Disseminated cerebral fusariosis in a liver-transplant patient: A case report and review of the literature

2021 ◽  
Author(s):  
Pernilla Stropnicky ◽  
Katharina Heß ◽  
Thomas Becker ◽  
Felix Braun
Keyword(s):  
Transplant Patient ◽  
Distress Syndrome ◽  
Case Reports ◽  
Solid Organ Transplantation ◽  
Invasive Infection ◽  
Solid Organ ◽  
Fusarium Spp ◽  
Liver Transplant Patient ◽  
Complicated Course ◽  
Brain Abscesses

AbstractFusarium spp. can cause invasive infection with fatal outcomes in immunocompromised patients. Therefore, invasive fusariosis is rare after solid organ transplantation. For this reason, experience and management are limited to single published case reports.We report a 65-year-old female patient with disseminated brain abscesses caused by Fusarium after liver transplantation (LT). The patient underwent LT for secondary sclerosing cholangitis after acute respiratory distress syndrome (ARDS). After a complicated course with aneurysm and thrombosis of the hepatic artery, re-transplantation was performed after one month. Due to inadequate awakening response, cerebral imaging was performed, which showed multiple abscesses. The patient died shortly thereafter, and an autopsy showed fusariosis.

scholarly journals Varicella-Zoster Gastritis in a Liver Transplant Patient: A Call to Attention

2021 ◽  
Vol 05 (02) ◽  
pp. 1-1
Author(s):  
Víctor Escrich ◽  
◽  
Ángela Martinez ◽  
Berta Lapeña ◽  
Marta Mayorga ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Transplant Patient ◽  
Solid Organ Transplantation ◽  
Gastrointestinal Symptoms ◽  
Solid Organ ◽  
Liver Transplant Patient ◽  
Cutaneous Manifestations ◽  
Varicella Zoster ◽  
Acute Gastritis ◽  
Histologic Changes

The reactivation of the Varicella-zoster virus (VZV) is a rare cause of acute gastritis in adults. About 30 cases have been reported in the literature, mostly with immunocompromised patients and mainly after bone marrow transplantation or during the development of malignant hematological diseases. Clinically, it is usually accompanied by cutaneous manifestations. Here, we studied a case of VZV gastritis in a liver transplant (LT) patient. We described the main symptoms, endoscopic findings, histologic changes, and treatment of VZV gastritis. Till now, no case of acute gastritis due to the reactivation of VZV after solid organ transplantation had been reported [2–5]. This was the first reported case of acute gastritis by the reactivation of VZV after LT without cutaneous vesicular eruption. Gastrointestinal symptoms usually develop a week before the onset of fever and cutaneous manifestations. However, in some cases, like this one, vesicular rashes may be absent, making the diagnosis quite challenging. In conclusion, through this case, we suggest including VZV gastritis in the differential diagnosis of gastrointestinal symptoms after transplantation and informing about the response of VZV gastritis to treatment with oral acyclovir.

scholarly journals Immunomodulatory Therapies for COVID-19 in Solid Organ Transplant Recipients

2020 ◽  
Vol 7 (4) ◽  
pp. 379-389 ◽  
Author(s):  
Mario Fernández-Ruiz ◽  
José María Aguado
Keyword(s):  
Case Reports ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Case Series ◽  
Control Group ◽  
Supporting Evidence ◽  
Solid Organ ◽  
Transplant Patients ◽  
Group Limit ◽  
Immunomodulatory Therapies

Abstract Purpose of Review Severe coronavirus disease 2019 (COVID-19) is characterized by the development of a deleterious hyperinflammatory response, in which the pleiotropic cytokine interleukin (IL)-6 plays a pivotal role. The administration of immunomodulatory therapies has been proposed to revert the tissue damage induced by COVID-19-related cytokine release syndrome (CRS). The present review summarizes the biological rationale and available clinical experience with this therapeutic strategy in the specific scenario solid organ transplantation (SOT). Recent Findings A number of case reports, case series, and non-controlled cohort studies have assessed the efficacy and safety of the anti-IL-6-receptor monoclonal tocilizumab in SOT (namely kidney transplantation) recipients with COVID-19 pneumonia and CRS. Although the heterogeneity in patient management and the lack of a control group limit the interpretation of these results, tocilizumab therapy appears to provide some clinical benefit in post-transplant COVID-19 and to be reasonably safe in terms of bacterial superinfection. A large randomized clinical trial (RCT) has shown survival benefit with adjuvant corticosteroids in non-transplant patients, but supporting evidence is scarce for SOT recipients and confounded by the variable adjustment of baseline immunosuppression. Anecdotal experiences have been reported with the use of the anti-IL-1 agent anakinra and the NLRP3 inflammasome inhibitor colchicine in this population. Summary Immunomodulation has emerged as a promising option for SOT recipients with COVID-19-related CRS, with available experience mainly restricted to the anti-IL-6 agent tocilizumab. However, the supporting evidence is scarce and of low quality. In the absence of RCT, observational studies including well-matched control groups should be designed in future.

scholarly journals Everolimus and Malignancy after Solid Organ Transplantation: A Clinical Update

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Hallvard Holdaas ◽  
Paolo De Simone ◽  
Andreas Zuckermann
Keyword(s):  
Organ Transplantation ◽  
Mtor Inhibitor ◽  
De Novo ◽  
Case Reports ◽  
Meta Analysis ◽  
Mammalian Target Of Rapamycin ◽  
Solid Organ Transplantation ◽  
Population Data ◽  
Solid Organ ◽  
Mtor Inhibition

Malignancy after solid organ transplantation remains a major cause of posttransplant mortality. The mammalian target of rapamycin (mTOR) inhibitor class of immunosuppressants exerts various antioncogenic effects, and the mTOR inhibitor everolimus is licensed for the treatment of several solid cancers. In kidney transplantation, evidence from registry studies indicates a lower rate ofde novomalignancy under mTOR inhibition, with some potentially supportive data from randomized trials of everolimus. Case reports and small single-center series have suggested that switch to everolimus may be beneficial following diagnosis of posttransplant malignancy, particularly for Kaposi’s sarcoma and nonmelanoma skin cancer, but prospective studies are lacking. A systematic review has shown mTOR inhibition to be associated with a significantly lower rate of hepatocellular carcinoma (HCC) recurrence versus standard calcineurin inhibitor therapy. One meta-analysis has concluded that patients with nontransplant HCC experience a low but significant survival benefit under everolimus monotherapy, so far unconfirmed in a transplant population. Data are limited in heart transplantation, although observational data and case reports have indicated that introduction of everolimus is helpful in reducing the recurrence of skin cancers. Overall, it can be concluded that, in certain settings, everolimus appears a promising option to lessen the toll of posttransplant malignancy.

scholarly journals Mending a Broken Heart: Treatment of Stress-Induced Heart Failure after Solid Organ Transplantation

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
N. Thao Galván ◽  
Kayla Kumm ◽  
Michael Kueht ◽  
Cindy P. Ha ◽  
Dor Yoeli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Liver Transplant ◽  
Organ Transplantation ◽  
Transplant Patient ◽  
Solid Organ Transplantation ◽  
Kidney Transplant Patient ◽  
Solid Organ ◽  
Takotsubo Syndrome ◽  
Transplant Patients

Stress-induced heart failure, also known as Broken Heart Syndrome or Takotsubo Syndrome, is a phenomenon characterized as rare but well described in the literature, with increasing incidence. While more commonly associated with postmenopausal women with psychiatric disorders, this entity is found in the postoperative patient. The nonischemic cardiogenic shock manifests as biventricular failure with significant decreases in ejection fraction and cardiac function. In a review of over 3000 kidney and liver transplantations over the course of 17 years within two transplant centers, we describe a series of 7 patients with Takotsubo Syndrome after solid organ transplantation. Furthermore, we describe a novel approach of successfully treating the transient, though potentially fatal, cardiogenic shock with a percutaneous ventricular assistance device in two liver transplant patients, while treating one kidney transplant patient medically and the remaining four liver transplant patients with an intra-aortic balloon pump. We describe our experience with Takotsubo’s Syndrome and compare the three modalities of treatment and cardiac augmentation. Our series is novel in introducing the percutaneous ventricular assist device as a more minimally invasive intervention in treating nonischemic heart failure in the solid organ transplant patient, while serving as a comprehensive overview of treatment modalities for stress-induced heart failure.

scholarly journals COVID-19 in Patients with Solid Organ Transplantation: A Systematic Review

2020 ◽  
Vol 1 (1) ◽  
pp. 1-15 ◽  
Author(s):  
René Hage ◽  
Carolin Steinack ◽  
Christian Benden ◽  
Macé M. Schuurmans
Keyword(s):  
Systematic Review ◽  
Social Life ◽  
Case Reports ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Case Series ◽  
Google Scholar ◽  
Current Evidence ◽  
Solid Organ ◽  
Increased Risk

The novel coronavirus, SARS-CoV-2, is causing a pandemic of unknown precedent, with huge healthcare challenges and worldwide disruptions to economic and social life. Lung transplant recipients and other solid organ transplant (SOT) recipients are immunosuppressed, and therefore are generally considered at an increased risk for severe infections. Given the current gap in knowledge and evidence regarding the best management of these patients, we conducted a systematic review of studies on SARS-CoV-2 infections and Coronavirus Disease 2019 (COVID-19) in SOT recipients, to evaluate the association between immunosuppression in these patients, SARS-CoV-2 infection and COVID-19 outcomes. The focus was the severity of the disease, the need for mechanical ventilation and intensive care unit (ICU) admissions, and rate of death. The literature search was conducted repeatedly between 16 March and 8 April 2020. We searched original papers, observational studies, case reports, and meta-analyses published between 2019 and 2020 using two databases (PubMed, Google Scholar) with the search terms: [transplant OR immunosuppression] AND [COVID-19 OR SARS-CoV-2]. Further inclusion criteria were publications in English, French, German and Italian, and reference to humans. We also searched the reference lists of the studies encountered. From an initial search of PubMed and Google Scholar, 19 potential articles were retrieved, of which 14 were excluded after full-text screening (not being case reports or case series), leaving 5 studies for inclusion. No further studies were identified from the bibliographies of retrieved articles. Based on the limited research, no firm conclusions can be made concerning SOT recipients, but the current evidence suggests that immunosuppression is most likely associated with a better outcome of SARS-CoV-2 infection and COVID-19 because it prevents hyperinflammation (cytokine storm) in this particular population. There is a need for further research that would allow results to be adjusted for other factors potentially impacting COVID-19 severity and outcome.

scholarly journals EBV-Associated Smooth Muscle Neoplasms: Solid Tumors Arising in the Presence of Immunosuppression and Autoimmune Diseases

Sarcoma ◽  
2008 ◽  
Vol 2008 ◽  
pp. 1-6 ◽  
Author(s):  
Kimberly Moore Dalal ◽  
Cristina R. Antonescu ◽  
Ronald P. DeMatteo ◽  
Robert G. Maki
Keyword(s):  
Smooth Muscle ◽  
Organ Transplantation ◽  
Case Reports ◽  
Solid Organ Transplantation ◽  
Tumor Necrosis Factor Inhibitor ◽  
Cancer Center ◽  
Tumor Control ◽  
Solid Organ ◽  
Hiv Aids

Background. Epstein-Barr virus (EBV)-related smooth muscle neoplasms (SMNs) have been associated with immune dysregulation, most notably in patients who have undergone solid organ transplantation or in patients with HIV/AIDS.Objective. to report our experience with EBV-related neoplasms as well as describing the first EBV-related SMN in the setting of administration of glucocorticoids and the tumor necrosis factor inhibitor etanercept.Design. We have case reports, of minimum 3-year follow-up, 2002–2005.Setting. It was held in an academic and tertiary referral cancer center.Patients. Patients are with dysregulated immunity after solid organ transplantation, HIV/AIDS, or with psoriasis after treatment with etanercept.Interventions. There were discontinuation of etanercept, right hepatic trisegmentectomy, and chemotherapy.Measurements. We use survival as a measurement here.Results. Patients who were able to withstand reduction in immunosuppression survived. Surgical resection or chemotherapy was successful in delaying progression of disease.Limitations. There was a relatively short follow-up for these slow-growing neoplasms.Conclusion. EBV-related SMNs have variable aggressiveness. While chemotherapy may slow disease progression, resection and improving the host immune status provide the best opportunity for primary tumor control.

scholarly journals Patients with Primary Brain Tumors as Organ Donors

2015 ◽  
Vol 13 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Lidija Orlic ◽  
Branka Sladoje-Martinovic ◽  
Ivana Mikolasevic ◽  
Zeljko Zupan ◽  
Sanjin Racki
Keyword(s):  
Brain Tumors ◽  
Case Reports ◽  
Waiting Times ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Waiting List ◽  
Solid Organ ◽  
Primary Brain Tumors ◽  
End Stage ◽  
Severe Shortage

AbstractOrgan transplant is now the treatment of choice for many end-stage diseases. The success of solid organ transplantation is accompained by a severe shortage of available organs for those currently awaiting transplantation. In recent years, there has been an increasing demand for organs, but not a similar increase in the supply leading to a severe shortage of organs for transplant that resulted in increasing waiting times for recipients. This has resulted in expanded donor criteria to include older donors and donors with mild diseases. Malignancy is considered a contra-indication to organ donation, with a few possible exceptions. There is a significant controversy in the transplant literature around the use of organs from donors with primary brain tumors (PBT). While case reports and registry data have certainly documented transmission of PBT with resultant morbidity and even mortality, the loss of quality and quantity of life by those on the waiting list remains a staggering and sobering reality. Ultimately the decision regarding transplantation from such donors lies with the transplanting team that should weigh the risk of donor tumor transmission against the risk of their patient dying on the waiting list.

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