scholarly journals Long-Term Infectious Complications of Kidney Transplantation

2021 ◽  
pp. CJN.15971020
Author(s):  
Akansha Agrawal ◽  
Michael G. Ison ◽  
Lara Danziger-Isakov
Keyword(s):  
Opportunistic Infections ◽  
Fungal Infections ◽  
Solid Organ Transplantation ◽  
Infectious Complications ◽  
Solid Organ ◽  
Post Transplant ◽  
Barr Virus ◽  
Clostridioides Difficile ◽  
Epstein Barr ◽  
Tract Infections

Infections remain a common complication of solid-organ transplantation. Most infections in the first month after transplant are typically health care–associated infections, whereas late infections, beyond 6–12 months, are community-acquired infections. Opportunistic infections most frequently present in the first 12 months post-transplant and can be modulated on prior exposures and use of prophylaxis. In this review, we summarize the current epidemiology of postkidney transplant infections with a focus on key viral (BK polyomavirus, cytomegalovirus, Epstein-Barr virus, and norovirus), bacterial (urinary tract infections and Clostridioides difficile colitis), and fungal infections. Current guidelines for safe living post-transplant are also summarized. Literature supporting prophylaxis and vaccination is also provided.

scholarly journals Analysis of Post-Transplant Lymphoproliferative Disorder (PTLD) Outcomes with Epstein–Barr Virus (EBV) Assessments—A Single Tertiary Referral Center Experience and Review of Literature

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 899
Author(s):  
Eric Lau ◽  
Justin Tyler Moyers ◽  
Billy Chen Wang ◽  
Il Seok Daniel Jeong ◽  
Joanne Lee ◽  
...  
Keyword(s):  
Epstein Barr Virus ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Allogeneic Bone ◽  
Hematopoietic Stem ◽  
Tertiary Referral Center ◽  
Post Transplant ◽  
Barr Virus ◽  
Significant Difference ◽  
Epstein Barr

Post-transplant lymphoproliferative disorders (PTLDs) are lymphoid or plasmacytic proliferations ranging from polyclonal reactive proliferations to overt lymphomas that develop as consequence of immunosuppression in recipients of solid organ transplantation (SOT) or allogeneic bone marrow/hematopoietic stem cell transplantation. Immunosuppression and Epstein–Barr virus (EBV) infection are known risk factors for PTLD. Patients with documented histopathologic diagnosis of primary PTLD at our institution between January 2000 and October 2019 were studied. Sixty-six patients with PTLD following SOT were followed for a median of 9.0 years. The overall median time from transplant to PTLD diagnosis was 5.5 years, with infant transplants showing the longest time to diagnosis at 12.0 years, compared to pediatric and adolescent transplants at 4.0 years and adult transplants at 4.5 years. The median overall survival (OS) was 19.0 years. In the monomorphic diffuse large B-cell (M-DLBCL-PTLD) subtype, median OS was 10.7 years, while median OS for polymorphic subtype was not yet reached. There was no significant difference in OS in patients with M-DLBCL-PTLD stratified by quantitative EBV viral load over and under 100,000 copies/mL at time of diagnosis, although there was a trend towards worse prognosis in those with higher copies.

EBV-negative post-transplant lymphoproliferative disorder: Clinical characteristics, response to therapy, and survival.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 8578-8578
Author(s):  
Daniel S. Heil ◽  
Marlise Rachael Luskin ◽  
Edward Allen Stadtmauer ◽  
Stephen J. Schuster ◽  
Donald Edward Tsai ◽  
...  
Keyword(s):  
Lymphoproliferative Disorder ◽  
Survival Rates ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Response Rates ◽  
Response To Therapy ◽  
Solid Organ ◽  
Post Transplant ◽  
Barr Virus ◽  
Epstein Barr

8578 Background: Post-transplant lymphoproliferative disorder (PTLD) is a potentially life-threatening complication of solid organ transplantation. PTLD is frequently linked with Epstein-Barr virus (EBV) and it was suggested that EBV negativity is associated with a poor prognosis and lack of response to reduction of immunosuppression (RI). We conducted a case-control study to identify the characteristics, outcome and response to therapy of EBVpos and EBVneg PTLD over a 20-year period. Methods: We reviewed data on patients diagnosed with PTLD at U. Penn. between 1982 and 2012. We determined EBV positivity on tumor samples according to WHO criteria. We compared clinical and pathologic characteristics, response to therapy, and survival of EBVpos and EBVneg patients. Results: Of 222 patients diagnosed with PTLD, we verified the EBV status of 169 patients, of whom 35% were EBVneg and 65% were EBVpos. Mean follow-up was 46.7 months. Median time from transplant to PTLD was 23.1 mo. in EBVpos vs. 59.3 mo. in EBVneg (p=0.003) with 42% of EBVpos patients being diagnosed within the first year after transplant vs. 15% in the EBVneg group (p<0.001). EBVneg PTLD was more likely to occur in non-thoracic vs. thoracic transplants (p=0.006). 28% of patients with EBVpos PTLD presented with disease originating from the graft vs. 14% in the EBVneg group (p=0.03). In terms of histology, 36% of EBVpos patients had polymorphic PTLD vs. 7% of EBVneg patients (p<0.001). Of patients who were treated with RI alone (40% of patients in both groups), the overall response rates were 50% and 48% in EBVpos and EBVneg patients respectively (p=NS). Response rates to rituximab were also similar. There was no difference in the mortality risk between groups (HR=1.04; p=0.84). The 5-year survival rates were 47% and 51% in EBVpos and EBVneg PTLD respectively (p=NS). Conclusions: In a large single-center series, EBVneg PTLD was associated with late occurrence after transplant, monomorphic histology and similar outcome in comparison with EBVpos PTLD. Importantly, the response of EBVneg PTLD to RI and rituximab was no different than EBVpos PTLD. These results have implications for the management of solid organ transplant recipients with PTLD.

scholarly journals How I treat EBV lymphoproliferation

Blood ◽  
2009 ◽  
Vol 114 (19) ◽  
pp. 4002-4008 ◽  
Author(s):  
Helen E. Heslop
Keyword(s):  
B Cells ◽  
Cytotoxic T Lymphocyte ◽  
Cytotoxic T Cells ◽  
Treatment Options ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Hematopoietic Stem ◽  
Serial Measurement ◽  
Barr Virus ◽  
Epstein Barr

Abstract Epstein-Barr virus (EBV)–associated B-cell lymphoproliferation is a life-threatening complication after hematopoietic stem cell or solid organ transplantation resulting from outgrowth of EBV-infected B cells that would normally be controlled by EBV-cytotoxic T cells. During the past decade, early detection strategies, such as serial measurement of EBV-DNA load in peripheral blood samples, have helped to identify high-risk patients and to diagnose early lymphoproliferation. Treatment options include manipulation of the balance between outgrowing EBV-infected B cells and the EBV cytotoxic T lymphocyte response and targeting the B cells with monoclonal antibodies or chemotherapy. Major challenges remain for defining indications for preemptive therapies and integrating novel and conventional therapies.

scholarly journals Diagnosis of a plasmoblastic lymphoma of the mandible after renal transplantation: a case report

2021 ◽  
Vol 27 (4) ◽  
pp. 46
Author(s):  
Inès Legeard ◽  
Marc-Antoine Chevrollier ◽  
Gérard Bader
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Renal Transplantation ◽  
Epstein Barr Virus ◽  
Solid Organ ◽  
Post Transplant ◽  
Barr Virus ◽  
Non Hodgkin Lymphoma ◽  
Epstein Barr

Introduction: Post-transplant lymphoproliferations (PTL) are a severe complication of solid organ transplants. Their locations can be extra-nodal. Observation: The diagnosis and management of a non-Hodgkin's plasmablastic lymphoma of mandibular localization affecting a 66-year-old kidney transplanted patient are reported here. Comment: The main risk factors for non-Hodgkin lymphoma are immunosuppression and infection with Epstein-Barr virus. Clinical and radiographic examinations, which are not specific, must be supplemented by a histological examination. Treatment which is not consensual will most often consist of a reduction in immunosuppression coupled with chemotherapy. Conclusion: Despite a constant evolution in the incidence and clinical picture of post-transplant lymphomas, the role of the dentist remains essential in the early detection of lesions.

scholarly journals Epstein-Barr Virus–Positive Posttransplant Lymphoproliferative Disease After Solid Organ Transplantation

2016 ◽  
Vol 2 (1) ◽  
pp. e48 ◽  
Author(s):  
Marieke L. Nijland ◽  
Marie José Kersten ◽  
Steven T. Pals ◽  
Frederike J. Bemelman ◽  
Ineke J.M. ten Berge
Keyword(s):  
Organ Transplantation ◽  
Epstein Barr Virus ◽  
Solid Organ Transplantation ◽  
Lymphoproliferative Disease ◽  
Solid Organ ◽  
Barr Virus ◽  
Posttransplant Lymphoproliferative Disease ◽  
Epstein Barr

Case 38

2020 ◽  
pp. 261-266
Author(s):  
Andrew Woodhouse
Keyword(s):  
B Cells ◽  
T Lymphocytes ◽  
Lymphoproliferative Disease ◽  
Solid Organ ◽  
Post Transplant ◽  
Barr Virus ◽  
Cd20 Antibody ◽  
Epstein Barr ◽  
Anti Cd20 ◽  
Lymphoid Proliferation

Post-transplant lymphoproliferative disease (PTLD) is a disorder of lymphoid proliferation seen in recipients of solid organ or haematopoietic transplants as a consequence of immunosuppression. A spectrum of disease is recognized ranging from non-malignant polyclonal proliferation of B cells to monoclonal proliferation of B or T lymphocytes which have features in common with lymphomas. Epstein–Barr virus (EBV) is associated with a majority of cases although it is not a universal feature. Treatment with anti-CD20 antibody in addition to reduction in immunosuppression has become the most common treatment approach.

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