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

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.

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New-Onset Diabetes after Transplant (NODAT)

Kathmandu University Medical Journal ◽

10.3126/kumj.v12i4.13740 ◽

2015 ◽

Vol 12 (4) ◽

pp. 301-305 ◽

Cited By ~ 1

Author(s):

R Maskey

Keyword(s):

Graft Loss ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Onset Diabetes ◽

Definition Of ◽

Liver Transplant Recipients ◽

New Onset

New onset diabetes mellitus after transplantation (NODAT) is a well known complication following solid organ transplantation and has been reported to occur in 4% to 25% of renal transplant recipients, 2.5% to 25% of liver transplant recipients, hepatitis C virus (HCV) infection between 40% and 60% and 2% to 53% of all solid organ transplants. This variation in the reported incidence may be because of lack of a universal agreement on the definition of NODAT, the duration of follow-up, and the presence of modifiable and non-modifiable risks factors. Moreover, reduced patient survival and accelerated graft loss have been reported with NODAT. In our country also there is increasing in number of kidney transplants patients and along with that there is chance of development of NODA. It is better to detect the NODATS early. So in this article I tried to presents an overview of the literature on the current diagnostic criteria for NODAT and discuss suggested risk factors for the development of NODAT, its potential pathogenic mechanisms, and its impact on post-transplant outcomes after solid organ transplantation.Kathmandu University Medical Journal Vol.12(4) 2014; 301-305

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Infections in the solid-organ transplant recipients

Ukrainian Journal of Nephrology and Dialysis ◽

10.31450/ukrjnd.2(70).2021.08 ◽

2021 ◽

pp. 64-76

Author(s):

Manal El Said

Keyword(s):

Solid Organ Transplantation ◽

Organ Transplant ◽

Organ Donor ◽

Solid Organ Transplant ◽

Molecular Techniques ◽

Solid Organ ◽

Transplant Recipients ◽

Antimicrobial Drugs ◽

Organ Transplant Recipients ◽

Solid Organ Transplant Recipients

The advancement in the field of transplant has led to the increasing number of solid-organ transplant recipients (SOTRs). This success leads to novel confronts in communicable infections, which are compound by the emergence of newly contagious and antimicrobial drugs resistant microorganisms. The prevention of infections is a cornerstone of any modern solid organ transplantation program. Understanding the fundamentals of these infections with early detection is crucial for improving the outcomes of such patients and lowers the probable extra complications. The probability of critical infections in SOTRs is established by relations between the patient’s epidemiological exposures and the net condition of immune repression. A timeline was formed to build up a discrepancy diagnosis of infection in SORTs. The improvement in screening, the investigations including imaging and molecular techniques and prophylactic intervention protocols, has made it promising to limit the penalty of infections and act towards better patient endurance. Pre-transplant screening of the prospective organ donor and recipient provides a chance to evaluate the viability and wellbeing of transplantation, to decide the prophylaxis and protective approaches developed post-transplant, to find out and entirely treat active infection in the possible recipient proceeding to transplant, to renovate the vaccination condition of the potential recipient.

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P1685POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDER (PTLD): SINGLE INSTITUTIONAL EXPERIENCE OF TWO DECADES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1685 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Inês Coelho ◽

Sofia Cerqueira ◽

Catarina Romãozinho ◽

Luís Rodrigues ◽

Rita Leal ◽

...

Keyword(s):

Renal Transplant ◽

Central Nervous System Involvement ◽

B Cell Lymphoma ◽

Early Investigation ◽

Solid Organ ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Hematopoietic Stem ◽

Significant Difference

Abstract Background and Aims Post-transplant lymphoproliferative disorders (PTLD) are a group of heterogeneous lymphoid proliferations in chronic immunosuppressed recipients of solid organ and hematopoietic stem cell transplantation. Due to rarity of this disease, retrospective studies from transplant centers have been the main source to provide knowledge and treatment guidelines, which are still in evolution. This study examined the clinical outcomes and identified the predictors of mortality in adult renal transplant recipients who developed PTLD. Method We have studied the incidence of PTLD in adult renal transplant recipients who were transplanted in our hospital from 1996 to 2019. Data was collected for demographics, transplant and immunosuppression history, EBV and CMV serostatus, diagnosis, treatment and outcomes of PTLD. We performed univariate and multivariate analysis to identify prognostic factors. PTLD was classified according to 2018 WHO lymphoma classification. Results Twenty-four patients (12 males and 12 females) were eligible for the analysis. Mean age at time of the transplant was 43.1 ± 16.9 years, with a time between grafting and PTLD of 66 months (IQR 36-98 months). Mean follow-up time was 87 months (IQR 61-117 months). 25% of patients received a living donor renal transplant. 12,5% of patients received induction therapy with thymoglobulin. Mean age at time of PTLD diagnosis was 48,8 ± 17,9 years. Five cases were from Epstein-Barr virus (EBV) mismatched (D+/R-) transplants and there was seroconversion at time of PTLD diagnosis. 25% of patients had central nervous system involvement. 19 patients have monomorphic PTLD and the most common histological diagnosis was diffuse large B cell lymphoma. We identified that age >30 years at time of the transplant was predictor of mortality (HR 33.01; 95% CI: 3.24-336.14; p=0.003). Surprisingly, presence of B symptoms at time of PTLD diagnosis confer a better prognosis (HR 0,143; 95% CI: 0,035-0,579; p=0.006). All cases were managed with reduction in immunosuppression and converted to everolimus. 8 patients were treated with rituximab and there was no significant difference in the survival of these patients. By the end of follow-up, 7 patients went into remission, 1 returned to chronic dialysis, and 16 patients died (15 of them due to the disease). Mean time between PTLD and death was 3 months (IQR 1-6 months). Conclusion PTLD is an infrequent disease with a poor prognosis in renal transplant patients. Some cases have a close relationship with EBV, but it can also develop in the absence of the classical risk factors. The factor affecting mortality in our population was age >30 years at time of the transplant. Presence of B symptoms at time of PTLD diagnosis seems to confer a better prognosis probably due to early investigation and diagnosis of the disease.

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Lung Cancer in Renal Transplant Recipients

BANTAO Journal ◽

10.1515/bj-2016-0004 ◽

2016 ◽

Vol 14 (1) ◽

pp. 17-19

Author(s):

Mirela Jozicic ◽

Alen Imsirovic ◽

Lea Katalinic ◽

Branimir Krtalic ◽

Nikolina Basic Jukic

Keyword(s):

Lung Cancer ◽

Renal Transplant ◽

Graft Function ◽

Solid Organ Transplantation ◽

Significant Risk ◽

Sarcomatoid Carcinoma ◽

Smoking History ◽

Solid Organ ◽

Renal Transplant Recipients ◽

Transplant Recipients

AbstractIntroduction. Although the incidence of malignancy has increased after solid organ transplantation, data on lung cancer in this group of patients is scarce. The aim of this study was to determine clinical characteristics and outcome of patients who developed lung cancer after renal transplantation. Methods. Among a cohort of 1658 patients who received a transplant at our institution and were followedup between 1973 and 2014, five patients developed lung cancer. We analyzed risk factors, transplantation characteristics, treatment options and survival. Results. Lung cancer was diagnosed in 5 patients (0.3%). Time to diagnosis after the transplant procedure ranged from 26 to 156 months (mean 115 months). All of them had a smoking history. Tumors were classified as IIB (20%), IIIA (40%), and IV (40%). Histological types included adenocarcinoma (80%) and there was one case of sarcomatoid carcinoma (20%). One patient had concomitant thyroid papillary carcinoma. Radiotherapy was applied in 2 patients, 2 underwent chemotherapy (erlotinib and combination of carboplatinum and etopozide in one patient each), and 2 died within one month after the diagnosis from disseminated malignant disease. Patients with stage IIIA survived 14 and 24 months after the diagnosis. The patient with sarcomatoid cancer underwent thoracotomy with a complete resection, lost his graft function and died 7 months after the diagnosis. Conclusion. Lung cancer is relatively rare malignancy in renal transplant recipients, but associated with high mortality. Smoking is a significant risk factor, thus smoking cessation should be promoted among renal transplant recipients, as well as regular screening for lung cancer.

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933. Incidence and Risk Factors for Cytomegalovirus Infection in Intestinal Transplant Recipients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1128 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S559-S559

Author(s):

Anmary A Fernandez ◽

Jacques Simkins ◽

Eric Martin ◽

Shweta Anjan ◽

Jennifer Garcia ◽

...

Keyword(s):

Risk Factors ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Transplant Recipients ◽

Cmv Infection ◽

Younger Age ◽

Peak Viral Load ◽

One Year ◽

Intestinal Transplant

Abstract Background Cytomegalovirus (CMV) infection is the most common infection after solid organ transplantation. Data on CMV infection in intestinal transplant recipients is limited. Methods This is a single-center retrospective cohort study which includes all consecutive intestinal transplant recipients who were transplanted between 2009 and 2019. We excluded recipients that showed CMV seronegativity of both donor and recipient. We also excluded those patients who did not have more than 3 months of follow-up. Univariate and multivariate analyses were performed to identify the risk factors for CMV infection. Of note, at our center CMV prophylaxis in intestinal transplant recipients is one year of valganciclovir. Results A total of 173 recipients were transplanted; 46 recipients were because of CMV serostatus and 32 due to short follow-up. Ninety-five recipients were included finally. The characteristics of our cohort are summarized in Table 1. Of note, the median age was 32 years [range 0-67] and 44 (46.3%) were male. Eighteen (18.9%) recipients needed to stop valganciclovir prophylaxis due to the side effect, especially cytopenia. Twenty-one recipients developed CMV infection including asymptomatic viremia (12/21, 57.1%), CMV syndrome (5/21, 23.8%) and end-organ disease (2 (9.5%) pneumonitis and 2 (9.5%) colitis) at median time of 155 [Interquartile range, IQR 28-254] days from transplant. The median peak viral load and time to negativity were 16000 [IQR 1500-43892] IU/ml and 56 [IQR 49-109] days, respectively. Younger age (p=0.007, Odds ratio 1.03, 95% confidence interval 1.003-1.055) was the independent factor associated with CMV infection. Conclusion Despite prolonged prophylaxis, 21 (22.1%) of intestinal transplant recipients developed CMV infection around 5 months post-transplant. This may be because they cannot tolerate valganciclovir prophylaxis and early termination was required. Further strategy should be developed to prevent CMV infection in this vulnerable population. Disclosures All Authors: No reported disclosures

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Gut Microbiome Dysbiosis is Associated with Increased Mortality following Solid Organ Transplantation

10.21203/rs.3.rs-185980/v1 ◽

2021 ◽

Author(s):

Rinse Weersma ◽

J. Casper Swarte ◽

Yanni Li ◽

Shixian Hu ◽

Johannes Björk ◽

...

Keyword(s):

Organ Transplantation ◽

Virulence Factors ◽

Gut Microbiome ◽

Metabolic Pathways ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Cell Transplant ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Post Transplantation

Abstract Organ transplantation is a life-saving treatment for patients with end-stage disease, but survival post-transplantation varies considerably. There is now increasing evidence that the gut microbiome is linked to the survival of hematopoietic cell transplant patients, yet little is known about the role of the gut microbiome in solid organ transplantation. We analyzed 1,370 fecal samples from liver and renal transplant recipients using shotgun metagenomic sequencing to assess microbial taxonomy, metabolic pathways, antibiotic resistance genes and virulence factors. To quantify taxonomic and metabolic dysbiosis, we analyzed 1,183 age-, sex- and BMI-matched subjects from the same population. A subset of patients were also followed longitudinally from pre- to post-transplantation. Our data show that transplant recipients suffer from gut dysbiosis—including lower microbial diversity, increased abundance of unhealthy microbial species, decreased abundance of important metabolic pathways, and increased prevalence and diversity of antibiotic resistant genes and virulence factors—that persist up to 20 years post-transplantation. Finally, we demonstrate that the use of immunosuppressive drugs is significantly associated with the observed dysbiosis and that the extent of dysbiosis is associated with increased post-transplant mortality.

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

Current Pharmaceutical Design ◽

10.2174/1381612826666200531152901 ◽

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.

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Comparison of Three Cellular Assays to Predict the Course of CMV Infection in Liver Transplant Recipients

Vaccines ◽

10.3390/vaccines9020088 ◽

2021 ◽

Vol 9 (2) ◽

pp. 88

Author(s):

Smaranda Gliga ◽

Melanie Fiedler ◽

Theresa Dornieden ◽

Anne Achterfeld ◽

Andreas Paul ◽

...

Keyword(s):

Liver Transplant ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Transplant Recipients ◽

Cmv Infection ◽

Cellular Assays ◽

Risk Patients ◽

Ifn Γ ◽

Liver Transplant Recipients

To estimate protection from cytomegalovirus (CMV) replication after solid organ transplantation, CMV serology has been considered insufficient and thus CMV immunity is increasingly assessed by cellular in vitro methods. We compared two commercially available IFN-γ ELISpot assays (T-Track CMV and T-SPOT.CMV) and an IFN-γ ELISA (QuantiFERON-CMV). Currently, there is no study comparing these three assays. The assays were performed in 56 liver transplant recipients at the end of antiviral prophylaxis and one month thereafter. In CMV high- or intermediate-risk patients the two ELISpot assays showed significant correlation (p < 0.0001, r > 0.6) but the correlation of the ELISpot assays with QuantiFERON-CMV was weaker. Results of both ELISpot assays were similarly predictive of protection from CMV-DNAemia ≥500 copies/mL [CMV pp65 T-SPOT.CMV at the end of prophylaxis: area under curve (AUC) = 0.744, cut-off 142 spot forming units (SFU), sensitivity set to 100%, specificity 46%; CMV IE-1 T-Track CMV at month 1: AUC = 0.762, cut-off 3.5 SFU, sensitivity set to 100%, specificity 59%]. The QuantiFERON-CMV assay was inferior, reaching a specificity of 23% when setting the sensitivity to 100%. In conclusion, both CMV-specific ELISpot assays appear suitable to assess protection from CMV infection/reactivation in liver transplant recipients.

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

Vojnosanitetski pregled ◽

10.2298/vsp1309848i ◽

2013 ◽

Vol 70 (9) ◽

pp. 848-853 ◽

Cited By ~ 1

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.

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Cytomegalovirus in urinary sediment in patients with acute kidney injury

BMC Nephrology ◽

10.1186/s12882-021-02377-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Sahra Pajenda ◽

Sebastian Kapps ◽

Daniela Gerges ◽

Gregor Hoermann ◽

Ludwig Wagner ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Allograft ◽

Quantitative Polymerase Chain Reaction ◽

Rna Extraction ◽

Kidney Injury ◽

Solid Organ ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Urine Sediment ◽

Urinary Sediment

Abstract Background Immunosuppression in solid organ transplantation is associated with frequent infections. Renal allograft recipients are susceptible to opportunistic infections and can acquire human cytomegalovirus (HCMV) infections even within the allograft. There, HCMV can be found in both the glomerulus and tubular cells, but is mostly restricted to specific and circumscribed sites. Therefore, not all organ infections are identifiable by immunohistology for HCMV proteins in fine needle core biopsies. Thus, we performed a urinalysis study to search for HCMV-specific RNA transcripts in the urine sediment of patients with acute kidney injury. Methods Urinary sediment of 90 patients with acute kidney injury (AKI), including 48 renal transplant recipients (RTX) and 42 non-transplant recipients (nRTX), was collected from morning urine for RNA extraction and reverse transcription. The copy number of HCMV transcripts was evaluated using a UL132 HCMV-specific probe set and by real-time quantitative polymerase chain reaction (RT-qPCR). Results Of the 48 RTX patients, ten showed HCMV copies in their urine sediment cells. Within this group, three recipients had negative HCMV serology and received an allograft from an HCMV-seropositive donor. In addition, all three RTX patients on a belatacept-based immunosuppressive regimen had HCMV transcripts in their urine. Of the 42 nRTX patients, only two had detectable HCMV transcripts in urine sediment cells and both were under immunosuppression. Conclusions Ten immunosuppressed renal allograft recipients and two immunosuppressed non-transplant patients with AKI showed HCMV copies in urine sediment. Thus, HCMV positivity in urinary sediment appears to be associated with immunosuppression. This study describes a novel noninvasive method for detection of HCMV in urinary sediment. Whether all HCMV infections can be detected or only those with viral replication warrants further investigation.

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