scholarly journals 928. Clinical Characteristics and Microbiology Testing Patterns Among Transplant Recipients Admitted to Acute Care Hospitals for Suspected Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S556-S556
Author(s):  
T Matthew Hill ◽  
Erick R Scott ◽  
Sivan Bercovici
Keyword(s):  
Clinical Characteristics ◽  
Lung Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Suspected Infection ◽  
Atypical Pathogens ◽  
Microbiological Testing ◽  
History Of ◽  
Lung Transplant Recipients ◽  
Testing Patterns

Abstract Background Solid organ transplant (SOT) is a growing option for patients with end-stage organ diseases. Immunosuppressive therapy (IT) is utilized in this population to minimize risk of allograft rejection, which increases infection risk particularly of atypical pathogens that can complicate the infection-related diagnostic journey. The purpose of this analysis was to evaluate baseline clinical characteristics and microbiological testing utilization patterns among a cohort of patients with a history of SOT and IT. Methods This retrospective cohort study utilized a US hospital-based, service-level database. Patients were selected from a subsample of database facilities utilizing plasma microbial cell-free DNA diagnostic assays. The study period was 1/1/2017-3/21/2020. Eligible patients were identified by 1st observation of SOT status and IT. Subsequent inpatient admissions for suspected infection were analyzed. Results We identified 749 patients with SOT history and use of IT, 56.4% were male, and the mean age was 52.8 (18.7) years. Kidney was the most prevalent transplant category (49.1%), followed by liver (14.1%), lung (10.9%), and heart (10.3%), and 9.7% were multi-organ. Patients experiencing multiple transplants had the most chronic conditions with a mean Elixhauser comorbidity score of 26.3 (14.7). The median length of stay was 4 [3-7] days. The median number of tests per encounter was 6 [IQR=3-11]. Culture was the most utilized test category (2 [1-4]). Blood culture was the highest utilized culture and overall test at 13.5% of all tests observed, while CMV PCR (7.8%) and multi-panel EIA (2.7%) were the most frequent molecular and antigen tests, respectively. Lung transplant recipients had the greatest utilization of tests overall (9 [3.5-17]) versus other transplant categories (6 [3-10]), consistent with the observed test rate in the 1st 48 hours of presentation (4 [1-7] vs. 2 [1-5]). Conclusion This analysis suggests that the infection-related diagnostic journey among patients with a history of SOT involves high utilization of microbiological testing, with greater utilization among lung transplant recipients versus other SOT recipients. Variation in clinical characteristics and microbiological testing patterns were observed across SOT categories. Disclosures T Matthew Hill, PharmD, PhD, Karius, Inc (Employee, Shareholder) Erick R. Scott, MD, MHS, Karius, Inc (Employee, Shareholder) Sivan Bercovici, PhD, Karius (Employee)

A systematic review of post-transplant lymphoproliferative disorder after lung transplant.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19046-e19046
Author(s):  
Mobeen Zaka Haider ◽  
Zarlakhta Zamani ◽  
Fnu Kiran ◽  
Hasan Mehmood Mirza ◽  
Muhammad Taqi ◽  
...  
Keyword(s):  
Lymphoproliferative Disorder ◽  
Lung Transplant ◽  
Late Onset ◽  
Adult Population ◽  
Solid Organ Transplantation ◽  
Chemotherapeutic Agents ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Post Transplant ◽  
Lung Transplant Recipients

e19046 Background: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after solid organ transplantation. This study aims to explore the association of PTLD diagnosed after lung transplant with infectious agents and immunosuppression regimen, explore types of PTLD, and their outcome. Methods: Following the PRISMA guideline, we searched the literature on PubMed, Cochrane, Embase, and clinicaltrials.gov. 1741 articles were screened and included five studies. Results: We analyzed data from five studies, n=13,643 transplant recipients with n=287 (2.10%) developed PTLD. Four studies showed that 32/63 (51%) PTLD patients were male and 31 (49%) were female. Three studies reported 53/55 (96.4%) patients were EBV positive at PTLD diagnosis. Courtwright. et al, reported that 217/224 (97%) PTLD was associated with either EBV positive donor or recipient. Four studies showed that the monomorphic B cell type 48/63 (76%) was the most common histological type of PTLD diagnosed with DLBCL the most common subtype 31/48 (64.6%). Data from 3 studies showed that the onset of PTLD following lung transplant varies with a median duration of 18.3 months (45 days to 20.2 years). Three studies showed that 26/55 (47.3%) patients had early-onset (≤ 1 yr of Tx) and 29/55 (52.7%) patients had late-onset PTLD (> 1 yr of Tx). Management of PTLD included a reduction in immunosuppression including corticosteroids, CNI, purine synthesis inhibitors, Rituximab, and chemotherapeutic agents. Three studies showed a mortality rate of 30/45 (66.7%) and 13/30 (43.3%) deaths were PTLD related. Conclusions: Our review concludes that PTLD is a serious complication, only 2% of lung transplant recipients developed PTLD. EBV seropositivity is the most factor associated with PTLD diagnosis. Monomorphic PTLD was reported as the most common type in the adult population and no association between gender and PTLD was found. The analysis shows that there is a slightly lower incidence of early (≤ 1 yr of Tx) than late-onset (> 1 yr of Tx) PTLD. Table 1 PTLD after a Lung transplant in adults - a review. [Table: see text]

Providing post-lung transplant care during the time of COVID-19

2021 ◽  
Vol 30 (16) ◽  
pp. 976-980
Author(s):  
Sara Winward ◽  
Iain Lawrie ◽  
Susan Talbot Towell ◽  
Nina Sheridan ◽  
Patricia Ging
Keyword(s):  
Lung Transplant ◽  
Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Model Of Care ◽  
Community Based Interventions ◽  
Community Based ◽  
Solid Organ Transplant Recipients ◽  
Remote Monitoring Systems ◽  
Lung Transplant Recipients

The COVID-19 pandemic is a public health emergency of international concern. Solid organ transplant recipients have been identified as being at high risk of acquiring the virus SARS-CoV-2 and having a more severe COVID-19 disease. This article describes the experience of the National Lung Transplant Centre in Ireland in changing established care pathways for lung transplant recipients during the pandemic. The innovations which were put in place to protect this clinically vulnerable group are discussed. With the advancement of technology and remote monitoring systems available, patient-focused strategies and community-based interventions were implemented. Additional strategies have been implemented so that the new model of care can be safely maintained.

scholarly journals Chronic Pulmonary Silicone Embolism from Breast Augmentation Is Not a Common Finding in Explanted Lungs

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Jarmanjeet Singh ◽  
Hanine Inaty ◽  
Sanjay Mukhopadhyay ◽  
Atul C. Mehta
Keyword(s):  
Lung Transplantation ◽  
Pulmonary Disease ◽  
Breast Augmentation ◽  
Lung Transplant ◽  
Common Finding ◽  
Transplant Recipients ◽  
Chronic Lung Diseases ◽  
Pathologic Features ◽  
History Of ◽  
Lung Transplant Recipients

Objective. Acute pulmonary silicone embolism (APSE) related to subcutaneous silicone injections is a well-known entity. Recently, a few cases of pathologically confirmed chronic pulmonary silicone embolism (CPSE) from breast implants have been reported. The prevalence of CPSE in women with breast augmentation is unknown. This study was done to determine the prevalence of CPSE in female lung transplant recipients with a history of breast augmentation and to determine whether breast augmentation plays a role in chronic lung diseases requiring lung transplantation. Methods. A retrospective chart review was performed to identify female lung transplant recipients with a history of breast augmentation prior to or at the time of lung transplantation. Ten patients meeting these criteria were identified. The pathologic features of the explanted lungs of these patients were reexamined for CPSE by a board-certified pathologist with expertise in lung transplantation and pulmonary embolism. Results. Of 1518 lung transplant recipients at Cleveland Clinic, 578 were females. Of 578 females, 10 (1.73%) had history of breast augmentation. A total of 84 H&E-stained slides from the explanted lungs from 10 cases were examined. No pathologic evidence of chronic silicone embolism was seen in any of the 10 cases. Conclusions. CPSE is not associated with pulmonary disease leading to lung transplantation. Breast augmentation is not a significant contributor to pulmonary disease requiring lung transplantation. Further studies are required to ascertain the prevalence of CPSE in the general breast augmentation populace and to define the relationship between breast augmentation and pulmonary disease.

scholarly journals Cytomegalovirus in Lung Transplant

2021 ◽  
Vol 05 (02) ◽  
pp. 1-1
Author(s):  
Justin P. Rosenheck ◽  
◽  
Mena M B otros ◽  
David R Nunley ◽  
◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Lung Transplant ◽  
Therapeutic Option ◽  
Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Ongoing Research ◽  
Complex Patients ◽  
Lung Transplant Recipients ◽  
New Generation

Lung transplantation is a therapeutic option for patients with advanced lung diseases. Lung transplant outcomes have improved over time with improvements in the management of these complex patients. Cytomegalovirus is a common opportunistic organism affecting all solid organ transplant recipients. Characteristics unique to lung transplantation can make this virus difficult to manage, with myriad complications including graft failure and death. Ongoing research into and understanding of cytomegalovirus has opened exciting new avenues of management. We discuss the various manifestations of CMV related pathologies in the lung transplant recipient. We discuss current mainstays of risk stratification, diagnosis, and treatment, as well as present new and evolving concepts. Current medications are highly effective at preventing and treating CMV manifestations, but may be poorly tolerated. A new generation of therapies carry the promise of efficacy, with a greater safety profile and improved tolerance of adverse effects. We discuss host-virus immune interactions, specifically how these can be utilized in clinical practice to individualize the cytomegalovirus related care of lung transplant recipients. Finally, we turn our attention to the near horizon as we continue to evolve the care of this unique population.

scholarly journals 1103. Improving Perioperative Prophylactic Antimicrobial Guideline Concordance in Liver and Lung Transplant Recipients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S391-S392
Author(s):  
Cynthia T Nguyen ◽  
Rachel Marrs ◽  
Jennifer Pisano ◽  
Natasha N Pettit ◽  
Lisa Potter
Keyword(s):  
Antimicrobial Stewardship ◽  
Lung Transplant ◽  
Small Sample Size ◽  
Solid Organ Transplantation ◽  
Composite Endpoint ◽  
Small Sample ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Modifiable Factor ◽  
Lung Transplant Recipients

Abstract Background Surgical site infection (SSI) is a common complication among patients undergoing solid-organ transplantation. Administration of perioperative antimicrobials is one modifiable factor that may reduce the risk of SSIs. We sought to evaluate antimicrobial stewardship efforts to improve concordance of perioperative antimicrobial selection (AS) and dose timing (DT) with the institution’s perioperative antimicrobial guidelines among liver (LVR) and lung transplant recipients (LNG). Methods This was a single-center, observational study of LVR and LNG between January 1, 2017 and December 31, 2018. Patients receiving antimicrobials for the treatment of infection immediately prior to transplant were excluded. Throughout the study period, several interventions were performed, including: updating AS and DT protocols (2017 Q2) and preoperative order sets (2017 Q4), improving availability of antibiotics in the operating room (2018 Q1), and most recently developing a guideline and providing education for intraoperative redosing based on renal function (2018 Q3). The primary outcome was overall guideline concordance (GC). This was a composite endpoint including preoperative and intraoperative AS and DT, based on the institution’s guideline. Secondary outcomes included SSI rates based on the CDC National Healthcare Safety Network definition and rate of new C. difficile or vancomycin-resistant Enterococci infection or colonization. Results Among 112 patient screened, 79 patients were included (45 LNG and 34 LVR). The median age was 60 years and BMI was 26.5 kg/m2. The median procedure length was 7.8 hours for LNG and 6.9 hours for LVR. Results are shown in Table 1, Figure 1 and Figure 2. All GC rates demonstrate improvements over time, except for intraoperative DT for LNG. Conclusion Limited by a small sample size, our study demonstrates that noninvasive antimicrobial stewardship strategies can yield improvements in GC. Disclosures All authors: No reported disclosures.

scholarly journals Use of Foscarnet Therapy for EBV Infection following Control of PTLD with Enhancement of Cellular Immunity in a Lung-Transplant Recipient

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Kamyar Afshar ◽  
A. Purush Rao ◽  
Vipul Patel ◽  
Kevin Forrester ◽  
Sivagini Ganesh
Keyword(s):  
Lymphoproliferative Disorder ◽  
Lung Transplant ◽  
Strong Association ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Posttransplant Lymphoproliferative Disorder ◽  
Annual Incidence Rate ◽  
Ebv Infection ◽  
Lung Transplant Recipients

Posttransplant lymphoproliferative disorder (PTLD) is a serious complication following solid organ transplantation with an annual incidence rate of 3–5% in lung-transplant recipients. Pathogenesis indicates a strong association with functional over-immunosuppression and EBV infection. Clinical improvement is generally observed with reduction in immunosuppression intensity alone. We present a case of a 24-year-old woman with EBV-associated PTLD following lung transplant where decreasing the immunosuppression improved PTLD but was ineffective against controlling the EBV infection. Foscarnet in combination with immunoglobulins was successfully administered to cause a remission of the EBV infection. This is the second case reported of a persistent EBV infection after reducing immunosuppression levels and evidence of PTLD remission that required foscarnet for EBV infection control.

scholarly journals Noninvasive monitoring of infection and rejection after lung transplantation

2015 ◽  
Vol 112 (43) ◽  
pp. 13336-13341 ◽  
Author(s):  
Iwijn De Vlaminck ◽  
Lance Martin ◽  
Michael Kertesz ◽  
Kapil Patel ◽  
Mark Kowarsky ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
High Frequency ◽  
Lung Transplant ◽  
Area Under The Curve ◽  
Human Herpesvirus ◽  
Clinical Results ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Clinical Complications ◽  
Lung Transplant Recipients

The survival rate following lung transplantation is among the lowest of all solid-organ transplants, and current diagnostic tests often fail to distinguish between infection and rejection, the two primary posttransplant clinical complications. We describe a diagnostic assay that simultaneously monitors for rejection and infection in lung transplant recipients by sequencing of cell-free DNA (cfDNA) in plasma. We determined that the levels of donor-derived cfDNA directly correlate with the results of invasive tests of rejection (area under the curve 0.9). We also analyzed the nonhuman cfDNA as a hypothesis-free approach to test for infections. Cytomegalovirus is most frequently assayed clinically, and the levels of CMV-derived sequences in cfDNA are consistent with clinical results. We furthermore show that hypothesis-free monitoring for pathogens using cfDNA reveals undiagnosed cases of infection, and that certain infectious pathogens such as human herpesvirus (HHV) 6, HHV-7, and adenovirus, which are not often tested clinically, occur with high frequency in this cohort.

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.

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