Pyridoxine Deficiency After Solid Organ Transplant

2017 ◽  
Vol 27 (3) ◽  
pp. 251-256
Author(s):  
Summer Van Arsdale ◽  
Sarah E. Yost ◽  
Chiu-Hsieh Hsu ◽  
Mary Meer ◽  
Shari Schoentag ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Multivariate Logistic Regression Analysis ◽  
Study Cohort ◽  
Solid Organ ◽  
Immune Functions ◽  
Pyridoxine Deficiency ◽  
The Mean ◽  
Low Levels

Objective: Pyridoxine is 1 of 8 B vitamins that assist in a variety of essential functions including immune functions. The purpose of this study was to assess the risk factors associated with low pyridoxine levels in solid organ transplantation recipients. Design: The study cohort was divided into 2 groups: (a) patients with normal pyridoxine levels or (b) patients with low pyridoxine levels. Dietary evaluation and clinical characteristics of all patients, rejection episodes, and immunosuppression were collected. Simple descriptive statistics were used to analyze the overall cohort. Results: Of the 48 patients, 29 (60%) in the study cohort were identified to have low pyridoxine levels. The mean interval between transplantation and pyridoxine level check was 910 days (standard deviation [SD] 456). The mean weight at the time of dietary consultation was 80 kg (SD 20.7). More patients in the deficient group received thymoglobulin for rejection treatment (56% vs 0%; P = .01) and were thymoglobulin recipients (78% vs 10%; odds ratio [OR] = 31.5; 95% confidence interval [CI], 2.35-422.30; P < .01). A strong correlation was identified between thymoglobulin treatment for induction and a low level of pyridoxine (correlation coefficient R = 0.6, P = .004) and between thymoglobulin treatment for rejection and a low pyridoxine level (correlation coefficient R = 0.5, P = .05). Based on multivariate logistic regression analysis, only thymoglobulin treatment (induction or rejection treatment) was significantly associated with low pyridoxine levels (OR = 19.5, 95% CI, 1.01-375.24; P < .05). Conclusions: Low levels of pyridoxine appear to be relatively common, and thymoglobulin treatments are associated with low pyridoxine levels. Prospective studies are needed to confirm and valuate the significance of these findings.

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.

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.

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 Posttransplant Lymphoproliferative Disease Presenting as an Extracranial Mass

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Reuben J. Arasaratnam ◽  
Alejandro Restrepo
Keyword(s):  
Soft Tissue ◽  
Early Recognition ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Antibody Therapy ◽  
B Cell Lymphoma ◽  
Lymphoproliferative Disease ◽  
Solid Organ ◽  
Tissue Mass ◽  
Posttransplant Lymphoproliferative Disease

Posttransplant lymphoproliferative disease is a serious complication following stem cell and solid organ transplantation. Early recognition of the disease is important in facilitating timely therapy and improving long-term outcomes. We report a renal transplant recipient presenting with an extracranial frontoparietal soft tissue mass that was subsequently diagnosed as a B-cell lymphoma. The patient was treated successfully with immunosuppression reduction, anti-CD20 monoclonal antibody therapy, and cytotoxic chemotherapy. Our case highlights the importance of recognizing soft tissue masses in the head and neck as a potential clinical manifestation of PTLD in solid organ transplant recipients.

scholarly journals Future of Solid Organ Transplantation: Organ-Specific Tolerance

KIDNEYS ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 130-136
Author(s):  
Yusuf Ercin Sonmez
Keyword(s):  
Immune System ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Immunological Tolerance ◽  
The Body ◽  
Solid Organ ◽  
Donor Organ ◽  
Organ Specific ◽  
Specific Tolerance

A transplant between two people who are not genetically identical is called an allotransplant and the process is called allotransplantation. Donor organs and tissues can be from people who are living, or people who have died because of a significant brain injury or lack of circulation. Allotransplantation can create a rejection process where the immune system of the recipient attacks the foreign donor organ or tissue and destroys it. The recipient may need to take immunosuppressive medication for the rest of their life to reduce the risk of rejection of the donated organ. In general, deliberately induced immunosuppression is performed to prevent the body from rejecting an organ transplant. The adverse effects associated with these agents and the risks of long-term immunosuppression present a number of challenges for the clinician. Immune tolerance, or immunological tolerance, or immunotolerance, is a state of unresponsiveness of the immune system to substances or tissue that have the capacity to elicit an immune response in a given organism.

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.

scholarly journals Herpes Zoster in Solid Organ Transplantation: Incidence and Risk Factors

2021 ◽  
Vol 12 ◽  
Author(s):  
Marcia M. L. Kho ◽  
Stefan Roest ◽  
Dominique M. Bovée ◽  
Herold J. Metselaar ◽  
Rogier A. S. Hoek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Herpes Zoster ◽  
Multivariable Analysis ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Clinical Signs ◽  
Significant Risk ◽  
Solid Organ ◽  
Disseminated Disease ◽  
Cmv Prophylaxis

BackgroundStudies on herpes zoster (HZ) incidence in solid organ transplant (SOT) recipients report widely varying numbers. We investigated HZ incidence, severity, and risk factors in recipients of four different SOTs, with a follow-up time of 6–14 years.MethodsRecords of 1,033 transplant recipients after first heart (HTx: n = 211), lung (LuTx: n = 121), liver (LiTx: n = 258) and kidney (KTx: n = 443) transplantation between 2000 and 2014 were analyzed for VZV-PCR, clinical signs of HZ, and complications.ResultsHZ was diagnosed in 108 of 1,033 patients (10.5%): 36 HTx, 17 LuTx, 15 LiTx, and 40 KTx recipients. Overall HZ incidence rate after HTx (30.7 cases/1,000 person–years (PY)), LuTx (38.8 cases/1,000 PY), LiTx (22.7 cases/1,000 PY) and KTx (14.5 cases/1,000 PY) was significantly higher than in the general 50–70 year population. Multivariable analysis demonstrated age ≥50 years at transplantation (p = 0.038, RR 1.536), type of organ transplant (overall p = 0.002; LuTx p = 0.393; RR 1.314; LiTx p = 0.011, RR 0.444; KTx p = 0.034, RR 0.575), CMV prophylaxis (p = 0.043, RR 0.631) and type of anti-rejection therapy (overall p = 0.020; methylprednisolone p = 0.008, RR 0.475; r-ATG p = 0.64, RR1.194) as significant risk factors. Complications occurred in 33 of 108 (31%) patients (39% of HTx, 47% of LuTx, 20% of LiTx, 20% of KTx): post-herpetic neuralgia, disseminated disease, and cranial nerve involvement.ConclusionHZ incidence and severity in SOT recipients are most pronounced after heart and lung transplantation, in older patients, and when CMV prophylaxis is lacking.

Rashes associated with transplantations

2020 ◽  
pp. 535-538
Keyword(s):  
Fungal Infections ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Host Immunity ◽  
Solid Organ ◽  
Graft Versus Host ◽  
Gingival Hypertrophy ◽  
Life Threatening ◽  
Transplant Complications

Dermatological manifestations following transplantation are common but important to recognize and diagnose since they may be severe and life-threatening if not adequately and promptly treated. This chapter provides a systematic overview of the types of skin disease that may be encountered in children that have received a haematological or solid organ transplant. Complications relating to immunosuppression include an increased susceptibility to bacterial, viral, and fungal infections which may be significantly more virulent and hazardous in the context of reduced host immunity. Immune suppressant drugs may also cause drug rashes and aesthetic complications such as acne, hypertrichosis, or gingival hypertrophy, as well as longer-term risks from the development of malignancy. It is also important to recognize the range of mucocutaneous signs of acute and chronic graft versus host disease following bone marrow and solid organ transplantation which, again, may be severe and associated with significant morbidity and mortality.

scholarly journals Challenges in the Diagnosis and Management of Bacterial Lung Infections in Solid Organ Recipients: A Narrative Review

2020 ◽  
Vol 21 (4) ◽  
pp. 1221 ◽  
Author(s):  
Manuela Carugati ◽  
Letizia Morlacchi ◽  
Anna Peri ◽  
Laura Alagna ◽  
Valeria Rossetti ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Narrative Review ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Diagnosis And Management ◽  
Solid Organ Transplant Recipients

Respiratory infections pose a significant threat to the success of solid organ transplantation, and the diagnosis and management of these infections are challenging. The current narrative review addressed some of these challenges, based on evidence from the literature published in the last 20 years. Specifically, we focused our attention on (i) the obstacles to an etiologic diagnosis of respiratory infections among solid organ transplant recipients, (ii) the management of bacterial respiratory infections in an era characterized by increased antimicrobial resistance, and (iii) the development of antimicrobial stewardship programs dedicated to solid organ transplant recipients.

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