scholarly journals Case Report of Heart Transplantation for Giant Cell Myocarditis in a Patient with Common Variable Immunodeficiency

2021 ◽  
Author(s):  
Thomas A Franzon ◽  
Anna Kovalszki ◽  
Raja Rabah ◽  
John M Nicklas
Keyword(s):  
Heart Transplantation ◽  
Giant Cell ◽  
Organ Transplantation ◽  
Common Variable Immunodeficiency ◽  
Solid Organ Transplantation ◽  
Infectious Complications ◽  
Solid Organ ◽  
Giant Cell Myocarditis ◽  
Common Variable

Abstract Background Solid organ transplantation in patients with common variable immunodeficiency (CVID) is controversial due to the risk for severe and recurrent infections. Determining transplantation candidacy in CVID patients is further complicated by the presence of CVID-related noninfectious complications that can reduce overall survival and also recur in the transplanted organ. Data regarding solid organ transplantation in patients with CVID is limited, particularly in heart transplantation. Case Summary A 32 year-old female with CVID presented with new heart failure after 3 months of dyspnea on exertion. Her echocardiogram showed severe global systolic dysfunction with an ejection fraction of approximately 10%, and her right heart catheterization revealed severe biventricular pressure overload and severely reduced cardiac output. Endomyocardial biopsy revealed giant cells and mononuclear infiltrate consistent with giant cell myocarditis. Despite medical management, she developed progressive cardiogenic shock and underwent uncomplicated orthotopic heart transplantation on hospital day 38. After two years of follow up, she has had no major infectious complications and continues to have normal graft function with no recurrence of giant cell myocarditis. Conclusion We report a case of successful heart transplantation for giant cell myocarditis in a patient with CVID, with no major infectious complications after 2 years of follow up. CVID should not be considered an absolute contraindication for heart transplantation.

scholarly journals Calcineurin Inhibitor-Based Immunosuppression and COVID-19: Results from a Multidisciplinary Cohort of Patients in Northern Italy

2020 ◽  
Vol 8 (7) ◽  
pp. 977 ◽  
Author(s):  
Lorenzo Cavagna ◽  
Elena Seminari ◽  
Giovanni Zanframundo ◽  
Marilena Gregorini ◽  
Angela Di Matteo ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Calcineurin Inhibitor ◽  
Clinical Course ◽  
Solid Organ Transplantation ◽  
Calcineurin Inhibitors ◽  
Infectious Complications ◽  
Study Data ◽  
Solid Organ ◽  
The North

The role of immunosuppression in SARS-CoV-2-related disease (COVID-19) is a matter of debate. We here describe the course and the outcome of COVID-19 in a cohort of patients undergoing treatment with calcineurin inhibitors. In this monocentric cohort study, data were collected from the COVID-19 outbreak in Italy up to 28 April 2020. Patients were followed at our hospital for solid organ transplantation or systemic rheumatic disorders (RMDs) and were on calcineurin inhibitor (CNI)-based therapy. Selected patients were referred from the North of Italy. The aim of our study was to evaluate the clinical course of COVID-19 in this setting. We evaluated 385 consecutive patients (220 males, 57%; median age 61 years, IQR 48–69); 331 (86%) received solid organ transplantation and 54 (14%) had a RMD. CNIs were the only immunosuppressant administered in 47 patients (12%). We identified 14 (4%) COVID-19 patients, all transplanted, mainly presenting with fever (86%) and diarrhea (71%). Twelve patients were hospitalized and two of them died, both with severe comorbidities. No patients developed acute respiratory distress syndrome or infectious complications. The surviving 10 patients are now fully recovered. The clinical course of COVID-19 patients on CNIs is generally mild, and the risk of superinfection seems low.

Bilateral sequential lung transplantation in Jehovah’s Witnesses

Perfusion ◽  
2020 ◽  
pp. 026765912093936
Author(s):  
Ernest G Chan ◽  
Matthew R Morrell ◽  
Patrick G Chan ◽  
Pablo G Sanchez
Keyword(s):  
Lung Transplantation ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Limited Resource ◽  
Solid Organ ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Long Term Follow Up

The ethical concerns of refusing lifesaving treatments after receiving an already limited resource such as a solid organ transplantation in a Jehovah’s Witness patient have been discussed in the literature. Many of these studies have concluded that with a multidisciplinary approach, solid organ transplantation is possible in the setting of Jehovah’s Witness patients. To date, there are no reported cases of bilateral sequential lung transplantation in the literature. We report two successful cases of bilateral sequential lung transplantation in Jehovah’s Witness patients with excellent long-term follow-up.

scholarly journals No Recurrence of Pneumocystis jirovecii Pneumonia after Solid Organ Transplantation Regardless of Secondary Prophylaxis

2012 ◽  
Vol 56 (11) ◽  
pp. 6041-6043 ◽  
Author(s):  
Tark Kim ◽  
Heungsup Sung ◽  
Yu-Mi Lee ◽  
Hyo-Lim Hong ◽  
Sung-Han Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
Organ Transplantation ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Solid Organ Transplantation ◽  
Secondary Prophylaxis ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Solid Organ ◽  
Content Type

ABSTRACTThere are no data on the efficacy of secondary prophylaxis againstPneumocystispneumonia after solid organ transplantation. Therefore, we investigated the rate of recurrence ofPneumocystispneumonia after solid organ transplantation in a retrospective cohort study. Between 2005 and 2011, a total of 41 recipients recovered fromPneumocystispneumonia. Of these, 22 (53.7%) received secondary prophylaxis. None of the 41 recipients experienced recurrence ofPneumocystispneumonia during the follow-up, regardless of secondary prophylaxis.

Impact of age and cytomegalovirus on CD8+ T-cell compartment remodeling after solid organ transplantation: A one-year follow-up study

2017 ◽  
Vol 95 ◽  
pp. 98-106 ◽  
Author(s):  
Sara Cantisán ◽  
Aurora Páez-Vega ◽  
Francisco Santos ◽  
Alberto Rodríguez-Benot ◽  
Rocío Aguado ◽  
...  
Keyword(s):  
T Cell ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Cd8 T Cell ◽  
Solid Organ ◽  
Cell Compartment ◽  
Follow Up Study ◽  
One Year

Anti-CD20 Monoclonal Antibody (rituximab) for Refractory PTLD after Pediatric Solid Organ Transplantation: Multicenter Experience from a Registry and from a Prospective Clinical Trial.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 746-746 ◽  
Author(s):  
Steven Webber ◽  
William Harmon ◽  
Albert Faro ◽  
Michael Green ◽  
Minnie Sarwal ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Monoclonal Antibody ◽  
B Cell ◽  
Organ Transplantation ◽  
Graft Loss ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Refractory Disease ◽  
First Line

Abstract Background: Anti B cell antibodies have been proposed as a treatment for post-transplant lymphoproliferative disorders (PTLD). Experience in children is limited. Methods and Results: We report experience (n=40) with use of the chimeric mouse/human antiCD20 monoclonal antibody (rituximab) in pediatric PTLD patients with refractory disease (no response to reduced immunosuppression, progressive or relapsed disease, or concomitant allograft rejection). Initial experience was through a voluntary registry (n=26), and most recent experience is from an onging prospective, non-randomized clinical trial (n=14). Use of chemotherapy or other experimental therapies were an exclusion criteria for both studies. All PTLD were of B cell origin and expressed CD20 and all but 2 (both in registry cohort) were EBV positive. The first cohort (registry) comprised 26 solid organ recipients from 12 centers (heart 11, kidney 6, lung 4, other 5) with mean age of 12.5 years, 29 months (range 2–132) from transplant. Histology revealed these lesions: polymorphic 17, monomorphic 7 (including 1 Burkitts-like), Hodgkins-like 1, unspecified 1. 21/26 received 375mg/m2 x 4 doses. There were no SAE’s. 18 pts (69%) showed CR, and 4 (16%) showed PR. The 4 non-responders comprised the 2 EBV negative cases, the Burkitts-like disease and the earliest onset case (fulminant disease at 2 months post-transplant). At latest follow-up (mean 41 months), 73% survive with one graft loss (kidney). In the prospective clinical trial, 14 patients (to date) with refractory disease were enrolled. The protocol comprises 4 doses of 375mg/m2 (weeks 1–4) with no further treatment for patients with CR or for those with no response. Patients with PR receive 4 further doses (weeks 5–8). The 14 patients were from 5 centers (lung 5, kidney 5, heart 4) with mean age of 6.5 years, 41 months (range 4–120) from transplant. Histology revealed the following: polymorphic 10, monomorphic 3, Hodgkin-like 1. There were no SAE’s. Two are still recieving therapy. Of the other 12, 9 (75%) acheived CR and 10 pts (83%) are alive with one graft loss (kidney) at mean follow-up of 1.5 years. The two deaths were due to fungal pneumonia and complications of elective surgery in a patient in CR (both lung recipients). Conclusions: These results suggest that rituximab may have an important role to play in management of refractory PTLD in solid organ recipients (CR rate approx. 70–75% with low incidence of graft loss). This group of patients traditionally has high mortality and has been treated with chemotherapy. Rituximab should be considered as first line treatment for refractory polymorphic PTLD in children after solid organ transplantation. Role in monomorphic disease requires further investigation. Use of rituximab as first line therapy is under investigation.

Outcomes In the Pre-Rituximab and Post-Rituximab Eras In Post-Transplantation Lymphoproliferative Disorders (PTLD) In Adult Solid Organ Transplant Recipients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2859-2859
Author(s):  
Thomas M. Habermann ◽  
Matthew J Maurer ◽  
Kay Ristow ◽  
William R. Macon ◽  
Timothy S Larson ◽  
...  
Keyword(s):  
Overall Survival ◽  
Organ Transplantation ◽  
Mayo Clinic ◽  
Conflicts Of Interest ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ ◽  
Overall Response ◽  
Chi Squared

Abstract Abstract 2859 Background: PTLD is the most common malignancy, other than melanomatous skin cancer complicating solid organ transplantation and has been one of the most commonly observed fatal consequences. The histologies are diverse and include B-cell, T-cell and Hodgkin lymphomas. Rituximab has affected the outcome in CD20+ patients with PTLD. This single institution study sought to identity the outcomes in patients of all histologies and presentations managed in the post-rituximab era. Methods: Patients with solid organ transplantation who were diagnosed with PTLD at Mayo Clinic (Rochester, MN) between December 1970 and October 2009 were identified through the Mayo Clinic Lymphoma Data Base. The rituximab era was defined as patients diagnosed after December 26, 2000, the date of diagnosis for the first patient treated with rituximab in our series. Cox proportional hazards models were used to assess the association of clinical factors and overall survival (OS). Results: 143 patients diagnosed with PTLD between December 1970 and October 2009 were identified. The median age at the time of diagnosis of PTLD was 50 years (range 15–84) with 41 patients (29%) over the age of 60. 93 were male (65%). At a median follow-up of 84 months (range 1–295), 95 patients (65%) have died. The types of organ transplant included renal (39%), liver (31%), cardiac (11%), lung (6%), renal/pancreas (6%), pancreas (4%), and multiorgan (4%). 83% of patients presented with extranodal disease. 28% had involvement of the engrafted organ. 76% of the patients developed PTLD that was EBV+ by in situ hybridization. 62% were stage 3–4. The IPI was intermediate-high in 39% of patients. Initial approaches to management included reduction in immunosuppression (45%), chemotherapy (12%), reduction in immunosuppression with rituximab (12%), rituximab (8%), and radiation therapy (6%). The overall response to therapeutic approaches was 46% in the pre-rituximab era and 56% in the post-rituximab era (chi-squared p=0.25). Patients treated with rituximab had an improved overall survival (HR = 1.66, 95% CI: 0.99–2.79). Patients treated in the rituximab era had improved 1 year survival (76%) compared to patients in the pre-rituximab era (59%) (chi-squared p=0.03). However, the survival advantage in the rituximab era was not maintained in longer follow-up. The median overall survival in the pre-rituximab era was 31 months compared to 56 months in the post-rituximab era (logrank p=0.63). Conclusion: The overall response rates and overall survival are improved with rituximab treatment in CD20+ PTLD, however, the natural history of all PTLD has not improved significantly in the post-rituximab era. New approaches are needed for the prevention and management of all the histologies of PTLD. Disclosures: No relevant conflicts of interest to declare.

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