Transplant Infectious Disease最新文献

{"title":"Impact of Severe Persistent BK Polyomavirus on Graft Function and Quality of Life Outcomes in Kidney Transplant Recipients.","authors":"Emily M Eichenberger, Wairimu Magua, Geeta Karadkhele, Grace Zhou, Payaswini Vasanth, Christian Larsen","doi":"10.1111/tid.70010","DOIUrl":"https://doi.org/10.1111/tid.70010","url":null,"abstract":"<p><strong>Background: </strong>The risk factors and outcomes associated with severe persistent BK polyomavirus (BKPyV) in kidney transplant recipients (KTR) are unknown.</p><p><strong>Methods: </strong>This is a single-center retrospective study of KTR with severe persistent BKPyV compared to (1) KTR with low/no BKPyV-DNAemia and (2) KTR with high BKPyV-DNAemia. Severe persistent BKPyV was defined as BKPyV load reaching > 6 log₁₀ (1 000 000 copies/mL) for ≥ 90 days. Low/no BKPyV was defined as BKPyV load remaining < 3 log₁₀ (1000 copies/mL), and high BKPyV was defined as BKPyV load ≥ 3 log₁₀ without meeting criteria for severe persistent BKPyV.</p><p><strong>Results: </strong>Out of 2586 KTR, 22 had severe persistent BKPyV and were compared to 1843 KTR with low/no BKPyV and 721 KTR with high BKPyV. A low absolute lymphocyte count during the first month posttransplant was associated with an increased risk of severe persistent BKPyV relative to those with low/no BKPyV and high BKPyV (OR 0.91, 95%CI 0.84, 0.99). KTR with severe persistent BKPyV had significantly lower eGFR at 2 years posttransplant relative to low/no and high BKPyV groups eGFR (36 vs. 61 and 59 mL/min; p < 0.001 for both). Additionally, KTR with severe persistent BKPyV required more lab draws and incurred significantly higher total lab-associated costs relative to KTR with low/no BKPyV and high BKPyV ($7516 vs. $4631, p < 0.001; $7516 vs. $5811, p < 0.001, respectively).</p><p><strong>Conclusions: </strong>Severe persistent BKPyV is uncommon but associated with poor outcomes including impaired renal function, a higher burden of labs, and lab-associated costs. Future studies are needed to determine underlying factors that predict severe persistent BKPyV.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70010"},"PeriodicalIF":2.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658619","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":"De Novo Lymphocytic Choriomeningitis Virus in a Heart-Kidney Transplant Recipient.","authors":"Kevin D He, Hawra Al Lawati, Audrey Li","doi":"10.1111/tid.70017","DOIUrl":"https://doi.org/10.1111/tid.70017","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70017"},"PeriodicalIF":2.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658424","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":"Critique on \"Infection-Associated Immune Reconstitution Inflammatory Syndrome in Hematopoietic Cell Transplantation\".","authors":"Javed Iqbal, Muna A Al-Maslamani","doi":"10.1111/tid.70022","DOIUrl":"https://doi.org/10.1111/tid.70022","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70022"},"PeriodicalIF":2.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658241","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":"Prophylactic Vancomycin in the Primary Prevention of Clostridium difficile in Allogeneic Stem Cell Transplant.","authors":"Brendon Fusco, Jasmine Tomita-Barber, Natale Mazzaferro, Anne Tyno, Nicole McEntee, Patricia Greenberg, Roger Strair, Dale Schaar, Dennis Cooper","doi":"10.1111/tid.70025","DOIUrl":"https://doi.org/10.1111/tid.70025","url":null,"abstract":"<p><strong>Background: </strong>Clostridium difficile (C. difficile) infection is a frequent complication following hematopoietic stem cell transplant, contributing to increased morbidity in this population. Despite current infection prevention strategies, rates among posttransplant patients at some centers remain high. Oral vancomycin is a safe and well-tolerated antibiotic that may be a potential adjunct to prevent C. difficile.</p><p><strong>Objectives: </strong>To evaluate the effectiveness of oral vancomycin in preventing C. difficile among allogeneic stem cell transplant patients and assess other posttransplant outcomes.</p><p><strong>Study design: </strong>A retrospective cohort study was conducted comparing the rate of C. difficile following allogeneic transplant in patients who received oral vancomycin versus no prophylaxis during hospitalization. The primary outcome was the development of C. difficile infection within the first 100 days following transplant, defined as a positive stool toxin assay or PCR. Secondary outcomes included hospital length of stay, hospital-acquired infections, overall mortality, graft-versus-host disease (GVHD), and rehospitalization.</p><p><strong>Results: </strong>Among the 202 patients, one case of C. difficile occurred in the prophylaxis group (1/71, 1.4%) compared to 31 cases in the unexposed group (31/131, 23.6%). Patients who received prophylaxis were significantly less likely to develop C. difficile infection during the study period (OR 0.046, p = 0.003). No differences were observed between groups in hospital-acquired infections, mortality, incidence of acute GVHD, and rehospitalization.</p><p><strong>Conclusion: </strong>Prophylactic vancomycin was associated with a marked reduction in C. difficile infection in allogeneic transplant patients. Despite no significant impact on other clinical outcomes, there was a significant reduction in symptomatic C. difficile infection. Further prospective studies are warranted.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70025"},"PeriodicalIF":2.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658766","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":"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":"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":"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":"The Utility of Interferon-γ Release Assays in the Diagnosis of Tuberculosis in Patients With Cancer.","authors":"Marjorie V Batista, Joseph Sassine, Fareed Khawaja, Prathit A Kulkarni, Georgios Angelidakis, Joumana Kmeid, Firas El Chaer, Ella J Ariza-Heredia, Edward A Graviss, Victor E Mulanovich, Roy F Chemaly","doi":"10.1111/tid.14428","DOIUrl":"10.1111/tid.14428","url":null,"abstract":"<p><strong>Background: </strong>Patients with cancer are at elevated risk for tuberculosis (TB) reactivation. Diagnosis of latent TB infection and TB disease remains challenging in this patient population despite the advent of interferon-γ release assays (IGRA).</p><p><strong>Methods: </strong>We retrospectively reviewed medical records of all patients with cancer who had IGRA testing (QuantiFERON-TB [QFT-TB] or T-SPOT.TB) at a major cancer center in the United States from June 2010 to July 2017. The results were analyzed with respect to the likelihood of latent TB infection and TB disease.</p><p><strong>Results: </strong>A total of 1299 patients were included with 1599 tests performed: 586 QFT-TB and 1013 T-SPOT.TB. Forty-nine (4%) patients were diagnosed with latent TB, and four (1%) with TB disease. T-SPOT.TB was more likely to yield an actionable result (positive or negative) than QFT-TB (89% vs. 65%, p < 0.001). The rate of indeterminate results for QFT-TB was higher than the rate of invalid results for T-SPOT.TB (35% and 10%, respectively, p < 0.001). On multivariate analysis, independent predictors of an invalid T-SPOT.TB included prior receipt of alemtuzumab, lower hemoglobin, absolute lymphocyte count, or serum albumin (p < 0.05 each), whereas the independent predictors of an indeterminate QFT-TB were female gender, prior receipt of systemic corticosteroids, and lower hemoglobin, or serum albumin or higher absolute neutrophil count (p < 0.05 each).</p><p><strong>Conclusions: </strong>T-SPOT.TB yielded more actionable results than QFT-TB in patients with cancer. T-SPOT.TB might be a better IGRA for screening for latent TB infection in patients with cancer, although a direct comparison would be needed to definitively determine this.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14428"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898342","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":"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":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017301/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}