Transplant Infectious Disease最新文献

{"title":"Cytomegalovirus Retinitis During Idecabtagene Vicleucel Therapy in Patients With Relapsed/Refractory Multiple Myeloma.","authors":"Taku Kikuchi, Miyu Watanabe, Nobuhiro Tsukada, Chiaki Matsumoto, Moe Nomura-Yogo, Kodai Kunisada, Haruka Sawada, Kota Sato, Tomomi Takei, Mizuki Ogura, Yu Abe, Kenshi Suzuki, Osamu Hosoya, Tadao Ishida","doi":"10.1111/tid.70040","DOIUrl":"https://doi.org/10.1111/tid.70040","url":null,"abstract":"<p><strong>Background: </strong>Chimeric antigen receptor T-cell (CAR-T) therapy has improved outcomes in patients with triple-class-exposed relapsed/refractory multiple myeloma (RRMM); however, it is associated with complications, including infections. Cytomegalovirus (CMV) infection is one of the infections associated with idecabtagene vicleucel (ide-cel) treatment. While there have been several reports on CMV replication, CMV retinitis has only been documented in case reports, making it a severe but under-reported complication.</p><p><strong>Study design: </strong>This retrospective single-institution study was conducted at the Japanese Red Cross Medical Center. The study analyzed the clinical features of CMV retinitis in 53 patients with RRMM treated with ide-cel between December 2022 and December 2024. CMV retinitis was diagnosed based on ophthalmological findings, with CMV polymerase chain reaction (PCR) confirmation in the vitreous fluid, if necessary.</p><p><strong>Results: </strong>The cumulative incidence of CMV retinitis at 6 months was 9.2%, with a median onset time of 2.2 months postinfusion. Among the four patients with CMV retinitis, three patients experienced visual impairment and one patient was asymptomatic. One patient was diagnosed with CMV retinitis, despite having negative serum CMV PCR results, which highlights the limitations of replication-based screening. All patients required treatment, with one patient achieving improvement and three patients undergoing ongoing treatments.</p><p><strong>Conclusions: </strong>CMV retinitis is a significant complication of ide-cel therapy. Regular CMV PCR is important, but early ophthalmological consultations are crucial for timely detection and management, even in the absence of CMV replication, particularly when visual impairment develops. Further studies are needed to identify the risk factors and establish preventive strategies.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70040"},"PeriodicalIF":2.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043727","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":"Bacteremia in Pediatric Solid Organ Transplant Recipients within 1 Year of Transplant.","authors":"Mario M Landa, Ayelet Rosenthal, Caitlin Naureckas Li, Mehreen Arshad, Sameer Patel, Larry Kociolek, Alyah Barnes, Stella Karuri, William J Muller","doi":"10.1111/tid.70030","DOIUrl":"https://doi.org/10.1111/tid.70030","url":null,"abstract":"<p><strong>Background: </strong>Bacteremia is a major cause of morbidity and mortality in immunocompromised children, yet there are limited data in children who have undergone solid organ transplantation (SOT).</p><p><strong>Methods: </strong>We retrospectively reviewed bloodstream infections (BSI) in 581 recipients of heart, liver, or kidney transplants over a 14-year period.</p><p><strong>Results: </strong>Overall 1-year incidence in this population was 8.4%, and was highest in recipients of liver transplants compared to heart or kidney. Younger age, transplantation earlier in the time period studied, need for repeat surgery within 30 days of transplant, and prior diagnosis of diabetes or tumor were associated with an increased risk of BSI. Most BSI occurred within 90 days of transplant, and most were associated with central venous lines. Coagulase-negative staphylococci and enteric commensals were commonly isolated. Multiple BSI within the year after transplant were uncommon. Although overall mortality was not increased in patients with BSI compared to those without, patients with BSI had more total hospitalizations and more days spent in the hospital in the year following SOT.</p><p><strong>Conclusion: </strong>In a large pediatric SOT population, overall BSI rates were significant but decreased over time. Identifying factors which contribute to BSI after SOT may direct interventions that can impact inpatient care requirements for these patients.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70030"},"PeriodicalIF":2.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020383","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":"Clinically Significant EBV Infection in Allogeneic Stem Cell Transplanted Children Receiving Letermovir as Primary CMV Prophylaxis.","authors":"Christina Oikonomopoulou, Anna Paisiou, Aikaterini Kaisari, Eleni-Dikaia Ioannidou, Anna Komitopoulou, Marina Letsiou, Ioannis Grafakos, Michalis Kastamoulas, Georgia Stavroulaki, Sofia Hante, Evgenios Goussetis","doi":"10.1111/tid.70032","DOIUrl":"https://doi.org/10.1111/tid.70032","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) infection and disease constitute an important complication of allogeneic hematopoietic stem cell transplantation with high morbidity. Letermovir prophylactic use in adult recipients has reduced the incidence of CMV infection with minimal toxicity. Relevant data on children is scarce, and letermovir has been used off-label. Recently, a couple of studies indicated an association of letermovir with EBV reactivation/PTLD in adults, raising a significant concern.</p><p><strong>Methods: </strong>We aimed to retrospectively compare ultra-high-risk for CMV infection children with leukemia [seropositive children/seronegative donors], who received (LET-group) or did not receive (not LET-group) letermovir. Primary objectives were cumulative incidence (CI) of CMV reactivation, EBV reactivation, and clinically significant EBV infection (csEBVi).</p><p><strong>Results: </strong>A total of 37 patients (median age 8.2 years), LET-group-11 and not LET-group-26, were included. The median follow-up was 34.3 months. Compared to the not LET group, patients of the LET group had a lower CI of CMV reactivation, 10% versus 38.4%, p = 0.07, a higher CI of EBV reactivation, 55%, referring to 6/11 patients, versus 23%, p = 0.07, and a higher CI of csEBVI, 40% (4/11 patients) versus 0%, p < 0.001. No patient in the LET group developed GvHD, compared to 23% for aGvHD p = 0.08 and 11.5% for cGvHD p = 0.25 in the non-LET group.</p><p><strong>Conclusion: </strong>Our study confirms letermovir's effectiveness against CMV. Yet, it also reports a high incidence of EBV reactivation and significant EBV infection, as well as a reduced GvHD prevalence in children receiving the drug. Our single-center, retrospective analysis has major limitations but raises a concern. Our findings require further validation in larger, multicenter, prospective studies.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70032"},"PeriodicalIF":2.6,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014673","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":"The Challenge of Bacterial Infections During Intensive Care Unit Stay After Heart Transplantation.","authors":"Rita Minucci, Annalisa De Silvestri, Patrizia Cambieri, Marta Corbella, Carlo Pellegrini, Silvia Roda, Chiara Dezza, Stefano Pelenghi, Raffaele Bruno, Mirko Belliato, Elena Seminari","doi":"10.1111/tid.70031","DOIUrl":"https://doi.org/10.1111/tid.70031","url":null,"abstract":"<p><strong>Background: </strong>Infections occurring in the early post-heart transplant (HT) period heavily contribute to morbidity and mortality. Our goal is to evaluate the incidence of hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAPs) and/or bloodstream infections (BSIs) after HT during the intensive care unit (ICU) stay and identify their associated risk factors in our tertiary hospital.</p><p><strong>Methods: </strong>Observational prospective study including all adult patients who consecutively underwent HT from January 1, 2015 to August 31, 2023 at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. HAP/VAPs and BSIs diagnosed during ICU were included in the analysis.</p><p><strong>Results: </strong>A total of 106 patients were included, 38 of whom had at least one infectious episode (35.8%), for a total of 57 independent episodes and their incidence was 2.2 per 100 days (95% CI 1.7-2.8). Length of ICU stay was 8 days (IQR: 6-11) for patients without infectious events and 27 days (IQR 14-52) for those with infectious events (p < 0.001). Gram-negative bacteria were associated with 62.8% of BSIs (mainly Enterobacterales) and with 77.9% of HAP/VAP, in this setting Pseudomonas aeruginosa accounted for 17.6% of infections while Klebsiella spp. accounted for 22.1% of infections. Colonization with resistant bacteria (HR 2.21, 95% CI 1.12-4.35) was associated with increased risk of infections while perioperative antimicrobial prophylaxis (PAP) covering Gram-negative bacteria at transplant (HR 0.45, 95% CI 0.23-0.90, p = 0.023) was a protective factor.</p><p><strong>Conclusion: </strong>This study shows that Gram-negative infections represent the major challenge for HT patients during ICU stay and shows some evidence in support of the PAP covering Gram-negative infections at transplant.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70031"},"PeriodicalIF":2.6,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038640","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":"Proof of Concept that Implementation of a Multispecialty Educational Intervention May Improve Acceptance of Organs from Donors with HIV at a Tertiary Care Hospital: A Single-Center Study.","authors":"Neeraja Swaminathan, Yoram A Puius, Jonathan Czeresnia, Victoria A Muggia, Yorg Azzi, Harith Raees, Enver Akalin, Vagish Hemmige","doi":"10.1111/tid.70039","DOIUrl":"https://doi.org/10.1111/tid.70039","url":null,"abstract":"<p><strong>Background: </strong>People living with HIV have a higher waitlist mortality and decreased access to transplants. The enactment of the HIV Organ Policy Equity Act (HOPE Act) in 2013 was a step toward increasing the donor population. However, utilization of organs through the act has been less than initially anticipated, both nationally and initially at our center.</p><p><strong>Methods: </strong>To improve the acceptance of abdominal organs from donors with positive HIV tests (D+) for recipients with HIV (R+), we implemented a multidisciplinary educational intervention at our center in December 2020.</p><p><strong>Results: </strong>Comparing the preintervention period (March 2018-November 2020) to the postintervention period (December 2020-April 2022), the number of organs that were declined for potentially HIV-related reasons decreased significantly from 91% to 63% (p = 0.004). The proportion of organs declined at our center for potentially HIV-related reasons that were accepted later by another center was 40% (10/25) preintervention and 24% (12/49) postintervention (p = 0.2). The rate of transplants/patient-years on our center's waiting list overall tripled (IRR 3.11; 95% CI 1.08-9.44, p = 0.036), with the rate of HIV D+/R+ transplants increasing more dramatically (IRR 16.3; 95% CI 2.90-305, p = 0.009).</p><p><strong>Conclusion: </strong>Intensive provider education may have an impact on improving rates of transplantation of HIV+ recipients and realizing the potential of the HOPE ACT.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70039"},"PeriodicalIF":2.6,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038699","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":"A Six-Year-Old Boy With Fever and Deranged Liver Function Tests, Post-Living-Donor Liver Transplantation.","authors":"Dhiraj Agrawal, Shwetha Kamath, Dharmesh Kapoor","doi":"10.1111/tid.70035","DOIUrl":"https://doi.org/10.1111/tid.70035","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70035"},"PeriodicalIF":2.6,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050304","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":"Antibiotic Exposure and Risk of Allograft Rejection and Survival After Liver Transplant: An Observational Cohort Study From a Tertiary Referral Centre.","authors":"Olivia C Smibert, Sara Vogrin, Marie Sinclair, Avik Majumdar, Mohamed Nasra, Dinesh Pandey, Hossein Jahanabadi, Jason A Trubiano, Kate A Markey, Monica A Slavin, Adam Testro, Jason C Kwong","doi":"10.1111/tid.70026","DOIUrl":"https://doi.org/10.1111/tid.70026","url":null,"abstract":"<p><strong>Introduction: </strong>Our goal is to understand whether there is an association between Abx exposure-and the inferred downstream damage to the intestinal microbiome-and the key patient outcomes of overall survival and rejection following liver transplant.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 462 liver transplant recipients treated at a multistate liver transplant (LTx) service during a 7-year period. The association between antibiotic exposure and outcome was tested across models that addressed antibiotic spectrum, duration, and timing relative to transplant. Cox proportional hazard regression was used to evaluate the relationship between antibiotics with survival and rejection.</p><p><strong>Results: </strong>The observed 1-year survival in this cohort was 95% (95% CI: 93%, 97%), and 20.8% of patients (96/462) experienced rejection at 1 year. In multivariable analyses, exposure to anaerobe-targeting antibiotics for longer than 14 days pretransplant (p = 0.055) or posttransplant (p = 0.040) was significantly associated with reduced 1-year survival. In multivariable analyses, exposure to any anaerobe-targeting Abx posttransplant was significantly associated with an increased risk of rejection (p = 0.001).</p><p><strong>Conclusions: </strong>Exposure to anaerobic spectrum antibiotics either before or after LTx was associated with poor outcomes during the first year posttransplant and provides an impetus to further characterize the relationship between antibiotic use, microbiota disruption, and cellular immunity in liver transplantation.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70026"},"PeriodicalIF":2.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735699","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":"Re: Universal Multiplex Panel Testing of Donor Lungs as a Strategy to Optimize Antibiotic Prophylaxis against Multidrug-Resistant Bacteria.","authors":"Andrea Lombardi, Davide Mangioni, Giulia Renisi, Arianna Liparoti, Alessandra Bandera","doi":"10.1111/tid.70029","DOIUrl":"https://doi.org/10.1111/tid.70029","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70029"},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731623","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-Induced Arterial Intimal Fibrosis in the Kidney Transplant.","authors":"Anukul Ghimire, Simon R Walker, Fareed Kamar","doi":"10.1111/tid.70027","DOIUrl":"https://doi.org/10.1111/tid.70027","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70027"},"PeriodicalIF":2.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701655","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":"Direct-Acting Antiviral Treatment Failure and Retreatment Strategies Following Hepatitis C-Positive Solid Organ Transplantation in Hepatitis C-Negative Recipients: A Multicenter Case Series.","authors":"Alicia B Carver, Claire Özoral, Morgan Lange, Alysa Mattise, Kristen Whelchel, Roman Perri","doi":"10.1111/tid.70024","DOIUrl":"https://doi.org/10.1111/tid.70024","url":null,"abstract":"<p><strong>Background: </strong>Transplanting solid organs from hepatitis C virus (HCV) nucleic acid testing (NAT+) donors (D+) into HCV-negative recipients (R-) has become more common with the development of curative direct-acting antiviral (DAA) treatment. Limited information exists to guide retreatment strategies for patients not achieving sustained virologic response (SVR) with DAAs. This multisite case series examines retreatment strategies and subsequent SVR rates in HCV-negative solid-organ transplant (SOT) recipients who did not achieve SVR following reactive initial DAA therapy following NAT+ SOT.</p><p><strong>Methods: </strong>A retrospective multisite case series was conducted on patients not achieving SVR with initial DAA treatment post-NAT+ HCV SOT between September 2016 and September 2022 across four tertiary medical centers in the United States.</p><p><strong>Results: </strong>Thirteen patients were identified, predominantly receiving HCV NAT+ kidneys (77%) and SOF/VEL for 12 weeks as initial DAA therapy (43%). Baseline resistance testing was not performed. Median time to treatment initiation post-SOT was 35 [IQR 22-41] days, and to retreatment postpositive viral load was 35 days [IQR 17-76]. Most patients (62%) were retreated with sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) for 12 weeks. Two patients required retreatment extension with SOF/VEL/VOX and SOF/VEL/VOX + ribavirin (RBV) from 12 to 24 weeks due to persistent viremia. Only one patient did not achieve SVR following retreatment with SOF/VEL/VOX for 12 weeks but did achieve SVR after a third course of treatment with SOF + GLE/PIB + RBV for 24 weeks.</p><p><strong>Conclusion: </strong>Despite initial DAA failures, all HCV-negative SOT recipients achieved SVR following one or more courses of retreatment with DAAs.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70024"},"PeriodicalIF":2.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701662","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}