scholarly journals Emergence of Letermovir-resistant HCMV UL56 mutant during rescue treatment in a liver transplant recipient with ganciclovir-resistant infection HCMV: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stefania Paolucci ◽  
Giulia Campanini ◽  
Irene Cassaniti ◽  
Alessandra Tebaldi ◽  
Federica Novazzi ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Antiviral Drug ◽  
Organ Transplant ◽  
Hepatopulmonary Syndrome ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Genetic Barrier ◽  
Seronegative Patient ◽  
Rescue Treatment ◽  
Resistant Infection

Abstract Background Human Cytomegalovirus (HCMV) still represents a crucial concern in solid organ transplant recipients (SOTRs) and the use of antiviral therapy are limited by side effects and the selection of viral mutations conferring antiviral drug resistance. Case presentation Here we reported the case of an HCMV seronegative patient with common variable immunodeficiency (CVID), multiple hepatic adenomatosis, hepatopulmonary syndrome and portal hypertension who received a liver transplant from an HCMV seropositive donor. The patient was treated with Valganciclovir (vGCV) and then IV Ganciclovir (GCV) at 5 week post-transplant for uncontrolled HCMV DNAemia. However, since mutation A594V in UL97 gene conferring resistance to ganciclovir was reported, GCV therapy was interrupted. Due to the high toxicity of Foscarnet (FOS) and Cidofovir (CDV), Letermovir (LMV) monotherapy at the dosage of 480 mg per day was administered, with a gradual viral load reduction. However, a relapse of HCMV DNAemia revealed the presence of mutation C325Y in HCMV UL56 gene conferring resistance to LMV. Conclusions In conclusion, even if LMV is an effective and favorable safety molecule it might have a lower genetic barrier to resistance. A warning on the use of LMV monotherapy as rescue treatments for HCMV GCV-resistant infections in transplant recipients is warranted.

scholarly journals Hepatitis E Virus Seroprevalence Among Liver Transplant Recipients with Persistent Elevation of Liver Enzymes: A Single Center Report

2021 ◽  
Vol 24 (1) ◽  
pp. 22-26
Author(s):  
Maryam Chorami ◽  
Kamran Bagheri Lankarani ◽  
Fardad Ejtehadi ◽  
Seyed Ali Malek-Hosseini ◽  
Maryam Moini
Keyword(s):  
Chronic Hepatitis ◽  
Liver Transplant ◽  
Hepatitis E Virus ◽  
Liver Enzymes ◽  
Organ Transplant ◽  
Hepatitis E ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Liver Transplant Recipients ◽  
Persistent Elevation

Background: Chronic hepatitis E infection has been reported in solid organ transplant recipients following acute hepatitis due to the compromised immune status. Almost all reports are from areas where hepatitis E virus (HEV) genotypes 3 and 4 are the dominant genotypes. This study was conducted to investigate the role of hepatitis E infection as an etiology for liver enzymes elevation in liver transplant recipients from the largest liver transplant program in Iran. Methods: In a prospective study from June to December 2015, in a single liver transplantation center in Iran, all adult liver recipients who were investigated for the etiology of persistent elevation of liver enzymes were tested for HEV serology status. Results: Of 122 patients included in the study, 19 (15.6%) were positive for HEV serology. Seropositive patients were significantly older than seronegative ones (mean age 43.79 vs. 31.58, P < 0.001); however, they were not different in other characteristics including sex distribution and mean of liver enzymes in each occasion. Liver biopsies were done in 16 HEV seropositive patients and none of the biopsies showed evidence for acute or chronic viral hepatitis. Conclusion: In this study, with 15.6% rate of HEV seropositivity in liver recipients with persistent elevation of liver enzymes, we were not able to confirm any clinical evidence for active acute or chronic hepatitis E infection. This could theoretically be attributed to the fact that the dominant prevalent HEV genotype in our endemic area is not associated with a chronic form of infection.

scholarly journals A unique case of Miller Fisher-Guillain-Barré overlap syndrome in a liver transplant recipient

2021 ◽  
Author(s):  
Claudia Ramirez-Sanchez ◽  
Rehan Syed ◽  
Angela Meier ◽  
Jamie Nicole LaBuzetta ◽  
Diana J. Hylton ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Overlap Syndrome ◽  
Guillain Barre Syndrome ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients ◽  
Guillain Barré

AbstractGuillain-Barré syndrome (GBS) is an ascending demyelinating polyneuropathy often associated with recent infection. Miller Fisher syndrome represents a variant with predominant facial and cranial nerve involvement, although Miller Fisher and Guillain-Barré overlap syndromes can occur. Guillain-Barré spectrum syndromes have been thought to be rare among solid organ transplant recipients. We describe an immunocompromised patient with a liver transplant who presented with ophthalmoplegia and bulbar deficits. His symptoms rapidly progressed to a state of descending paralysis involving the diaphragm; he then developed acute respiratory failure and eventually developed quadriparesis. Electromyography and a nerve conduction study demonstrated a severe sensorimotor axonal polyneuropathy consistent with Miller Fisher variant Guillain-Barré syndrome. Despite several negative nasopharyngeal swabs for COVID-19 polymerase chain reaction, a serology for SARS-CoV-2 IgG was positive. He was diagnosed with Miller Fisher-Guillain-Barré overlap syndrome with rapid recovery following treatment with plasma exchange. Although Guillain-Barré is a rare complication in solid organ transplant recipients, this case highlights the importance of rapid diagnosis and treatment of neurologic complications in transplant patients. Furthermore, it demonstrates a possible case of neurological complications from COVID-19 infection.

scholarly journals Analysis and Characterization of Antiviral Drug–Resistant Cytomegalovirus Isolates from Solid Organ Transplant Recipients

2002 ◽  
Vol 186 (6) ◽  
pp. 760-768 ◽  
Author(s):  
Nell S. Lurain ◽  
Sangeeta M. Bhorade ◽  
Kenneth J. Pursell ◽  
Robin K. Avery ◽  
Vijay V. Yeldandi ◽  
...  
Keyword(s):  
Antiviral Drug ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Drug Resistant ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

scholarly journals Humoral Response to SARS-Cov-2 Vaccination in Liver Transplant Recipients–A Single-Center Experience

Vaccines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 738
Author(s):  
Jassin Rashidi-Alavijeh ◽  
Alexandra Frey ◽  
Moritz Passenberg ◽  
Johannes Korth ◽  
Jaqueline Zmudzinski ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Organ Transplant ◽  
Humoral Response ◽  
Solid Organ Transplant ◽  
Control Group ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Single Center Experience ◽  
Solid Organ Transplant Recipients

Vaccination against SARS-CoV-2 infection is currently approved and shows favorable outcomes, but little known about antibody responses in solid organ transplant recipients, since these patients are known to have an impaired immune response upon vaccination and have not been included in admission studies. We therefore analyzed immunogenicity in 43 liver transplant (LT) recipients in a median of 15 days (IQR, 12–24) after receiving two doses of the mRNA-based SARS-CoV-2 vaccine BNT162b2 following the standard protocol, and compared these results to a control group consisting of 20 healthcare workers (HCWs). Thirty-four of the 43 (79%) LT recipients developed antibodies, compared to 20 out of 20 (100%) in the control group (p = 0.047). The median SARS-CoV-2 IgG titer was significantly lower in the LT recipients compared to the control group (216 vs. >2080 BAU/mL, p = 0.0001). Age and sex distribution was similar in the LT patients that developed antibodies after vaccination compared to those who did not. Interestingly, the patients who received mycophenolate mofetil exhibited a reduced vaccination response compared to the other LT patients (5 of 11 (45.5%) vs. 29 of 32 (90.6%), p = 0.004). In conclusion, our data reveal lower immunogenicity of SARS-CoV-2 vaccine BNT162b2 in LT patients compared to the control group, but still show superior results compared to other solid organ transplant recipients reported so far.

scholarly journals COVID-19 Severity and Mortality in Solid Organ Transplantation: Differences between Liver, Heart, and Kidney Recipients

2021 ◽  
Vol 2 (3) ◽  
pp. 296-303 ◽  
Author(s):  
Ricardo Wesley Alberca ◽  
Gabriela Gama Freire Alberca ◽  
Lucas Chaves Netto ◽  
Raquel Leão Orfali ◽  
Sarah Cristina Gozzi-Silva ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Kidney Transplant ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Control Group ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Solid Organ Transplant Recipients ◽  
Liver Transplant Recipients

The infection by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can generate a wide spectrum of clinical manifestations ranging from asymptomatic to severe respiratory and systemic disease with coagulation disorder named coronavirus disease 2019 (COVID-19). Patients with comorbidities have been identified as risk groups for severe COVID-19, also having a higher death risk. Previous reports have conflicting results regarding if solid organ transplant recipients present an increased risk for COVID-19. Nevertheless, previous investigations failed to distinguish between different organs received or made a longitudinal investigation on those patients. We recruited 39 solid organ transplant recipients: 25 kidney transplant recipients, 7 heart transplant recipients, and 7 liver transplant recipients and 25 age-matched non-transplant COVID-19 patients without comorbidities (control group) and compared daily laboratory data in addition to performing survival analysis. Heart and kidney transplant recipients presented an increase in several COVID-19 severity-associated biomarkers, such as neutrophil-to-lymphocyte ratio and thrombocytopenia, in comparison to the control group and liver transplant recipients. Heart and kidney transplant recipients also presented an increase in the need for intensive care and invasive mechanical ventilation during the disease’s course. Importantly, heart and kidney transplant recipients presented a higher mortality rate in comparison to liver transplant recipients and non-transplant recipients. In our cohort, heart and kidney transplant recipients presented a difference in clinical characteristics and survival rate in comparison to liver transplant recipients. Further investigation involving immune response to SARS-CoV-2 in solid organ recipients should consider and separate patients according to the organ grafted.

scholarly journals Successful Treatment of Invasive Mucormycosis in Orthotopic Liver Transplant Population

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Taryn A. Eubank ◽  
Constance M. Mobley ◽  
Mozhgon Moaddab ◽  
Mark J. Hobeika ◽  
Melissa O’Neal ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Immunosuppressive Agents ◽  
Organ Transplant ◽  
Orthotopic Liver Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Solid Organ Transplant Recipients ◽  
End Stage

Mucormycosis is caused by ubiquitous fungi and encompasses a variety of different opportunistic syndromes in humans that disproportionately affect immunocompromised patients. Mortality has been documented to range between 50 and 100%; however, location of infection greatly dictates likelihood of survival. Treatment of mucormycosis involves aggressive surgical intervention and combination therapy of antifungal agents. In solid organ transplant recipients, immunosuppressive agents used to prevent rejection of the transplanted organ pose additional obstacles in the treatment of invasive fungal infections. We report on 3 high models for end-stage liver disease (MELD-Na) score orthotopic liver transplant (OLT) recipients who all were diagnosed with Rhizopus spp. infections with positive, 1-year outcomes after aggressive, individualized treatment.

scholarly journals Rising Levels of Human Cytomegalovirus (HCMV) Antigenemia during Initial Antiviral Treatment of Solid-Organ Transplant Recipients with Primary HCMV Infection

1998 ◽  
Vol 36 (4) ◽  
pp. 1113-1116 ◽  
Author(s):  
Giuseppe Gerna ◽  
Maurizio Zavattoni ◽  
Elena Percivalle ◽  
Paolo Grossi ◽  
Maria Torsellini ◽  
...  
Keyword(s):  
Human Cytomegalovirus ◽  
Hcmv Infection ◽  
Antiviral Treatment ◽  
Antiviral Drug ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

In 7 of 18 solid-organ transplant recipients with primary human cytomegalovirus (HCMV) infection, HCMV antigenemia levels were unexpectedly found to rise significantly (P = 0.018) during a mean time of 7.3 ± 3.2 days after initiation of specific antiviral treatment, whereas corresponding levels of viremia dropped significantly (P = 0.043). Thus, shifting to an alternative antiviral drug based solely on increasing antigenemia levels is not justified in this group of patients.

Steroid Withdrawal in Liver Transplant Recipients

2001 ◽  
Vol 11 (3) ◽  
pp. 217-223 ◽  
Author(s):  
Rebecca W. Adams ◽  
Robin L. Chapman ◽  
Gregory A. Smallwood
Keyword(s):  
Liver Transplant ◽  
Organ Transplant ◽  
Disease State ◽  
Solid Organ ◽  
Biliary Cirrhosis ◽  
Steroid Withdrawal ◽  
Transplant Recipients ◽  
Primary Disease ◽  
Solid Organ Transplant Recipients ◽  
Liver Transplant Recipients

Because of troublesome side effects associated with steroid use, many transplant centers have tried to withdraw steroids from stable, solid organ transplant recipients. The objective of this study was to evaluate the ability to wean liver transplant recipients off steroids, depending on both their primary immunosuppressive regimen and their primary disease state. This was a retrospective, single-center review of steroid weaning in adult orthotopic liver transplant recipients. Based on primary immunosuppression, patients could be weaned off steroids similarly if they were taking cyclosporine or tacrolimus (53.9% vs 61.4%). When triple immunosuppressive regimens were compared with dual regimens, a difference was found in ability to wean patients off steroids (52.4% vs 74.5%, P=.001). When steroid weaning was stratified for primary immunosuppression and primary disease state, patients with autoimmune-mediated diseases (autoimmune hepatitis, sclerosing cholangitis, and primary biliary cirrhosis) were less likely to be weaned if they were receiving cyclosporine-based immunosuppressants (36.8% vs 62.2%, P=.03). In conclusion, it appears that a large number of liver transplant recipients can safely be tapered off steroids.

scholarly journals Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Melissa Parkinson ◽  
Spandana Vuyyuru ◽  
Jay Patel ◽  
Chinelo Animalu
Keyword(s):  
Liver Transplant ◽  
Organ Transplant ◽  
Febrile Illness ◽  
Solid Organ Transplant ◽  
Sudden Onset ◽  
Orthotopic Liver Transplant ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Transplant Recipients ◽  
Diagnostic Dilemma

In recent solid organ transplant recipients, acute febrile illness is usually a source of grave concern and a diagnostic dilemma, especially if no response is noted after initiation of broad antimicrobial therapy. Human Monocytic Ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffeensis and is not considered an opportunistic infection in immunocompromised patients such as solid organ transplant patients. Ehrlichiosis in immunocompromised patients can be life-threatening, and a strong index of suspicion is needed, especially in patients who live in endemic areas, for proper treatment initiation with doxycycline. We report a case of a 40-year-old male who received an orthotopic liver transplant six months earlier secondary to primary sclerosing cholangitis, on chronic immunosuppressive medication, who presented with complaints of sudden onset fever associated with nausea, vomiting, and diarrhea. Initial extensive infectious workup was negative and no response to empiric antimicrobials. There was suspicion for ehrlichiosis prompting empiric doxycycline use. Subsequently, E. chaffeensis polymerase chain reaction (PCR) was positive, and the antibiotic regimen was de-escalated to only doxycycline with complete resolution of his symptoms and progressive improvement in previously abnormal biochemical indices.

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