Outcomes of nontuberculous mycobacteria isolation among lung transplant recipients: A matched case-control with retrospective cohort study

2021 ◽  
Author(s):  
Razelle Grimes ◽  
Lauren Cherrier ◽  
Aasya Nasar ◽  
Michael D Nailor ◽  
Rajat Walia ◽  
...  
Keyword(s):  
Adverse Events ◽  
Drug Interactions ◽  
Diagnostic Criteria ◽  
Lung Transplant ◽  
Nontuberculous Mycobacteria ◽  
Case Control ◽  
Transplant Recipients ◽  
Lung Colonization ◽  
Increased Risk ◽  
Lung Transplant Recipients

Abstract Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Lung transplant recipients are at increased risk for acquiring nontuberculous mycobacteria (NTM), but the clinical significance of NTM isolation, particularly among patients not meeting guideline-endorsed diagnostic criteria for NTM pulmonary disease, is unclear. Methods A case-control study of lung transplant recipients with culture-positive NTM infections treated at a large transplant center during a 7-year period (2013-2019) was performed. Results Twenty-nine cases were matched 1:2 to non-NTM controls. The median time to NTM isolation was 10.7 months post transplant. Only 34.5% of all cases, and half of treated cases, met diagnostic criteria for NTM pulmonary infection. All-cause mortality at 12 months was numerically higher among NTM cases versus controls (20.7% vs 8.6%, P = 0.169); however, no deaths were attributed to NTM. No increase in the 12-month rate of acute rejection was observed (27.6% vs 36.2%, P = 0.477). Recent augmented immunosuppression was associated with increased odds of NTM isolation, while azithromycin prophylaxis was associated with reduced odds of isolation and was not associated with macrolide resistance. Both adverse events and actual or potential drug-drug interactions occurred in more than 90% of treated cases; these events included ocular toxicity, hearing loss, and supratherapeutic calcineurin inhibitor concentrations. Eight of the 14 treated cases (57.1%) required early antibiotic discontinuation due to adverse events or drug-drug interactions. Conclusion Among lung transplant recipients, most patients with NTM isolation did not meet guideline criteria for infection and had outcomes similar to non‒NTM-infected patients, which may reflect transient lung colonization by NTM rather than true disease. As adverse events are common with NTM therapy, limiting unnecessary antibiotic treatment represents an area for future antimicrobial stewardship efforts.

Pre-transplant cytomegalovirus-specific cellular immunity and risk of viral reactivation following lung transplantation: a prospective cohort study

2020 ◽  
Author(s):  
Mohammed Altaf ◽  
Katie Lineburg ◽  
Pauline Crooks ◽  
Sweera Rehan ◽  
Katherine K Matthews ◽  
...  
Keyword(s):  
Lung Transplant ◽  
Viral Reactivation ◽  
Transplant Recipients ◽  
Post Transplant ◽  
Transplant Patients ◽  
Cell Immunity ◽  
Increased Risk ◽  
Significant Burden ◽  
Lung Transplant Recipients ◽  
Cmv Reactivation

Abstract Cytomegalovirus (CMV) remains a significant burden in lung transplant recipients. Deficiencies in T-cell immunity post-transplant increase the risk of CMV-associated complications. However, it is not clear if underlying poor pre-transplant immunity increases risk. To assess this, we recruited 39 prospective lung transplant patients and performed QuantiFERON-CMV on their peripheral blood. More than a third of prospective CMV-seropositive transplant recipients were CMV non-immune-reactive (CMV-NIR) pre-transplant. CMV-NIR status was associated with a significantly higher incidence of CMV reactivation post-transplant, demonstrating that dysfunctional CMV immunity in prospective lung transplant recipients is associated with an increased risk of viral reactivation post-transplant.

Dementia-Like Symptoms Associated With Posaconazole

2020 ◽  
pp. 089719002095823
Author(s):  
Carmela E. Corallo ◽  
Steven P. Ivulich ◽  
Dr Sakhee Kotecha ◽  
Orla Morrissey
Keyword(s):  
Lung Transplant ◽  
Fungal Infections ◽  
Transplant Recipients ◽  
First Case ◽  
Increased Risk ◽  
Post Marketing ◽  
Scedosporium Prolificans ◽  
Lung Transplant Recipients ◽  
Dose Dependent

Posaconazole is widely used in lung transplant recipients as pre-emptive therapy or universal fungal prophylaxis. In this patient group, posaconazole is increasingly used instead of voriconazole due to the concerns of an increased risk of squamous cell carcinoma (SCC) with voriconazole, particularly with its long-term use. Dose dependent toxicity has not been identified for posaconazole in the registration trials of intravenous (IV) and modified-release tablet formulations. This is supported by post-marketing experience. We describe a lung transplant recipient who experienced dementia-like symptoms almost 3 years after commencing posaconazole for treatment of Aspergillus fumigatus complex and Lomentospora prolificans (formerly Scedosporium prolificans) fungal infections. Symptoms resolved upon discontinuation of posaconazole, but recurred when re-challenged at a lower dose more than a year later. To the best of our knowledge, this is the first case reporting a dementia-like state with posaconazole.

Depression, Immunosuppressant Levels, and Clinical Outcomes in Postlung Transplant Recipients

2020 ◽  
Vol 55 (6) ◽  
pp. 421-436 ◽  
Author(s):  
Michael C Chu ◽  
Patrick J Smith ◽  
John M Reynolds ◽  
Scott M Palmer ◽  
Laurie D Snyder ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Lung Transplant ◽  
Epidemiological Studies ◽  
Hazard Ratio ◽  
Adverse Outcomes ◽  
Consecutive Series ◽  
Transplant Recipients ◽  
Increased Risk ◽  
Coefficient Of Variability ◽  
Lung Transplant Recipients

Objective Posttransplant depression has been linked to increased risk for adverse outcomes in lung transplant patients. Maintaining target serum immunosuppressant levels is also essential for optimal lung transplant clinical outcome and may be a crucial predictor of outcomes. Because depression could affect medication nonadherence, resulting in out-of-range immunosuppressant levels, we examined the relationship between posttransplant depression, immunosuppressant medication trough level variability, indexed by out-of-range values on clinical outcomes and coefficient of variability, and clinical outcomes. Method A consecutive series of 236 lung transplant recipients completed the Center for Epidemiological Studies-Depression two-month posttransplant. Immunosuppressant trough levels (i.e., tacrolimus or cyclosporine) within the range of individualized immunosuppressant targets were obtained at three-, six-, nine-month follow-up clinic visits. Clinical outcomes including hospitalizations and mortality were obtained from medical records. Results Fourteen percent of patients were classified as depressed (Center for Epidemiological Studies-Depression ≥16), 144 (61%) of patients had at least 25% out-of-range immunosuppressant values, and the average coefficient of variability was 36%. Over a median of 2.6 years (interquartile range = 1.2), 32 participants died (14%) and 144 (61%) had at least one unplanned, transplant-related hospitalization. Both depression (hazard ratio = 1.45 (1.19, 1.76), p < . 01) and immunosuppressant variation (immunosuppressant out-of-range: hazard ratio = 1.41 (1.10, 1.81), p < .01) independently predicted more frequent hospitalizations and higher mortality. Conclusions Early posttransplant depression was associated with significantly worse clinical outcomes. While immunosuppressant level variability is also related to adverse outcomes, such variability does not account for increased risk observed with depression.

scholarly journals Respiratory Viruses in Solid Organ Transplant Recipients

Viruses ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2146
Author(s):  
Roni Bitterman ◽  
Deepali Kumar
Keyword(s):  
Lung Transplant ◽  
Viral Infections ◽  
Solid Organ Transplantation ◽  
Clinical Manifestations ◽  
Respiratory Viruses ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Increased Risk ◽  
Respiratory Viral Infections ◽  
Lung Transplant Recipients

Solid organ transplantation is often lifesaving, but does carry an increased risk of infection. Respiratory viral infections are one of the most prevalent infections, and are a cause of significant morbidity and mortality, especially among lung transplant recipients. There is also data to suggest an association with acute rejection and chronic lung allograft dysfunction in lung transplant recipients. Respiratory viral infections can appear at any time post-transplant and are usually acquired in the community. All respiratory viral infections share similar clinical manifestations and are all currently diagnosed using nucleic acid testing. Influenza has good treatment options and prevention strategies, although these are hampered by resistance to neuraminidase inhibitors and lower vaccine immunogenicity in the transplant population. Other respiratory viruses, unfortunately, have limited treatments and preventive methods. This review summarizes the epidemiology, clinical manifestations, therapies and preventive measures for clinically significant RNA and DNA respiratory viruses, with the exception of SARS-CoV-2. This area is fast evolving and hopefully the coming decades will bring us new antivirals, immunologic treatments and vaccines.

scholarly journals A Concise Review of Hepatitis C in Heart and Lung Transplantation

2011 ◽  
Vol 25 (8) ◽  
pp. 445-448 ◽  
Author(s):  
Edward Kim ◽  
Hin Hin Ko ◽  
Eric M Yoshida
Keyword(s):  
Hepatitis C ◽  
Lung Transplant ◽  
Interferon Therapy ◽  
Antiviral Treatment ◽  
Graft Loss ◽  
Hcv Infection ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Increased Risk ◽  
Lung Transplant Recipients

Hepatitis C (HCV) infection is prevalent in recipients of, and candidates for, solid organ transplants. The outcomes of HCV infection in cardiac and lung transplant recipients have yet to be clearly established, and future prospective studies are needed. In the absence of safe and effective antiviral treatment for HCV infection in heart and lung transplant recipients, the management of these patients remains a challenge and must be considered on an individual basis. Interferon therapy for HCV before transplantation appears to improve outcomes; however, post-transplant interferon therapy in the cardiac and pulmonary transplant setting may be associated with an increased risk of graft rejection. Given the paucity of information regarding HCV treatment in these transplant recipients, and with appropriate concerns that graft loss from rejection may not be amenable to a second transplant (given the scarcity of suitable cadaveric organs), multicentre, randomized controlled trials are needed to determine the optimal approach for treatment of HCV infection in this population.

scholarly journals 2640. Aerosol vs. Oral Ribavirin for the Treatment of Community-Acquired Respiratory Virus Infections in Lung Transplant Recipients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S923-S923
Author(s):  
Emily Mui ◽  
Marisa Holubar ◽  
Roy Lee ◽  
Danielle Pham ◽  
Lina Meng ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Lung Transplant ◽  
Respiratory Virus ◽  
Graft Loss ◽  
Transplant Recipients ◽  
Organ Rejection ◽  
Increased Risk ◽  
Significant Difference ◽  
Lung Transplant Recipients ◽  
Overall Mortality

Abstract Background Community-acquired respiratory virus (CARV) infections are associated with an increased risk of chronic lung allograft dysfunction (CLAD) and graft loss in lung transplant recipients (LTR). Administration of ribavirin by aerosol was the standard of care at Stanford Health Care in the management of CARV infections. Given the sparse evidence of benefit with aerosol ribavirin (AR) and its increasing cost and teratogenic risk for exposed healthcare personnel, AR was restricted to the treatment of respiratory syncytial virus (RSV) in 2016 and was ultimately removed from formulary in 2017. Oral (PO) ribavirin was used at the discretion of the transplant team. The objective of this study was to evaluate the clinical outcomes of AR compared with PO ribavirin in lung transplant recipients. Methods We performed a retrospective cohort analysis of adult lung transplant recipients diagnosed with CARV (metapneumovirus, parainfluenza virus, and RSV) infections treated with either AR or PO ribavirin. The analysis included the first treatment course of ribavirin by either route and patients were excluded if they received ribavirin in the prior 12 months. The primary outcome was the development/progression of CLAD, acute organ rejection, and overall mortality. Results Of 85 patients, 41 received AR and 44 received PO ribavirin. There was no significant difference in the following clinical outcomes with AR and oral ribavirin, respectively: development or progression of CLAD (30 days: 9.7% vs. 4.5%, P = 0.4227; 90 days: 14.6% vs. 6.8%, P = 0.303; 6 months: 17% vs. 9%, P = 0.3413; 12 months: 24% vs. 15.9%, P = 0.4188), acute organ rejection (90 days: 7.3% vs. 4.5%, P = 0.6689; 6 months: 12.1% vs. 9%, P = 0.7329; 12 months: 19.5% vs. 13.6%, P = 0.5635), and overall mortality (30 days: 0% vs. 4.5%, P = 0.4947; 90 days: 7.3% vs. 4.5%, P = 0.6689; 6 months: 7.3% vs. 9%, P = 1.0; 12 months: 7.3% vs. 13.6%, P = 0.4858). There was no observable difference in reported adverse effects between AR and PO ribavirin. Conclusion Lung transplant recipients with CARV infections had similar outcomes when treated with AR or PO ribavirin. Oral ribavirin is a less costly treatment than AR, but the efficacy of ribavirin by any route remains questionable. Disclosures All authors: No reported disclosures.

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