ng/mL). The association was strongest for urinary tract infection among male recipients (aRR = 2.20; 95% CI: 1.57-3.08; p < 0.01).</p><p><strong>Conclusion: </strong>Vitamin D deficiency is significantly associated with a higher incidence of late-onset infection among KTRs, especially urinary tract infections in male recipients. Further research, including clinical trials, is needed to determine the causal relationship.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70016"},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543433","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":"Evaluation of Titer-Proven Response Rates of Pediatric Hepatitis B-Combination Vaccines in Adult Hematopoietic Cell Transplant Recipients.","authors":"Charles M Gallagher, Spencer K Yingling, Aaron Cumpston, Lauren Veltri, Salah Ud Din Safi, Sijin Wen, Kelsea Seago","doi":"10.1111/tid.70005","DOIUrl":"https://doi.org/10.1111/tid.70005","url":null,"abstract":"<p><strong>Background: </strong>Patients who have undergone hematopoietic cell transplant (HCT) should be revaccinated with common childhood vaccines due to loss of immunity. It is common for transplant centers to encourage adherence by administering combination vaccines to alleviate high vaccine burden. A combination product containing pediatric doses of hepatitis B surface antigen (10 µg) is commonly utilized, although limited data are available on response post-HCT.</p><p><strong>Methods: </strong>The primary objective of this study was to determine the efficacy of a low-dose, combination hepatitis B vaccine by assessing titer-proven response rates. The secondary objective was to characterize factors that influence non-response. Post-HCT patients were included in this analysis if they received all three post-HCT doses of low-dose DTaP-HepB-IPV with a subsequently documented hepatitis B titer result. Following the successful completion of the protocol, patients were considered responders to the vaccine if they had measurable titers ≥10 mIU/mL.</p><p><strong>Results: </strong>Thirty-nine patients met inclusion criteria. A serologic response to the vaccine series was observed in 21 of the 39 patients (54%). Allogeneic HCT recipients were found to have a response rate of 76%, whereas autologous recipients were less likely to respond (response rate 36%, p = 0.02).</p><p><strong>Conclusion: </strong>An appropriate response to a low-dose, combination hepatitis B vaccine was observed in allogeneic HCT recipients. Autologous response rates are low, though this finding is consistent with prior literature.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70005"},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543436","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":"Posttransplant HBV Vaccine Compliance, Seroprotection, and Kinetics of Hepatitis B Surface Antibody in Thoracic Organ Transplant Recipients.","authors":"Chia-Yu Chiu, Priya Sampathkumar, Lisa M Brumble, Holenarasipur R Vikram, Kymberly D Watt, Elena Beam","doi":"10.1111/tid.70015","DOIUrl":"https://doi.org/10.1111/tid.70015","url":null,"abstract":"<p><strong>Introduction: </strong>Vaccination is crucial to the thoracic solid organ transplant (SOT) population to reduce vaccine-preventable infection. However, data on posttransplant hepatitis B virus (HBV) vaccination compliance and vaccine-induced seroprotection are lacking.</p><p><strong>Methods: </strong>We conducted a retrospective study of adult thoracic organ (heart and lung) transplant recipients at Mayo Clinic sites in Minnesota, Arizona, and Florida between January 2018 and August 2023. Recombivax HB was used before 2020, and Heplisav-B was preferred after 2020. Recipients with posttransplant hepatitis B surface antibody (HBsAb) < 10 IU/L were eligible for the HBV vaccine. HBV seroprotection was defined as an HBsAb ≥ 10 IU/L.</p><p><strong>Results: </strong>A total of 1116 recipients were evaluated, all of whom underwent posttransplant HBsAb testing. Of these, 751 (67%) had an HBsAb level < 10 IU/L and were eligible for posttransplant HBV vaccination. Of the eligible recipients, 117 (16%) completed the HBV vaccine series during the study period. Among these 117 recipients, 40 (34%) had their HBsAb levels rechecked after completing the vaccine series, with a seroprotection rate of 37.5% (15/40). There was no statistically significant difference in the seroprotection rates between Heplisav-B and Recombivax HB vaccines (39% [13/33] vs. 29% [2/7]; p = 0.691). In addition, HBsAb levels were lowest at week 2 but rebounded at week 4 posttransplant and pretransplant HBsAb levels of ≥100 IU/L ensured 5-year seroprotection.</p><p><strong>Conclusion: </strong>Suboptimal compliance with HBV vaccination and poor vaccine-induced seroprotection occur in thoracic organ transplant recipients, regardless of the vaccine used. These findings underscore the necessity of enhancing vaccination strategies for SOT recipients.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70015"},"PeriodicalIF":2.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493915","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":"Safety of Once-Weekly Dapsone for Pneumocystis jirovecii Pneumonia Prophylaxis in Kidney Transplant Recipients.","authors":"Lauren Schumacher, Olivia Philippart, Abbey Carr, Catherine J Cj Sadler, Sravanthi Paluri","doi":"10.1111/tid.70012","DOIUrl":"https://doi.org/10.1111/tid.70012","url":null,"abstract":"<p><strong>Background: </strong>Sulfamethoxazole-trimethoprim (SMX-TMP) is recommended first-line for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in kidney transplant recipients. In cases of sulfa allergy or intolerance, our center utilizes dapsone 100 mg once weekly as alternative prophylaxis. As both agents have the potential to cause hematologic abnormalities, we sought to compare hematologic effect profiles of weekly dapsone versus SMX-TMP in kidney transplant recipients.</p><p><strong>Methods: </strong>This retrospective, single-center, cohort study included kidney transplant recipients who received SMX-TMP or dapsone for PJP prophylaxis. The primary endpoint was the change in hemoglobin from baseline to nadir. Secondary endpoints included hemoglobin and white blood cell (WBC) count at 1, 3, and 6 months posttransplant, time to hemoglobin nadir, neutropenia incidence, and ANC nadir. In addition, we evaluated the incidence of hospital readmission, bacteremia, and PJP.</p><p><strong>Results: </strong>A total of 509 kidney transplant recipients were included (334 SMX-TMP vs. 175 dapsone). Median decrease in hemoglobin (g/dL) from baseline to nadir was greater in the dapsone group (0 SMX-TMP vs. -0.20 dapsone; p = 0.046). Mean absolute hemoglobin count was lower in the dapsone group at all time points. There was no difference in WBC, ANC nadir, or incidence of neutropenia at any time point between groups. Greater frequencies in readmissions (30.7% vs. 55.7%; p < 0.001) and bacteremia (3.6% vs. 10.8%; p < 0.001) were observed in the dapsone arm.</p><p><strong>Conclusions: </strong>Once-weekly dapsone is associated with statistically significant decreases in hemoglobin when compared to SMX-TMP in a kidney transplant cohort, which may be clinically relevant in select patients. Dapsone use may also increase infection risk.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70012"},"PeriodicalIF":2.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493919","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":"Addressing the Rising Burden of Carbapenemase-Producing Enterobacterales in Liver Transplant Recipients: A Call for Enhanced Surveillance and Prevention Strategies.","authors":"Muna A Al-Maslamani, Javed Iqbal","doi":"10.1111/tid.70014","DOIUrl":"https://doi.org/10.1111/tid.70014","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70014"},"PeriodicalIF":2.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493811","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":"Lessons From the Utilization of Hepatitis B Virus Nucleic Acid Test Positive Donors for Hepatitis B Vaccinated Lung Transplant Candidates (INHIBITOR) Study.","authors":"Andrew M Courtwright, Stacey Prenner, Jeffrey B Doyon, Tamara Claridge, Emily Blumberg, Christian A Bermudez, Maria M Crespo","doi":"10.1111/tid.70013","DOIUrl":"https://doi.org/10.1111/tid.70013","url":null,"abstract":"<p><strong>Background: </strong>This was a single-center pilot study to determine the safety and efficacy of transplanting lungs from hepatitis B virus (HBV) nucleic acid positive (NAT+) donors to HBV vaccinated (sAb+) candidates. We report our study experience, including barriers to utilizing NAT+ donors.</p><p><strong>Methods: </strong>Primary candidate eligibility criteria included: HBV sAb+, < 70 years old, not on mechanical support, no liver fibrosis, normal esophageal motility, and cPRA < 60. Only brain-dead donors with no marginal characteristics or concurrent hepatitis C virus (HCV) were accepted. Recipients of HBV NAT+ organs would receive intravenous hepatitis B immunoglobulin as well as appropriate HBV antiviral therapy.</p><p><strong>Results: </strong>A total of 155 patients were screened for eligibility. Most (64.5%) were excluded because they were HBV sAb negative. Of the 25 eligible sAb+ candidates, 13 enrolled, and 6 were listed for HBV NAT+ organs. There were 16 donor offers, all of which were rejected because of quality or concurrent donor HCV infection. No other centers utilized these organs.</p><p><strong>Conclusions: </strong>Reduced enrollment related to strict eligibility criteria, few HBV immune candidates, and stringent requirements on HBV NAT+ donors were limiting factors. Further studies are needed to assess the safety and efficacy of HBV NAT+ donor lung transplants.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70013"},"PeriodicalIF":2.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493819","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}