scholarly journals Exploring the Epidemiology of Cancer after Solid Organ Transplantation (EpCOT): an observational cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e043731
Author(s):  
Adnan Sharif ◽  
Javeria Peracha ◽  
David Winter ◽  
Raoul Reulen ◽  
Mike Hawkins
Keyword(s):  
Organ Transplantation ◽  
Record Linkage ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Study Cohort ◽  
Solid Organ ◽  
Post Transplantation ◽  
Increased Risk ◽  
Risk Of Cancer

IntroductionSolid organ transplant patients are counselled regarding increased risk of cancer (principally due to their need for lifelong immunosuppression) and it ranks as one of their biggest self-reported worries. Post-transplantation cancer is common, associated with increased healthcare costs and emerging as a leading cause of post-transplant mortality. However, epidemiology of cancer post-transplantation remains poorly understood, with limitations including translating data from different countries and national data being siloed across different registries and/or data warehouses.Methods and analysisStudy methodology for Epidemiology of Cancer after Solid Organ Transplantation involves record linkage between the UK Transplant Registry (from NHS Blood and Transplant), Hospital Episode Statistics (for secondary care episodes from NHS Digital), National Cancer Registry (from cancer registration data hosted by Public Health England) and the National Death Registry (from NHS Digital). Deterministic record linkage will be conducted by NHS Digital, with a fully anonymised linked dataset available for analysis by the research team. The study cohort will consist of up to 85 410 solid organ transplant recipients,who underwent a solid organ transplant in England between 1 January 1985 and 31 December 2015, with up-to-date outcome data.Ethics and disseminationThis study has been approved by the Confidentiality Advisory Group (reference: 16/CAG/0121), Research Ethics Committee (reference: 15/YH/0320) and Institutional Review Board (reference: RRK5471). The results of this study will be presented at national and international conferences, and manuscripts with results will be submitted for publication in high-impact peer-reviewed journals. The information produced will also be used to develop national evidence-based clinical guidelines to inform risk stratification to enable risk-based clinical follow-up.Trial registration numberNCT02991105.

scholarly journals Viral Enteritis in Solid-Organ Transplantation

Viruses ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2019
Author(s):  
Anum Abbas ◽  
Andrea J. Zimmer ◽  
Diana Florescu
Keyword(s):  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Organ Transplant Recipients ◽  
Increased Risk ◽  
Viral Enteritis ◽  
Solid Organ Transplant Recipients

Solid organ transplant recipients are at increased risk for infections due to chronic immunosuppression. Diarrhea is a commonly encountered problem post transplantation, with infectious causes of diarrhea being a frequent complication. Viral infections/enteritides in solid organ transplant recipients often result from frequently encountered pathogens in this population such as cytomegalovirus, adenovirus, and norovirus. However, several emerging viral pathogens are increasingly being recognized as more sensitive diagnostic techniques become available. Treatment is often limited to supportive care and reduction in immunosuppression, though antiviral therapies mayplay a role in the treatment in certain diseases. Viral enteritis is an important entity that contributes to morbidity and mortality in transplant recipients.

Cytomegalovirus in Solid Organ Transplant Recipients: Clinical Updates, Challenges and Future Directions

2020 ◽  
Vol 26 (28) ◽  
pp. 3497-3506
Author(s):  
Raymund R. Razonable
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Future Directions ◽  
Prevention And Treatment ◽  
Solid Organ Transplant Recipients

Cytomegalovirus is the classic opportunistic infection after solid organ transplantation. This review will discuss updates and future directions in the diagnosis, prevention and treatment of CMV infection in solid organ transplant recipients. Antiviral prophylaxis and pre-emptive therapy are the mainstays of CMV prevention, but they should not be mutually exclusive and each strategy should be considered depending on a specific situation. The lack of a widely applicable viral load threshold for diagnosis and preemptive therapy is emphasized as a major factor that should pave the way for an individualized approach to prevention. Valganciclovir and intravenous ganciclovir remain as drugs of choice for CMV management, and strategies for managing drug-resistant CMV infection are enumerated. There is increasing use of CMV-specific cell-mediated immune assays to stratify the risk of CMV infection after solid organ transplantation, and their potential role in optimizing CMV prevention and treatment efforts is discussed.

scholarly journals A case of positive pregnancy test in a sexually inactive solid organ transplant recipient -- can human chorionic gonadotropin be transmitted through solid organ transplantation?

2016 ◽  
Vol 3 (4) ◽  
pp. 4
Author(s):  
Mina Al-Badri ◽  
Kunam Reddy ◽  
Paru David ◽  
Raymond Heilman ◽  
Christine Snozek ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Organ Transplant Recipient ◽  
Solid Organ Transplant Recipient ◽  
Solid Organ ◽  
Post Transplantation ◽  
Pregnancy Test ◽  
Stage Renal Disease ◽  
End Stage

A 21-year-old female with end stage renal disease underwent a non-related renal transplantation from a deceased pregnant donor. The recipient had a negative serum pregnancy test prior to her surgery. However postoperatively, a rise in her serum human chorionic gonadotrophin (hCG) level, which lasted several days, was documented. Solid organ transplantation is known to transmit various infections, malignant cells and antibodies from donor to recipient but no previous reports described transmission of hCG. This case report highlights the importance of considering this possibility when managing post-transplantation hormonal disturbances. Further research is warranted to evaluate the different mechanisms through which transmission occurs between donor and recipient.

Entrustable professional activities for pharmacy students: A primer for solid organ transplant preceptors

2021 ◽  
Author(s):  
Alicia Lichvar ◽  
Mary Moss Chandran ◽  
Vincent Do ◽  
Trisann Rendulic ◽  
Amanda Szczepanik ◽  
...  
Keyword(s):  
Patient Care ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Pharmacy Students ◽  
Entrustable Professional Activities ◽  
Solid Organ ◽  
Professional Activities ◽  
Specialty Practice

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 The role of a solid organ transplant pharmacist is multifaceted and translates to diverse experiential and elective learning experiences that can be provided to pharmacy learners. Here we provide a guide to integrating pharmacy students into patient care and other pharmacist activities in solid organ transplantation. Summary Thoughtful incorporation of learners into clinical practice and clinical research creates a positive learning environment for pharmacy students that can foster the development of core skills necessary for students to become “practice-ready” and “team-ready” pharmacy graduates and can equip them with valuable skills to incorporate into the specialty practice areas and careers they pursue. To help develop these educational experiences, attention to the list of core entrustable professional activities (EPAs) established by the American Association of Colleges of Pharmacy can help create a rich environment of learning with carefully cultivated tasks. Furthermore, learners can serve as transplant pharmacist extenders to assist in overall patient care and multidisciplinary involvement on the transplant team. This article serves as a “how-to” guide for applying the EPA framework to integrating pharmacy students in patient care and other pharmacist activities in solid organ transplantation and other specialty practice areas. Conclusion As pharmacy preceptors design and operationalize their teaching to incorporate EPAs, they can benefit from recommendations tailored to specialty practice areas such as solid organ transplantation. Students may start and finish these experiences at different EPA levels, but continuance of training will allow them to achieve the final EPA level across the 6 EPA domains.

MGUS Transformation Into Multiple Myeloma In Patients With Solid Organ Transplantation

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5325-5325
Author(s):  
Mohamad A. Younes ◽  
Jonathan D Perez ◽  
Zaid Alirhayim ◽  
Cesar Ochoa ◽  
Ruchir Patel ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Kidney Transplant ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
M Protein ◽  
Solid Organ ◽  
Number Of Patients ◽  
The Mean

Abstract The risk of transformation of MGUS to MM is well studied and considered to be around 1%/year. However, this risk is not well defined in patients who undergo solid organ transplantation. A study by Jimenez et al Transplantation,2011 Sep 15;92(5):570-4 found no increased risk of transformation of MGUS to MM, but the sample size of patients who were diagnosed with MGUS prior to transplantation was small (34 patients). In another study by Naina et al Am J Nephrol. 2012;35(4):365-71, 2 out of 17 (11.7%) patients with pre-transplant MGUS and kidney transplant developed smoldering MM. To investigate this topic further, we reviewed the charts of patients who underwent solid organ transplant and who had a pre-transplant diagnosis of MGUS between years 2000 and 2010 and studied the incidence of transformation to MM in these patients. Patients who had MGUS diagnosed after the solid organ transplant were excluded. 57 patients were eligible. The number of patients with different kinds of transplant was as follows: 22 had liver transplant, 31 had kidney transplant, 3 patients had lung transplant, and 1 patient had heart transplant. The mean age was 57.3 years (range 32-76 years). 26.3% were females. The mean follow up was 45.6 months (range 1-156 months). The mean M protein on diagnosis was 0.52 g/dl. 16 patients had pre-transplant bone marrow biopsy with a mean plasma cell percentage of 4% (range 1-9%). 14 patients had normal cytogenetics and 1 patient had Trisomy 11 and another had deletion Y. 29 patients had their serum light chain ratio checked and it was normal in 22 out of 29 patients and abnormal in 7 patients. None of the 57 patients were diagnosed with MM during the follow up period. 1 patient developed PTLD 5 years post transplant. 14 patients died and 43 patients were still alive at the time of last follow up. Follow up on M protein was available for 35 patients with a mean follow up of 54 months (range 2-144 months) with the following observations: 19 patients (54%) had stable M protein (10 kidney, 8 liver, 1 lung), 6 patients (17%) had increase in M protein by at least 0.1 g/dl (4 kidney and 2 liver), and 10 patients had their M protein decrease or resolve (5 kidney, 4 liver, 1 Heart). Mean time to death was 18.65 months (1- 68.8 months). None of the deaths were related to MM and the causes were as follows: infection (3), GI bleed (1), malignancy (3) being Kaposi sarcoma, HCC and PTLD, liver failure (2), uremia (1), CVA (1), unknown (3). Immunosuppressants included mainly medrol, prograf, cellcept, cyclosporine and rapamune. Conclusion MGUS is not a contraindication to solid organ transplant as none of the patient developed MM during the follow up period and deaths were not related to progression of MGUS to MM. As 6 out of 57 patients (10.5%) had increase in M protein despite none being diagnosed with MM, we do suggest continued follow up on these patients at least once a year. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Colorectal Cancer Characteristics and Outcomes after Solid Organ Transplantation

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Amit Merchea ◽  
Faisal Shahjehan ◽  
Kristopher P. Croome ◽  
Jordan J. Cochuyt ◽  
Zhuo Li ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Organ Transplantation ◽  
Early Stage ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Categorical Variables ◽  
Solid Organ ◽  
Stage 4

Background. Individuals after solid organ transplant may develop secondary malignancies. In our clinical practice, we noted an increasing number of individuals who developed colorectal cancers after solid organ transplantation. The primary aim of this study was to describe the characteristics and outcomes of the patients who developed colorectal cancer after solid organ transplant. Materials and Methods. Data was gathered and merged from several registries at Mayo Clinic to identify all patients who received a diagnosis of colon or rectal cancer and solid organ transplant. Continuous variables were summarized as mean (standard deviation) and median (range), while categorical variables were reported as frequency (percentage). Time to colorectal cancer after transplant and overall survival after cancer diagnosis were estimated using Kaplan-Meier method. Results. Initially, 115 colorectal cancer patients who also had a transplant were identified. The diagnosis of colorectal cancer was noted after solid organ transplant in 63 patients. The mean age at transplant was 57 years. Majority had received a kidney transplant (44.4%) followed by liver (36.5%). The median time to develop colorectal cancer was 59.3 months (range: 4.4-251.4 months). 15 (24.6%) were stage 4 at diagnosis and 13 (21.3%) had stage 3 colorectal cancer. Median overall survival was 30.8 months; 5-, 10- and 15-year survival were noted to be 42.5%, 17.9%, and 7.5%, respectively. None of the stage 4 patients were alive at 5 years; 5-year survival rate for stage 1, 2, and 3 patients was 77%, 50%, and 42%, respectively. Conclusions. Our study reports on one of the largest cohorts of patients of colorectal cancer that developed the cancer after solid organ transplant. Survival is extremely poor for advanced cases. However, long-term survivors are noted who developed the cancer at a relatively early stage. Colorectal screening recommendations may need to be revised for patients after solid organ transplant.

scholarly journals SUN-367 Changes in Bone and Glucose Metabolism in Patients Post Solid Organ Transplant

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Keswick Lo ◽  
Omer H Tarar ◽  
Subhashini Yaturu
Keyword(s):  
Glucose Metabolism ◽  
Glycemic Control ◽  
Organ Transplantation ◽  
Immunosuppressive Agents ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Metabolic Complications

Abstract Introduction: Solid organ transplantation has emerged as a pivotal therapeutic option for various organ failures and has gained more popularity with newer technologies and better immunosuppressive options. However, immunosuppressive therapies for survival of solid organ transplant is also associated with various metabolic complications with changes in bone and glucose metabolism. The aim of our study is to review the changes in bone and glucose metabolism in post solid organ transplant recipient Veterans. Methods: Single center, retrospective study with subjects who had solid organ transplant conducted at William Jennings Bryan Dorn Veteran Hospital in Columbia, South Carolina. All available subjects who had solid organ transplant between January 1, 2008 till December 31st, 2017 and had at least one post-transplant followed up visit were included. Data was collected from computerized patient record system after approval by Institutional Review board (IRB) and Research and development. Collected data included age, sex, BMI, Laboratory data, Medications, Bone mineral density (BMD) by DXA, Diabetes status and medications pre and post operatively. Results: Data collected include 227 patients with solid organ transplants. Out of those, only 88 had BMD evaluation and only 45 had follow up BMD. Out of 88 with baseline BMD, 16 had osteoporosis, 36 had osteopenia and 36 had normal BMD. Although 51 were on Bisphosphonates, many of them did not have follow up DXA scans. 157 were receiving Vitamin D supplementation but very few had levels checked. A total of 158 patients had Diabetes, with 95 having pre-existing diabetes and 52 were diagnosed post transplantation. The time of onset was unknown in 11 patients. Majority of patients with pre-existing diabetes required intensification of their medications for diabetes to achieve optimal glycemic control. Discussion A multitude of factors including type of transplant, individual pre-operative metabolic profiles, choice of immunosuppressive agents and certain infections increase the risk of these metabolic complications. Given the complex post-operative care, issues with immunosuppressive agents and other comorbidities, metabolic bone disease and other complications may go unnoticed and under recognized which may later lead to higher risk of fractures, morbidity and mortality. Conclusion This study highlights the importance of monitoring prudently for metabolic changes after solid organ transplantation. Early identification and aggressive management of these complications may help decrease morbidity and mortality related to fractures and sub-optimal glycemic control.

scholarly journals Risk Factors for Failure of Primary (Val)ganciclovir Prophylaxis Against Cytomegalovirus Infection and Disease in Solid Organ Transplant Recipients

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
Mark P Khurana ◽  
Isabelle P Lodding ◽  
Amanda Mocroft ◽  
Søren S Sørensen ◽  
Michael Perch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Primary Prophylaxis ◽  
Solid Organ ◽  
Post Transplantation ◽  
Cox Models ◽  
Optimal Dosing ◽  
Increased Risk ◽  
Accurate Dose

Abstract Background Rates and risk factors for cytomegalovirus (CMV) prophylaxis breakthrough and discontinuation were investigated, given uncertainty regarding optimal dosing for CMV primary (val)ganciclovir prophylaxis after solid organ transplantation (SOT). Methods Recipients transplanted from 2012 to 2016 and initiated on primary prophylaxis were followed until 90 days post-transplantation. A (val)ganciclovir prophylaxis score for each patient per day was calculated during the follow-up time (FUT; score of 100 corresponding to manufacturers’ recommended dose for a given estimated glomerular filtration rate [eGFR]). Cox models were used to estimate hazard ratios (HRs), adjusted for relevant risk factors. Results Of 585 SOTs (311 kidney, 117 liver, 106 lung, 51 heart) included, 38/585 (6.5%) experienced prophylaxis breakthrough and 35/585 (6.0%) discontinued prophylaxis for other reasons. CMV IgG donor+/receipient- mismatch (adjusted HR [aHR], 5.37; 95% confidence interval [CI], 2.63 to 10.98; P < 0.001) and increasing % FUT with a prophylaxis score <90 (aHR, 1.16; 95% CI, 1.04 to 1.29; P = .01 per 10% longer FUT w/ score <90) were associated with an increased risk of breakthrough. Lung recipients were at a significantly increased risk of premature prophylaxis discontinuation (aHR, 20.2 vs kidney; 95% CI, 3.34 to 121.9; P = .001), mainly due to liver or myelotoxicity. Conclusions Recipients of eGFR-adjusted prophylaxis doses below those recommended by manufacturers were at an increased risk of prophylaxis breakthrough, emphasizing the importance of accurate dose adjustment according to the latest eGFR and the need for novel, less toxic agents.

State of the Science of Palliative Care in Solid Organ Transplantation

2020 ◽  
Vol 30 (4) ◽  
pp. 382-395
Author(s):  
Carolina Gustafson ◽  
Mi-Kyung Song
Keyword(s):  
Palliative Care ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Controlled Vocabulary ◽  
Free Text ◽  
Solid Organ ◽  
Provider Perspectives ◽  
State Of The Science

Introduction: Both solid organ transplant candidates and recipients and their family caregivers have complex care needs and may benefit from palliative care. But palliative care is not often considered as part of transplant care despite palliative care being promoted as an important component of transplant care both before and after solid organ transplantation. Further, the current state of the science of palliative care in solid organ transplantation has not been well-documented. Objective: To describe the state of the science of palliative care in solid organ transplant and identify gaps in the literature. Methods: Four electronic databases were searched using controlled vocabulary words and synonymous free text to find articles on palliative care and solid organ transplant. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist were also used. Results: Twenty articles were included in the final review for synthesis, 18 of which involved transplants for adults only. Twelve articles described palliative care for patients before transplant, four articles examined palliative care for patients after transplant, primarily at the end-of-life, and four articles described transplant provider perspectives on palliative care. The reviewed evidence suggested that patients could be benefited by palliative care both pre and posttransplant, particularly for symptom management and advance care planning and that transplant providers faced many barriers to implementing palliative care in practice. Discussion: There is limited research on palliative care following solid organ transplantation, particularly outside of hospice care. Much of the prior research on this topic has described adult patients.

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