scholarly journals Post-Transplant Diarrhea is Associated with Increased Rejection in Lung Transplant Recipients: A Retrospective Review

2020 ◽  
Author(s):  
Aruj Choudhry ◽  
Alexandera Selby ◽  
Padma Chamarthy ◽  
Emily Friedman ◽  
Navneet Goraya ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Lung Transplant ◽  
Tertiary Care ◽  
Graft Function ◽  
Organ Transplant ◽  
Solid Organ ◽  
Care Hospital ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Increased Risk

Abstract Background: Diarrhea causes significant morbidity among solid organ transplant recipients. It is well described in liver and kidney transplant recipients, yet data among lung transplant (LTx) recipients is lacking. The primary aim of this study was to characterize diarrhea in LTx recipients. Methods: A retrospective review was performed for all patients undergoing LTx at our tertiary care hospital between 01/2011 and 02/2019. Patient demographics, type of LTx, and transplant indication were noted. Electronic medical records (EMR) were reviewed for the development of diarrhea (defined by clinical assessment and after obtaining diagnostic studies). Clostridiodes difficile infection (CDI) was determined by PCR testing. LTx rejection was determined by board-certified Pulmonologists as documented in the EMR. Results: A total of 564 patients (66.3% male, mean age 64.4 ± 8.8 years) underwent LTx during the 8-year study period, with 289 patients (51.2%) experiencing post-LTx diarrhea. The most commonly identified etiologies of diarrhea were medication-induced (33.6%) and CDI (15.6%). Among patients with medication-induced diarrhea, mycophenolate mofetil (MMF) was the most common offending agent (33.3%). Diarrhea and age were significantly associated with increased LTx rejection rates in multivariate analysis (Diarrhea OR=2.26, 95% CI=1.48-3.45; Age OR=0.98, 95% CI=0.95-1.0).Conclusions: Diarrhea is common in LTx recipients, with medication-induced diarrhea being the most common etiology. Diarrhea and younger age were associated with an increased risk of LTx rejection. Recognizing the causes of diarrhea in LTx recipients is important for early diagnosis and treatment, leading to greater quality of life and improved graft function.

scholarly journals Post-Transplant Diarrhea is Associated with Increased Rejection in Lung Transplant Recipients: A Retrospective Review

2021 ◽  
Author(s):  
Aruj Choudhry ◽  
Andrew Leopold ◽  
Alexandra Selby ◽  
Padma Chamarthy ◽  
Emily Friedman ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Lung Transplant ◽  
Tertiary Care ◽  
Graft Function ◽  
Organ Transplant ◽  
Solid Organ ◽  
Care Hospital ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Increased Risk

Abstract Background Diarrhea causes significant morbidity among solid organ transplant recipients. It is described in liver and kidney transplant recipients, but not in lung transplant (LTx) recipients. The primary aim of this study was to characterize diarrhea in LTx recipients. Methods Retrospective review was performed for all patients undergoing LTx at our tertiary care hospital between 01/2011 and 02/2019. Electronic medical records were reviewed for the development of diarrhea. Results A total of 564 patients (66.3% male, mean age 64.4 ± 8.8 years) underwent LTx during the 8-year study period, with 289 patients (51.2%) experiencing post-LTx diarrhea. The most common etiologies of diarrhea were medication-induced (33.6%) and CDI (15.6%). Mycophenolate mofetil (MMF) was the most common cause of medication induced diarrhea (33.3%). Diarrhea and age were significantly associated with increased LTx rejection rates in multivariate analysis (Diarrhea OR = 2.26, 95% CI = 1.48–3.45; Age OR = 0.98, 95% CI = 0.95-1.0). Conclusions Diarrhea is common in LTx recipients, with medication-induced diarrhea being the most common etiology. Diarrhea and younger age were associated with an increased risk of LTx rejection. Recognizing the causes of diarrhea in LTx recipients is important for early diagnosis and treatment, leading to greater quality of life and improved graft function.

Skin Cancers and Lung Transplant

2021 ◽  
Vol 42 (03) ◽  
pp. 483-496
Author(s):  
Reason Wilken ◽  
John Carucci ◽  
Mary L. Stevenson
Keyword(s):  
Cell Carcinoma ◽  
Lung Transplant ◽  
Radiation Treatment ◽  
Organ Transplant ◽  
Adjuvant Radiation ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Skin Cancers ◽  
Increased Risk

AbstractIt is well known that solid-organ transplant recipients (SOTRs) have a 65- to 100-fold increase in the risk of developing skin cancer, namely, nonmelanoma skin cancers (NMSCs) such as cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC). In addition, these patients are also at increased risk for development of melanoma as well as other less common cutaneous malignancies (Merkel's cell carcinoma, Kaposi's sarcoma). SOTRs with NMSC (namely cSCC) are also at significantly increased risk of poor clinical outcomes including local recurrence, nodal and distant metastasis, and disease-specific death relative to patients who are not immunosuppressed. Increased surveillance and monitoring in patients at risk of aggressive disease and poor outcomes who are on immunosuppression is essential in patients with lung transplants given the high degree of immunosuppression. Increased awareness of risks, treatments, and management allows for improved outcomes in these patients. This article will provide an overview of the risk factors for the development of cutaneous malignancies in organ transplant recipients as well as a detailed discussion of various immunosuppressant and prophylactic medications used in this patient population that contribute to the risk of developing cutaneous malignancies, with an emphasis on NMSC (cSCC and BCC) in lung transplant recipients. Finally, this article includes a discussion on the clinical and dermatologic management of this high-risk immunosuppressed population including a review of topical and systemic agents for field therapy of actinic damage and chemoprevention of keratinocyte carcinomas. In addition, indications for additional treatment and preventive measures such as adjuvant radiation treatment after surgical management of cutaneous malignancies and potential modification of immunosuppressive medication regimens are discussed.

scholarly journals Combination checkpoint blockade for metastatic cutaneous malignancies in kidney transplant recipients

2020 ◽  
Vol 8 (1) ◽  
pp. e000908 ◽  
Author(s):  
Megan H Trager ◽  
Shana M Coley ◽  
Geoffrey Dube ◽  
Shaheer Khan ◽  
Matthew Ingham ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Function ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Cutaneous Squamous Cell Carcinoma ◽  
Solid Organ ◽  
Combination Immunotherapy ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Solid Organ Transplant Recipients

BackgroundImmune checkpoint blockade has emerged as a highly effective treatment for patients with metastatic melanoma and cutaneous squamous cell carcinoma. Nivolumab blocks the interactions between programmed cell death protein 1 and programmed death ligand 1 allowing for activation of a latent immune response against the malignancy. Ipilimumab binds to and blocks cytotoxic T-lymphocyte-associated protein 4, alleviating the negative regulation of T-cell activation that is mediated by that checkpoint. Combination therapy with nivolumab and ipilimumab is associated with longer overall survival at 5 years compared with nivolumab monotherapy. Solid organ transplant recipients have a significantly higher risk of malignancies compared with the general population. There is limited data surrounding the efficacy of combination immunotherapy in solid organ transplant recipients, as these patients were excluded from seminal trials due to risk of organ rejection.Case presentationsHere we present four cases of combination immunotherapy in kidney transplant recipients. Three patients had metastatic melanoma, and one patient had metastatic cutaneous squamous cell carcinoma. Two patients had radiographic responses from immunotherapy, one patient had stable disease, and one patient had disease progression. Only one patient had biopsy-proven rejection. At last follow-up, three patients had functioning grafts, though one required hemodialysis after treatment, and one patient succumbed to disease, but graft function remained intact throughout her course.ConclusionsThese cases describe the use of ipilimumab and nivolumab combination immunotherapy for cutaneous malignancies in kidney transplant recipients. They highlight the potential to preserve kidney graft function while effectively treating the disease.Trial Registration numberNCT03816332.

scholarly journals Epidemiology of Cryptococcosis and Cryptococcal Meningitis in a Large Retrospective Cohort of Patients After Solid Organ Transplantation

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Ige A. George ◽  
Carlos A. Q. Santos ◽  
Margaret A. Olsen ◽  
William G. Powderly
Keyword(s):  
Kidney Transplant ◽  
Median Time ◽  
Lung Transplant ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Risk Of Death ◽  
Increased Risk ◽  
Lung Transplant Recipients

Abstract Background Cryptococcosis is the third most common invasive fungal infection in solid organ transplant (SOT) recipients. There are no nationally representative data describing the incidence, risk factors, and outcomes of cryptococcosis after SOT. Methods We assembled a large cohort of adult SOT recipients using Classification of Diseases, Ninth Revision, Clinical Modification billing data from Healthcare Cost and Utilization Project State Inpatient Databases of Florida (2006–2012), New York (2006–2011), and California (2004–2010). Demographics, comorbidities, death, and cryptococcal infections coded during hospitalization were identified. Results A total of 42634 adults with SOT were identified during the study period. Cryptococcal disease was identified in 0.37% (n = 158), 44% of which had meningitis (n = 69). Median time to diagnosis of cryptococcosis was 464 days (range, 4–2393). The median time to onset of cryptococcosis was earlier for lung (191 days; range, 7.5–1816), heart (195 days; range, 4–1061), and liver (200 days; range, 4–1581) compared with kidney transplant recipients (616 days; range, 12–2393; P < .001, log rank test). Very early-onset disease (<30 days after transplantation) more frequently occurred in liver and lung transplant recipients. Lung transplant recipients had the highest risk of cryptococcosis (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.21–3.60). Cryptococcosis was associated with death (HR, 2.29; 95% CI, 1.68–3.11), after adjusting for age, type of SOT, and other comorbidities. Conclusions Cryptococcosis is rare after SOT, but it is associated with significantly increased risk of death. Lung transplant recipients are at highest risk for cryptococcosis among SOTs. Nonkidney transplants have earlier onset of cryptococcosis and higher risk of death compared with kidney transplant recipients.

Metabolic Complications and Kidney Transplantation: Focus on Glycaemia and Dyslipidaemia

2020 ◽  
Vol 18 (3) ◽  
pp. 273-281 ◽  
Author(s):  
Panagiotis Anagnostis ◽  
Stavroula Α. Paschou ◽  
Eleftherios Spartalis ◽  
Gerardo Sarno ◽  
Paride De Rosa ◽  
...  
Keyword(s):  
Graft Function ◽  
Current Data ◽  
Optimal Management ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cvd Risk ◽  
Oral Hypoglycaemic Agents ◽  
Metabolic Complications ◽  
Increased Risk ◽  
Regimen Modification

Post-transplant diabetes mellitus (PTDM) and dyslipidaemia are the most common metabolic complications in kidney transplant recipients (KTR). They are associated with a higher risk of lower graft function and survival, as well as an increased risk of cardiovascular disease (CVD). The aim of this review is to provide current data on the epidemiology, pathophysiology and optimal management of these two principal metabolic complications in KTR. Several risk factors in this metabolic milieu are either already present or emerge after renal transplantation, such as those due to immunosuppressive therapy. However, the exact pathogenic mechanisms have not been fully elucidated. Awareness of these disorders is crucial to estimate CVD risk in KTR and optimize screening and therapeutic strategies. These include lifestyle (preferably according to the Mediterranean pattern) and immunosuppressive regimen modification, as well as the best available anti-diabetic (insulin or oral hypoglycaemic agents) and hypolipidaemic (e.g. statins) regimen according to an individual’s metabolic profile and medical history.

scholarly journals Angiogenesis Inhibitors as Anti-Cancer Therapy Following Renal Transplantation: A Case Report and Review of the Literature

2021 ◽  
Vol 28 (1) ◽  
pp. 661-670
Author(s):  
Lawrence Kasherman ◽  
Jeffrey Doi ◽  
Katherine Karakasis ◽  
Jeffrey Schiff ◽  
Abhijat Kitchlu ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Organ Transplant ◽  
Angiogenesis Inhibitors ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Immunosuppressive Medication ◽  
Increased Risk ◽  
Anti Cancer ◽  
Solid Organ Transplant Recipients

Solid organ transplant recipients on long-term immunosuppressive medication are at increased risk of developing malignancy, and treatment of advanced cancers with angiogenesis inhibitors in this context has not been widely studied. We present a case of recurrent high-grade serous ovarian carcinoma treated with paclitaxel and bevacizumab in the context of prior renal transplantation where the patient responded well to treatment with controlled toxicities, discussing the potential for increased rates of adverse events and drug interactions in this select population.

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 Humoral Immune Response to SARS-CoV-2 Vaccination after a Booster Vaccine Dose in Two Kidney Transplant Recipients with Fabry Disease and Variable Secondary Immunosuppressive Regimens

Vaccines ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1412
Author(s):  
Lavinia Bernea ◽  
Oana R. Ailioaie ◽  
Nadine Benhamouda ◽  
Eric Tartour ◽  
Dominique P. Germain
Keyword(s):  
Fabry Disease ◽  
Organ Transplant ◽  
Vaccine Dose ◽  
Original Strain ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Success Rates ◽  
Kidney Transplant Recipients ◽  
Protection Measures ◽  
Renal Graft

The urgent need to fight the COVID-19 pandemic has accelerated the development of vaccines against SARS-CoV-2 and approval processes. Initial analysis of two-dose regimens with mRNA vaccines reported up to 95% efficacy against the original strain of the SARS-CoV-2 virus. Challenges arose with the appearance of new strains of the virus, and reports that solid organ transplant recipients may have reduced vaccination success rates after a two-dose mRNA vaccination regimen encouraged health authorities to recommend a booster in immunocompromised patients. Fabry disease is an X-linked inherited lysosomal disorder, which may lead to chronic end-stage renal disease. We report on two patients with advanced Fabry disease, renal graft and adjunctive immunosuppressive therapies who exhibited variable humoral vaccination-related immune responses against SARS-CoV-2 after three vaccine doses. The first patient developed mild COVID-19 infection, while the second patient did not seroconvert after three shots of an mRNA vaccine. Both cases emphasize that patients with Fabry disease and renal graft are susceptible to develop a weak response to COVID-19 vaccination and highlight the importance of maintaining barrier protection measures. Vaccination of family members should be encouraged to lower the risk of viral transmission to immunocompromised, transplanted patients, including vaccinated ones.

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.

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