Transplant Infectious Disease最新文献

{"title":"Evaluation of Cytomegalovirus (CMV) T-Cell Mediated Immunity in Children With CMV DNAemia After Allogeneic Hematopoietic Cell Transplantation.","authors":"Varvara Probst, Christopher P Ouellette, Eunkyung Song","doi":"10.1111/tid.70253","DOIUrl":"10.1111/tid.70253","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) is among the most common infectious complications following allogeneic hematopoietic cell transplantation (allo-HCT). The CMV T-cell immunity panel (CMV-TCIP, Viracor) assesses CMV cell-mediated immunity (CMV-CMI); however, its utility among pediatric allo-HCT recipients remains unknown.</p><p><strong>Methods: </strong>A retrospective analysis (January 2020-January 2024) among pediatric (≤ 18 years) allo-HCT recipients with CMV DNAemia and at least one CMV-TCIP test was performed. A %CMV-CD4⁺ or %CMV-CD8⁺ IFN-γ ≤ 0.2% was categorized as a poor response, whereas a result > 0.2% was classified as adequate. Clinically significant CMV infection (csCMVi) was defined as viral load (VL) ≥ 500 IU/mL. CMV-TCIP results were compared to CMV VL and the development of csCMVi after allo-HCT.</p><p><strong>Results: </strong>Twenty-seven CMV-TCIP results from 10 allo-HCT recipients were analyzed. The median age at transplant was 8.5 years (IQR 2.75-14.3), predominantly for hematologic malignancy (70%), and with high-risk CMV serostatus (R+, 90%). At the time of CMV-TCIP testing, subjects with a VL < 500 IU/mL had a higher %CMV-CD4⁺ IFN-γ compared to those with a VL ≥ 500 IU/mL (0.36 vs. 0.04, p = 0.02). Peak CMV VLs were lower in those with adequate CD4⁺ and CD8⁺ T-cell responses than in those with poor CD4⁺ and CD8⁺ T-cell responses. In those who received CMV viral-specific T-cells (CMV-VST, n = 5), increased %CD4⁺ and %CD8⁺ IFN-γ responses post-infusion were observed with a concordant downward trend in VL.</p><p><strong>Conclusions: </strong>Our results demonstrate that the development of CMV-CMI (particularly CD4⁺ IFN-γ > 0.2%) was observed with lower CMV VLs and may provide immunologic insights into pediatric allo-HCT recipients receiving CMV-VST.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70253"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278973","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":"Human Herpesvirus 8 Causes a Wide Spectrum of Disease in Liver Transplant Recipients and May be Donor Derived: Case Series and Systematic Review of an Emerging Challenge.","authors":"Karen M J Waller, Sudarshan Arvind, Simone I Strasser, Ken Liu, Geoff W McCaughan, David G Bowen, Madeleine Gill, Rebecca Davis, William Rawlinson, Sacha Stelzer-Braid, Geoff Watson, Vinay Vanguru, Tina Marinelli","doi":"10.1111/tid.70293","DOIUrl":"10.1111/tid.70293","url":null,"abstract":"<p><strong>Background: </strong>Human herpesvirus 8 (HHV8), also known as Kaposi sarcoma (KS)-associated herpesvirus, can cause severe disease in liver transplant (LT) recipients, be donor-derived, and present variably. We describe HHV8 disease post-LT.</p><p><strong>Methods: </strong>HHV8 disease was identified post-LT in New South Wales (NSW), 2017-2024, and from systematic review. Reports were compared by suspected donor-derived infection (DDI) and disease manifestation, using chi-square and t-tests. Survival was investigated with Cox proportional hazards.</p><p><strong>Results: </strong>Of 188 records, 79 publications (131 cases) were included, plus four NSW cases (n = 135). Median onset was 7 months posttransplant (IQR: 5-13), with 33% suspected DDI. After median 12 months of follow-up, 68/125 had disease remission/regression; 59/135 died (49 HHV8-related). In NSW, Case 1 was proven DDI: visceral KS, 6 months post-LT; complete remission occurred with immunosuppression modification and chemotherapy. Case 2 was probable DDI: KS, multicentric Castleman's disease, and hemophagocytic lymphohistiocytosis, 3 months post-LT; the patient died despite immunosuppression modification, hydrocortisone and rituximab. Case 3 was possible DDI: KS-herpesvirus-induced cytokine syndrome, 6 months post-LT; died despite immunosuppression modification and ganciclovir. Case 4 was unlikely DDI: visceral KS, 5 months post-LT; complete remission occurred with surgery and immunosuppression modification. Survival was worse with visceral KS and non-KS disease (aHR 5.83 and 4.32, p = 0.002). Reduced immunosuppression, mTORi, and chemotherapy improved survival (aHRs 0.53, 0.36, 0.43; p = 0.006, 0.044, and 0.030). Treatment effects diverged by KS and non-KS disease. Donor screening identified more KICS and DDI, with improved non-KS disease survival.</p><p><strong>Conclusion: </strong>Post-LT HHV8 disease is heterogeneous, with high mortality. Targeted treatments and possibly donor screening improve survival.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70293"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702297","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":"Invalid Nucleic Acid Test Results May Limit Deceased Donor Organ Utilization.","authors":"Sara Dionne, Hillary Akana, Kaitlin Logue, Brenden O'Neale, Chris Curran, Sean VanSlyck","doi":"10.1111/tid.70247","DOIUrl":"10.1111/tid.70247","url":null,"abstract":"<p><strong>Background: </strong>Nucleic acid testing (NAT) is essential for detecting transmissible viral infections in deceased organ donors and guiding safe organ allocation. However, invalid discriminatory NAT (dNAT) results may lead to unnecessary donor exclusion and reduced organ availability.</p><p><strong>Methods: </strong>We performed a retrospective analysis of HIV-1/2, HBV, and HCV NAT results from deceased organ donors in the United States. Donor specimens were tested at eleven laboratories using FDA-approved donor screening assays. Donor serologic results and organ utilization outcomes were reviewed to evaluate the clinical impact of invalid dNAT results.</p><p><strong>Results: </strong>Invalid dNAT results occurred in 0.027% of donor cases (n = 27), predominantly in cases suggestive of HCV infection (n = 22). Although infrequent, these cases had a disproportionate impact on organ utilization. Serologic findings frequently supported true infection despite unresolved NAT results. Repeat testing did not resolve these cases and extended result reporting times by a median of 22 h. In 30% of cases (n = 6) in which organ utilization was available, organs were not transplanted, reflecting uncertainty in infectious risk assessment.</p><p><strong>Conclusion: </strong>Although rare, invalid dNAT results have clinical and operational consequences, contributing to delays, conservative donor classification, and reduced organ utilization. These findings highlight the need for standardized reporting of invalid results and access to rapid alternative confirmatory testing to support informed clinical decision-making and reduce unnecessary organ discard.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70247"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989233","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":"Donor Dilemma: A National Simulation-Based Case Curriculum for Teaching Donor Call Decision-Making in Infectious Diseases Trainees.","authors":"Robert Sean Tyler, Rachel B Colven, Alexandra G Mills, Drew W Charles, Ruth O Adekunle, Divisha Sharma, Yosra Alkabab, Scott R Curry, Ricardo M La Hoz, Courtney E Harris","doi":"10.1111/tid.70284","DOIUrl":"10.1111/tid.70284","url":null,"abstract":"<p><strong>Introduction: </strong>Donor-call decision-making during organ allocation requires clinical reasoning in the setting of uncertainty, time pressure, and evolving information. In transplant infectious diseases (TID), this skill is essential, yet exposure during training is often inconsistent and informal. Educational strategies that allow trainees to practice this type of decision-making remain limited. We aimed to evaluate the feasibility, acceptability, and perceived impact of an asynchronous electronic, case-based progressive disclosure curriculum designed to support clinical reasoning during donor-call decision-making among infectious diseases (ID) trainees.</p><p><strong>Methods: </strong>In this pilot feasibility study, we developed a self-paced, asynchronous donor-call curriculum consisting of 12 case-based modules. Cases reflected real-world donor scenarios. After national dissemination to ID and TID training programs, participants completed all modules and a post-curriculum survey assessing feasibility and perceived educational impact.</p><p><strong>Results: </strong>Around 29 trainees from 22 academic medical centers completed all 12 modules. Most had little prior donor-call exposure. Eighty-six percent endorsed greater confidence in their clinical reasoning, and 97% reported greater confidence in assessing donor suitability. The curriculum was feasible within clinical workflows, and 97% of participants indicated they would recommend it to their peers. Perceived gains were most pronounced among trainees with minimal transplant experience, with benefit remaining high even among those in dedicated TID training years.</p><p><strong>Conclusion: </strong>An asynchronous donor-call case-based progressive disclosure curriculum was feasible and valued across diverse ID and TID training programs. This scalable approach may offer a framework for supporting clinical reasoning in other areas of medicine where complex decisions must be made quickly with limited information.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70284"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550759","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":"Expanding the Donor Pool: Transplantation of Hepatitis B and Hepatitis C Coinfected Kidneys.","authors":"Tasneem Wasfy, Jacob Ernst, Julie Sherman, Amanda Ingemi, Ralph Rogers","doi":"10.1111/tid.70270","DOIUrl":"10.1111/tid.70270","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70270"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377058","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":"Late-Onset PCR-Confirmed Whipple Disease Mimicking Mycophenolate Enteropathy in a Pediatric Renal Transplant Recipient.","authors":"Thotanolla Surya Prakash","doi":"10.1111/tid.70279","DOIUrl":"10.1111/tid.70279","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70279"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438191","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":"Continuous Trimethoprim-Sulfamethoxazole Prophylaxis Does Not Affect Engraftment in Patients Undergoing Allogeneic Stem Cell Transplantation.","authors":"Benedikt Färber, Jan Räder, Jan Vorwerk, Leopold Alexander Schawe, Jan Morf, Helen Sievert, Andrea Feindel, Niklas Gebauer, Nikolas von Bubnoff, Friederike Wortmann, Lorenz Oelschlaeger","doi":"10.1111/tid.70313","DOIUrl":"https://doi.org/10.1111/tid.70313","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70313"},"PeriodicalIF":2.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866825","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":"Impact of an Extended Peri- and Postoperative Antimicrobial Prophylaxis Protocol on Urinary Tract Infection Outcomes After Kidney Transplantation: A Quasi-Experimental Study From the Middle East.","authors":"Omar El Khatib, Jihad Mallat, Wasim S El Nekidy, Rania El Lababidi, Bashir Sankari, Faris Ahmed, Omar Aleter, Salma AlShaqfa, Sandra El Hajj","doi":"10.1111/tid.70309","DOIUrl":"https://doi.org/10.1111/tid.70309","url":null,"abstract":"<p><strong>Background: </strong>Urinary tract infections (UTIs) are frequent infectious complications post-kidney transplant (KT). In regions with high glucose-6-phosphate dehydrogenase (G6PD) deficiency, using alternatives to trimethoprim-sulfamethoxazole (TMP-SMX) creates a prophylactic gap, increasing UTI risk. We assessed the prevalence and risk factors for early post-KT UTIs and evaluated impact of an antimicrobial prophylaxis protocol.</p><p><strong>Methods: </strong>This single-center quasi-experimental study included adult KT recipients enrolled in two sequential phases. Phase I (n = 182; 2017-2023) identified predictors of UTI within 60 days post-KT, informing a prophylaxis protocol, implemented in March 2024. Phase II (n = 155; April 2024-November 2025) evaluated outcomes following protocol implementation, including extended nitrofurantoin or ciprofloxacin prophylaxis for patients unable to receive TMP-SMX. The primary endpoint was 60-day post-KT UTI; secondary endpoints included urinary-source bacteremia, UTI-related readmission, time to first UTI, and UTI-attributable hospital length of stay (LOS).</p><p><strong>Results: </strong>Cohorts were comparable in age (median: 49 vs. 50 years, p = 0.45) and female representation (41.7% vs. 41.9%, p = 0.94). In Phase I, female sex (OR: 3.88, 95%CI: 1.99-7.59) and omission of TMP-SMX (OR: 2.14, 95%CI: 1.04-4.43; p < 0.001) independently predicted 60-day UTI. Post-protocol implementation, 60-day UTI odds declined (OR: 0.42, 95%CI: 0.22-0.82), secondary bacteremia decreased (12.6% vs 3.9%, p = 0.005), median time to first UTI doubled (14 vs. 27 days, p < 0.001), and UTI-related readmissions dropped (27.3% vs. 12.5%, p = 0.027). Median UTI-attributable LOS remained 5 days in both groups, the interquartile range narrowed from 3-8 to 0-7 days (p = 0.031).</p><p><strong>Conclusions: </strong>Risk-stratified antimicrobial prophylaxis significantly reduced early post-KT UTIs and complications. Early TMP-SMX omission emerged as a modifiable determinant, highlighting a critical prophylactic gap in G6PD-deficient populations.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70309"},"PeriodicalIF":2.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819613","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":"Hepatitis B in Organ Transplantation-Current Evidence and Clinical Gaps.","authors":"Oscar A Fernandez-Garcia, Britta L Hirsch, Irene A Abela, Karen E Doucette","doi":"10.1111/tid.70299","DOIUrl":"https://doi.org/10.1111/tid.70299","url":null,"abstract":"<p><p>Over the past several decades there have been significant advances in nucleos(t)ide analogue (NA) antiviral therapy for hepatitis B virus (HBV) and global expansion of primary prevention through immunization. Despite this, HBV remains a leading cause of chronic liver disease globally, affecting over 250 million people. NA therapy has dramatically reduced the need for liver transplantation in HBV and transformed post-transplant outcomes from historically poor to excellent. Similarly, the outcomes of kidney transplant recipients with HBV under NA therapy are now similar to those without HBV. Kidney and other non-liver recipients, previously exposed to hepatitis B as demonstrated by a positive antibody to hepatitis B core antibody (anti-HBc) while at risk for reactivation posttransplant have excellent outcomes when prevention strategies of either HBV monitoring or NA prophylaxis are utilized. The advances in HBV antiviral therapy have also led to increasing evidence that the organ donor pool can be expanded not only through the use of donors with positive anti-HBc, but also those who are hepatitis B surface antigen (HBsAg) positive. In this review, we summarize the current state of the evidence regarding HBV amongst organ donors and recipients of liver and non-liver organ transplants as well as the persisting gaps in evidence and opportunities for further research.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70299"},"PeriodicalIF":2.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819696","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 Risk of Cytomegalovirus Infection After Intestine Transplantation.","authors":"Mayyadah H Alabdely, Jessica Lum, Blanca E Gonzalez, Masato Fujiki, Zachary A Yetmar","doi":"10.1111/tid.70314","DOIUrl":"https://doi.org/10.1111/tid.70314","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) is a major infectious complication after intestine transplantation, but data in this population remain limited. We evaluated the incidence, risk factors, and outcomes of clinically significant CMV infection (csCMVi) in intestine transplant recipients.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of adult and pediatric patients who underwent intestine transplantation between 2008 and 2022. csCMVi was defined as CMV disease or asymptomatic CMV DNAemia requiring treatment. Multivariable Cox regression identified predictors of csCMVi and its association with death or allograft failure.</p><p><strong>Results: </strong>Among 133 patients undergoing 143 intestine transplant procedures, csCMVi occurred in 44 patients (30.8%) at a median of 174 days posttransplant. Symptomatic disease occurred in 36.4% of cases, most commonly CMV enteritis. Breakthrough infection during prophylaxis occurred in 27.3% of csCMVi episodes, most frequently in patients receiving underdosed valganciclovir. Antiviral resistance mutations were identified in six patients. Donor-positive/recipient-negative (D+/R-) serostatus was strongly associated with csCMVi (HR 3.82, 95% CI 1.86-7.82), while donor-negative/recipient-negative serostatus was protective (HR 0.08, 95% CI 0.02-0.33). Lower absolute lymphocyte count independently increased risk (HR 1.23 per 50% decrease, 95% CI 1.10-1.37). Recurrent CMV infection occurred in 26 patients after treatment. Overall, csCMVi was independently associated with a higher risk of death or allograft failure (HR 2.28, 95% CI 1.28-4.07).</p><p><strong>Conclusions: </strong>csCMVi is a common and serious complication after intestine transplantation. Optimizing CMV prophylaxis dosing and monitoring immune status may help reduce risk, though further studies are needed to improve prevention and individualized management strategies.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70314"},"PeriodicalIF":2.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819704","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}