Case 14

2020 ◽  
pp. 87-92
Author(s):  
Hilary Humphreys
Keyword(s):  
Point Of Care ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Poor Countries ◽  
Treatment Regimens ◽  
Bird Droppings ◽  
Opportunist Infection ◽  
Immunosuppressed Patients ◽  
Respiratory Specimens

Cryptococcosis is an opportunist infection that should be considered in HIV/AIDS and in other at risk immunosuppressed patients such as those following solid organ transplantation. Cryptococcus neoformans is found in bird droppings and is the commonest cause in temperate climates but C. gattii is increasingly recognized in warmer climates. Diagnosis is usually via antigen detection, microscopy, and culture of blood, respiratory specimens and cerebrospinal fluid (CSF), in addition to histological analysis of appropriate tissue with specialised stains. New antigen assays facilitate point-of-care testing in resource-poor countries. Management includes initial treatment regimens with liposomal amphotericin B (the echinocandins have little activity) followed by follow-up antifungal therapy for up to a year, usually with fluconazole.

scholarly journals Management of Bladder Cancer following Solid Organ Transplantation

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Jeffrey J. Tomaszewski ◽  
Jeffrey A. Larson ◽  
Marc C. Smaldone ◽  
Matthew H. Hayn ◽  
Stephen V. Jackman
Keyword(s):  
Bladder Cancer ◽  
Organ Transplantation ◽  
Radical Cystectomy ◽  
Solid Organ Transplantation ◽  
Low Grade ◽  
Solid Organ ◽  
Immunosuppressed Patients ◽  
Muscle Invasive ◽  
Liver Transplant Recipients

Objective. Present our experience managing bladder cancer following liver and renal transplantation.Methods. Single institution retrospective review of patients diagnosed with bladder urothelial carcinoma (BUC) following solid organ transplantation between January 1992 and December 2007.Results. Of the 2,925 renal and 2,761 liver transplant recipients reviewed, we identified eleven patients (0.2%) following transplant diagnosed with BUC. Two patients with low grade T1 TCC were managed by TURBT. Three patients with CIS and one patient with T1 low grade BUC were treated by TURBT and adjuvant BCG. All four are alive and free of recurrence at a mean follow-up of 51 ± 22 months. One patient with T1 high grade BUC underwent radical cystectomy and remains disease free with a follow-up of 98 months. Muscle invasive TCC was diagnosed in four patients at a median of 3.6 years following transplantation. Two patients are recurrence free at 24 and 36 months following radical cystectomy. Urinary diversion and palliative XRT were performed in one patient with un-resectable disease.Conclusions. Bladder cancer is uncommon following renal and liver transplantation, but it can be managed successfully with local and/or extirpative therapy. The use of intravesical BCG is possible in select immunosuppressed patients.

scholarly journals Cancer immunotherapy in special challenging populations: recommendations of the Advisory Committee of Spanish Melanoma Group (GEM)

2021 ◽  
Vol 9 (3) ◽  
pp. e001664
Author(s):  
Maria Gonzalez-Cao ◽  
Teresa Puertolas ◽  
Mar Riveiro ◽  
Eva Muñoz-Couselo ◽  
Carolina Ortiz ◽  
...  
Keyword(s):  
Cancer Immunotherapy ◽  
Multidisciplinary Approach ◽  
Checkpoint Inhibitors ◽  
Solid Organ Transplantation ◽  
Latent Tuberculosis ◽  
Solid Organ ◽  
Chronic Infections ◽  
Immunosuppressed Patients ◽  
History Of ◽  
Evidence Based Guidelines

Cancer immunotherapy based on the use of antibodies targeting the so-called checkpoint inhibitors, such as programmed cell death-1 receptor, its ligand, or CTLA-4, has shown durable clinical benefit and survival improvement in melanoma and other tumors. However, there are some special situations that could be a challenge for clinical management. Persons with chronic infections, such as HIV-1 or viral hepatitis, latent tuberculosis, or a history of solid organ transplantation, could be candidates for cancer immunotherapy, but their management requires a multidisciplinary approach. The Spanish Melanoma Group (GEM) panel in collaboration with experts in virology and immunology from different centers in Spain reviewed the literature and developed evidence-based guidelines for cancer immunotherapy management in patients with chronic infections and immunosuppression. These are the first clinical guidelines for cancer immunotherapy treatment in special challenging populations. Cancer immunotherapy in chronically infected or immunosuppressed patients is feasible but needs a multidisciplinary approach in order to decrease the risk of complications related to the coexistent comorbidities.

scholarly journals Conversion from calcineurin inhibitors to sirolimus of recipients with chronic kidney graft disease grade iii for a period 2003-2011

2013 ◽  
Vol 70 (9) ◽  
pp. 848-853 ◽  
Author(s):  
Ljiljana Ignjatovic ◽  
Rajko Hrvacevic ◽  
Dragan Jovanovic ◽  
Zoran Kovacevic ◽  
Neven Vavic ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Immunosuppressive Therapy ◽  
Graft Function ◽  
Solid Organ Transplantation ◽  
Calcineurin Inhibitors ◽  
Solid Organ ◽  
Kidney Graft ◽  
Group I ◽  
Grade Iii

Background/Aim. Tremendous breakthrough in solid organ transplantation was made with the introduction of calcineurin inhibitors (CNI). At the same time, they are potentially nephrotoxic drugs with influence on onset and progression of renal graft failure. The aim of this study was to evaluate the outcome of a conversion from CNIbased immunosuppressive protocol to sirolimus (SRL) in recipients with graft in chronic kidney disease (CKD) grade III and proteinuria below 500 mg/day. Methods. In the period 2003-2011 24 patients (6 famale and 18 male), mean age 41 ? 12.2 years, on triple immunosuppressive therapy: steroids, antiproliferative drug [mycophenolate mofetil (MMF) or azathiopirine (AZA)] and CNI were switched from CNI to SRL and followe-up for 76 ? 13 months. Nine patients (the group I) had early postransplant conversion after 4 ? 3 months and 15 patients (the group II) late conversion after 46 ? 29 months. During the regular outpatient controls we followed graft function through the serum creatinine and glomerular filtration rate (GFR), proteinuria, lipidemia and side effects. Results. Thirty days after conversion, in all the patients GFR, proteinuria and lipidemia were insignificantly increased. In the first two post-conversion months all the patients had at least one urinary or respiratory infection, and 10 patients reactivated cytomegalovirus (CMV) infection or disease, and they were successfully treated with standard therapy. After 21 ? 11 months 15 patients from both groups discontinued SRL therapy due to reconversion to CNI (10 patients) and double immunosuppressive therapy (3 patients), return to hemodialysis (1 patient) and death (1 patient). Nine patients were still on SRL therapy. By the end of the follow-up they significantly improved GFR (from 53.2 ? 12.7 to 69 ? 15 mL/min), while the increase in proteinuria (from 265 ? 239 to 530.6 ? 416.7 mg/day) and lipidemia (cholesterol from 4.71 ? 0.98 to 5.61 ? 1.6 mmol/L and triglycerides from 2.04 ? 1.18 to 2.1 ? 0.72 mmol/L) were not significant. They were stable during the whole follow-up period. Ten patients were reconverted from SRL to CNI due to the abrupt increase of proteinuria (from 298 ? 232 to 1639 ? 1641/mg day in 7 patients), rapid growth of multiple ovarian cysts (2 patients) and operative treatment of persisted hematoma (1 patient). Thirty days after reconversion they were stable with an insignificant decrease in GFR (from 56.10 ? 28.09 to 47 ? 21 mL/min) and significantly improved proteinuria (from 1639 ? 1641 to 529 ? 688 mg/day). By the end of the follow-up these patients showed nonsignificant increase in the serum creatinine (from 172 ? 88 to 202 ? 91 mmol/L), decrease in GFR (from 56.10 ? 28.09 to 47 ? 21 mL/day) and increased proteinuria (from 528.9 ? 688 to 850 ? 1083 mg/min). Conclusion. In this small descriptive study, conversion from CNI to SRL was followed by an increased incidence of infections and consecutive 25-50% dose reduction in the second antiproliferative agent (AZA, MMF), with a possible influence on the development of glomerulopathy in some patients, which was the major reason for discontinuation of SRL therapy in the 7 (29%) patients. Nine (37.5%) of the patients experienced the greatest benefit of CIN to SRL conversion without serious post-conversion complications.

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

scholarly journals Transmission of synovial sarcoma from a single multi-organ donor to three transplant recipients: case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jian Zhang ◽  
Yang Yang ◽  
Ye Tian ◽  
Ruifang Xu ◽  
Jun Lin
Keyword(s):  
Synovial Sarcoma ◽  
Solid Organ Transplantation ◽  
Organ Donor ◽  
Malignant Potential ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Tumor Type ◽  
Transplant Recipients ◽  
Allograft Nephrectomy

Abstract Background Transmission of malignancy is a notable problem that cannot always be absolutely predicted at the time of transplantation. In particular, donor-derived transmission of synovial sarcoma in solid-organ transplantation is a rare but catastrophic event. Case presentation We are the first to report three cases of synovial sarcoma transmitted from a single multi-organ donor in China. The donor died of respiratory failure caused by an intrathoracic tumor, which was diagnosed as benign at the time of donation. All three recipients developed synovial sarcoma 3–13 months after transplantation; all three cases were confirmed to be donor transmitted. The liver transplant recipient died of tumor metastasis after partial-allograft hepatectomy. The two renal-transplant recipients survived after comprehensive therapy, including allograft nephrectomy, withdrawal of immunosuppressants and targeted therapy with anlotinib. Conclusions This report highlights the importance of detailed donor assessment, close follow-up and timely treatment of unexpected donor-transmitted malignancy. Although pathology is the most important evidence for the exclusion of donors for malignant potential, it should be combined with tumor type, tumor size and speed of growth. Organs from donors with malignant potential should be discarded. Allograft nephrectomy should be considered after confirmation of renal-allograft synovial sarcoma. Anlotinib for synovial sarcoma seems to be effective and well tolerated during long-term follow-up.

scholarly journals Risk-factors for re-admission and outcome of patients hospitalized with confirmed COVID-19

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hefziba Green ◽  
Dafna Yahav ◽  
Noa Eliakim-Raz ◽  
Nitzan Karny-Epstein ◽  
Shiri Kushnir ◽  
...  
Keyword(s):  
Risk Factors ◽  
Solid Organ Transplantation ◽  
Interquartile Range ◽  
Solid Organ ◽  
Post Discharge ◽  
Economic Implications ◽  
Admission Rates ◽  
Discharge Outcomes ◽  
Comorbidity Index

AbstractBurden of COVID-19 on Hospitals across the globe is enormous and has clinical and economic implications. In this retrospective study including consecutive adult patients with confirmed SARS-CoV-2 who were admitted between 3/2020 and 30/9/20, we aimed to identify post-discharge outcomes and risk factors for re-admission among COVID-19 hospitalized patients. Mortality and re-admissions were documented for a median post discharge follow up of 59 days (interquartile range 28,161). Univariate and multivariate analyses of risk factors for re-admission were performed. Overall, 618 hospitalized COVID-19 patients were included. Of the 544 patient who were discharged, 10 patients (1.83%) died following discharge and 50 patients (9.2%) were re-admitted. Median time to re-admission was 7 days (interquartile range 3, 24). Oxygen saturation or treatment prior to discharge were not associated with re-admissions. Risk factors for re-admission in multivariate analysis included solid organ transplantation (hazard ratio [HR] 3.37, 95% confidence interval [CI] 2.73–7.5, p = 0.0028) and higher Charlson comorbidity index (HR 1.34, 95% CI 1.23–1.46, p < 0.0001). Mean age of post discharge mortality cases was 85.0 (SD 9.98), 80% of them had cognitive decline or needed help in ADL at baseline. In conclusion, re-admission rates of hospitalized COVID-19 are fairly moderate. Predictors of re-admission are non-modifiable, including baseline comorbidities, rather than COVID-19 severity or treatment.

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.

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