Cost-effective immunosuppressive options for solid organ transplantation: a guide to lower cost for the renal transplant recipient in the USA

Pulmonary nodules are common following solid organ transplantation and vary in etiology. Nodules with central cavitation are most likely to be of infectious origin in the post-transplant population. A novel presentation of post-transplant lymphoproliferative disorder manifesting as multiple cavitating pulmonary nodules is described. The patient, a 45-year-old female renal transplant recipient, presented with constitutional symptoms and a chest x-ray showing multiple bilateral cavitating lesions. A computed tomography scan confirmed innumerable, randomly dispersed, cavitating nodules in the lung parenchyma. Multiple large hypodense lesions were identified in the liver and spleen. The appearance of the native and transplanted kidneys was normal. A liver biopsy identified an Epstein-Barr virus-negative, diffuse, large B cell lymphoma. Repeat imaging after treatment with a cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone/prednisolone regimen demonstrated dramatic resolution of all lesions. The present case represents a unique radiographic presentation of post-transplant lymphoproliferative disorder not previously reported in the literature.

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Detection of Toxoplasma Gondii Antibodies and DNA Among Renal Transplant Recipient and blood donor in Khartoum State, Sudan

International Journal of Scientific Research in Science and Technology ◽

10.32628/ijsrst218525 ◽

2021 ◽

pp. 135-141

Author(s):

Elghazali Mohammed ◽

Mustafa Yassin ◽

Khalid Anan ◽

Dina N Abdelrahman ◽

Abdelrahim M. ElHussein ◽

...

Keyword(s):

Toxoplasma Gondii ◽

Renal Transplant ◽

Transplant Recipient ◽

Renal Transplant Recipient ◽

Blood Donor ◽

Blood Donors ◽

Solid Organ ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Toxoplasma Gondii Infection

Background and Aim: Toxoplasma gondii infection arises in transplant recipient groups, but at varying frequencies. Reactivation of latent T. gondii infection in transplant patients is uncommon, but does occur. The incidence of reactivation is greater in patient groups receiving more aggressive immunosuppressive therapy. Early diagnosis and treatment should be considered in T. gondii-antibody-positive patients subjected to solid organ transplantation. The aim of this study was to estimate the seroprevalence of Toxoplasma gondii infection in renal transplant recipients in Khartoum, Sudan, using serological and molecular methods. Methods: This was a descriptive cross sectional, hospital based study, blood sample were collected from 108 participants; out of them 58 renal transplant recipient individuals and 50 healthy Blood donor attending Sudanese Kidney Association Hospital and Sudan Heart Center Blood Bank. Demographic data were collected by structured questionnaire. All samples were tested for anti-Toxoplasma IgG and IgM antibodies using ELISA, and PCR for detection of Toxoplasma DNA was performed. Results: The seropositivity of IgG anti-T. gondii antibodies was higher in renal transplant recipients than in blood donors (36.2% vs 32.0%). Anti-toxoplasma IgM was positive in one renal transplant recipient individual (1.70%), and no samples exhibit reactive IgM antibody for blood donors. None of the samples exhibited positivity to T.gondii DNA. Conclusion: the study showed a relatively high seroprevalence of T.gondii antibodies in renal transplant recipients and blood donor volunteers, on the other hand, the prevalence was much higher in the study conducted in pregnant woman in Sudan. Our study highlighted that asymptomatic blood donors, may constitute a significant risk of transmitting toxoplasmosis to susceptible recipients.

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Case Report: Management of a Multidrug-Resistant CMV-Strain in a Renal Transplant Recipient by High-Dose CMV-Specific Immunoglobulins, Modulation in Immunosuppression, and Induction of CMV-Specific Cellular Immunity

Frontiers in Immunology ◽

10.3389/fimmu.2020.623178 ◽

2021 ◽

Vol 11 ◽

Author(s):

Vanessa Wiening ◽

Tina Schmidt ◽

Maximilian Dahmen ◽

Sami Siam ◽

Stefan Reuter ◽

...

Keyword(s):

Case Report ◽

Renal Transplant ◽

Transplant Recipient ◽

Renal Transplant Recipient ◽

Successful Treatment ◽

Cyclosporine A ◽

Antiviral Treatment ◽

Multidrug Resistant ◽

High Dose ◽

Solid Organ

The management of multidrug-resistant strains of cytomegalovirus after solid organ transplantation is challenging. This case report demonstrates the successful treatment of a multidrug-resistant strain of cytomegalovirus that may represent a valuable option for problematic cases. This report illustrates the emergence of a multidrug-resistant cytomegalovirus (CMV) UL54 mutant strain in a renal transplant recipient with severe lymphopenia and thrombocytopenia. We show that the combined treatment with high-dose intravenous cytomegalovirus-specific immunoglobulins (CMV-IVIG) after the switch to a mammalian target of rapamycin (mTOR)-inhibitor and cyclosporine A was a successful treatment alternative to direct antiviral treatment with high-dose ganciclovir and foscarnet. This treatment was associated with a quantitative induction of CMV-specific CD4 and CD8 T cells that showed maturation in phenotype and functionality with decreasing viral load. Our case report illustrates that high-dose CMV-IVIG and conversion of immunosuppressive drugs to mTOR inhibitors and cyclosporine A can be a successful treatment in a situation where the use of direct antiviral drugs was considered insufficient.

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A New Viral Coinfection: SARS-CoV-2 Pneumonia and Cytomegalovirus Pneumonitis in a Renal Transplant Recipient

COVID ◽

10.3390/covid1010010 ◽

2021 ◽

Vol 1 (1) ◽

pp. 115-119

Author(s):

Abdullah S. Shaikh ◽

Hila Shaim ◽

Maria A. Caravedo ◽

Karen M. Ong ◽

David Reynoso

Keyword(s):

Renal Transplant ◽

Transplant Recipient ◽

Renal Transplant Recipient ◽

Severe Disease ◽

Respiratory Illness ◽

Solid Organ ◽

Acute Respiratory Illness ◽

Opportunistic Pathogens ◽

Global Pandemic ◽

Hypoxic Respiratory Failure

SARS-CoV-2 has caused a global pandemic of an acute respiratory illness known as COVID-19. Patients with solid organ transplants receiving chronic immunosuppressive therapy are at risk of severe disease caused by opportunistic pathogens, including cytomegalovirus (CMV). We present the case of a renal transplant recipient presenting with hypoxic respiratory failure because of severe COVID-19, whose course was complicated by ganciclovir-resistant CMV pneumonitis.

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A Case of Trauma-Induced Falciformispora lignatilis Eumycetoma in a Renal Transplant Recipient

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6030144 ◽

2021 ◽

Vol 6 (3) ◽

pp. 144

Author(s):

Maxwell Olenski ◽

Catriona Halliday ◽

James Gullifer ◽

Elena Martinez ◽

Amy Crowe ◽

...

Keyword(s):

Renal Transplant ◽

Transplant Recipient ◽

Renal Transplant Recipient ◽

Case Reports ◽

Organ Transplant ◽

Surgical Excision ◽

Human Infection ◽

Reference Laboratory ◽

Solid Organ ◽

Atypical Presentations

Mycetoma is a chronic, granulomatous, subcutaneous infection caused by several species of fungi and soil-inhabiting bacteria, and is divided into eumycetoma and actinomycetoma, respectively. Endemicity is described with worldwide distribution within the “mycetoma belt”; however, the global burden is ill-defined. Mycetoma is rare in Australia, with only a few published case reports. Over time, the breadth of eumycetoma pathogens has expanded with local epidemiology accounting for variations in regional prevalence. Direct inoculation of pathogens typically heralds the triad of subcutaneous mass, sinus formation and discharging grains. We describe a case of eumycetoma in a 48-year-old male Filipino renal transplant recipient who presented with a painless slow-growing elbow lesion. Ultrasonography revealed two ovoid masses and surgical excision ensued. Histopathology revealed necrotising granulomata with numerous chestnut-brown thick-walled cells, septate hyphae, and occasional grains. On suspicion of localised chromoblastomycosis, the isolate was sent to a reference laboratory which identified the fungus as Falciformispora lignatilis, an organism not hitherto associated with human infection. Amongst the solid organ transplant cohort, similar atypical presentations have been described. Clinicians need to consider eumycetoma where an epidemiological link with the tropics exists, especially in atypical presentations in transplant recipients, including absent preceding trauma.

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Opportunistic infections in a renal transplant recipient

Infectious Disease Reports ◽

10.4081/idr.2012.3744 ◽

2012 ◽

Vol 4 (1) ◽

pp. 8 ◽

Cited By ~ 1

Author(s):

Vijaya V. Mysorekar ◽

Mahesh Eshwarappa ◽

Umesh Lingaraj

Keyword(s):

Renal Transplant ◽

Transplant Recipient ◽

Renal Transplant Recipient ◽

Organ Transplantation ◽

Opportunistic Infections ◽

Intestinal Tuberculosis ◽

Transplant Recipients ◽

Allograft Survival ◽

Treatment Of Infection ◽

Transplantation Procedures

With the present progress in transplantation procedures, there is an improvement in patient and allograft survival. However, the immunosuppression necessary to sustain the allograft predisposes these transplant recipients to infection, which is now a significant cause of morbidity and mortality. We describe a case of a 30-year-old renal transplant recipient with two opportunistic infections, namely, primary cutaneous aspergillosis and intestinal tuberculosis, with terminal enterococcal pleuritis and peritonitis. Control of the degree of immunosuppression, and prompt recognition and treatment of infection are vital for successful organ transplantation.

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