scholarly journals The Importance of Screening Strongyloides stercoralis Infection in Solid Organ Transplant Donors and Recipients

2021 ◽  
Vol 16 (4) ◽  
Author(s):  
Sara Abolghasemi ◽  
Farnaz Zolfaghari ◽  
Shahnaz Sali ◽  
Abdollah Ghaffari ◽  
Mehran Noori
Keyword(s):  
Organ Transplant ◽  
Gastrointestinal Symptoms ◽  
Strongyloides Stercoralis ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Kidney Transplant Recipients ◽  
Place Of Residence ◽  
Birth Place ◽  
Immunosuppressed Patients ◽  
History Of

Background: Strongyloides stercoralis is an intestinal nematode with worldwide distribution which is endemic in tropical and subtropical areas. It is unique in its ability to complete its entire life cycle and reinfect its human host via a phenomenon called autoinfection. The majority of infections are clinically asymptomatic or can manifest with gastrointestinal symptoms, such as heartburn, bloating, diarrhea, abdominal discomfort, gastroesophageal reflux disease (GERD), or symptoms related to the penetration of larvae through skin, including dermatitis and eosinophilia. Immunosuppressed patients, such as solid organ transplant patients with untreated strongyloidiasis are at great risk of hyperinfection, dissemination syndromes, and often fatal conditions associated with strongyloidiasis. Methods: In this retrospective single-center cross-sectional study, we evaluated 157 cases (131 heart, lung, and kidney transplant recipients and 26 kidney donors) in Tehran, Iran, from March 2020 to April 2021. Demographic information including age, gender, place of birth, place of residence, underlying disease, being the donor or recipient, history of previous transplant and type of transplant, travel history to endemic regions, and seropositivity for S. stercoralis were evaluated. Results: Among 157 cases with a mean age of 38.9 years, 40 (25.5%) cases tested positive for S. stercoralis antibodies. Out of 26 donors, eight cases were seropositive, and among 131 recipients, 32 cases were seropositive. There was no significant correlation between birth place and place of residence in endemic areas and seropositivity for S. stercoralis. None of the cases showed hypereosinophilia, hyperinfection, or disseminated syndrome. Also, we found no significant correlation between the type and time of transplant, history of previous transplants, and S. stercoralis infection. Conclusions: Universal screening for S. stercoralis latent infection is important in immunosuppressed patients, especially in solid organ transplants because of the high risk of hyperinfection and disseminated syndrome, which may culminate in death. Furthermore, screening for latent strongyloides infection in donors seems to be necessary because of the possibility of strongyloides infection being transmitted from donors to recipients.

New Strategies for Prevention and Therapy of Cytomegalovirus Infection and Disease in Solid-Organ Transplant Recipients

2000 ◽  
Vol 13 (1) ◽  
pp. 83-121 ◽  
Author(s):  
Irene G. Sia ◽  
Robin Patel
Keyword(s):  
Antiviral Agents ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Cmv Infection ◽  
Human Organ ◽  
Preventative Measures ◽  
Daunting Task ◽  
History Of ◽  
Antiviral Chemotherapy

SUMMARY In the past three decades since the inception of human organ transplantation, cytomegalovirus (CMV) has gained increasing clinical import because it is a common pathogen in the immunocompromised transplant recipient. Patients may suffer from severe manifestations of this infection along with the threat of potential fatality. Additionally, the dynamic evolution of immunosuppressive and antiviral agents has brought forth changes in the natural history of CMV infection and disease. Transplant physicians now face the daunting task of recognizing and managing the changing spectrum of CMV infection and its consequences in the organ recipient. For the microbiology laboratory, the emphasis has been geared toward the development of more sophisticated detection assays, including methods to detect emerging antiviral resistance. The discovery of novel antiviral chemotherapy is an important theme of clinical research. Investigations have also focused on preventative measures for CMV disease in the solid-organ transplant population. In all, while much has been achieved in the overall management of CMV infection, the current understanding of CMV pathogenesis and therapy still leaves much to be learned before success can be claimed.

scholarly journals Perioperative risks of bariatric surgery among patients with and without history of solid organ transplant

2020 ◽  
Vol 20 (9) ◽  
pp. 2530-2539 ◽  
Author(s):  
John R. Montgomery ◽  
Jordan A. Cohen ◽  
Craig S. Brown ◽  
Kyle H. Sheetz ◽  
Grace F. Chao ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
History Of ◽  
Perioperative Risks

scholarly journals 479. Real-world Evaluation of SARS-CoV-2 Monoclonal Antibodies in Solid Organ Transplant Recipients

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S341-S341
Author(s):  
Kristen Zeitler ◽  
Nicholas Piccicacco ◽  
Lyndsey Bowman ◽  
Jose Montero ◽  
Margarita Cancio ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Organ Transplant ◽  
Panel Member ◽  
Retrospective Chart Review ◽  
Editorial Board Member ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Abstract Background Patients with COVID-19 infection at highest risk for poor outcomes include immunocompromised patients, such as solid organ transplant (SOT) recipients. Monoclonal antibody (mAb) infusions were developed to promote passive immunity. Analysis of the first 200 patients who received SARS-CoV-2 mAb at our hospital showed a 27 % absolute reduction in hospitalization and emergency department (ED) visits. Understanding the role of SARS-CoV-2 mAb therapy in management of the SOT population is likely to inform decision making for these patients. Methods We conducted a retrospective chart review of SOT patients diagnosed with COVID-19 who received mAb therapy between 11/18/20 and 04/26/21. Patients were excluded if they were < 18 years of age or if they weighed < 40 kg. We compared those patients who were hospitalized or visited the ED within 29 days of mAb therapy to those who recovered without further visits to our hospital. Results A total of 50 SOT patients receiving mAb therapy were included in this analysis. Bamlanivimab was given to 33 patients, while 9 patients received bamlanivimab/etesevimab and 8 patients received casirivimab/imdevimab. Twelve (24 %) patients were hospitalized or visited the ED within 29 days of mAb therapy; 38 patients did not. These 2 groups did not significantly differ by age, gender, body mass index, time from SOT, or other risk factors for severe COVID-19 illness per FDA Emergency Use Authorization guidance. Both groups were primarily made up of kidney transplant recipients (66.7 % and 68.4 %, respectively). Significantly more patients in the hospitalization/ED group were receiving antimetabolites as part of their immunosuppression (IS) regimen prior to COVID-19 diagnosis (100 % vs 68.4 %, p = 0.047). Patients in the hospitalization/ED group received mAbs within a median of 6 days (IQR 3.8) of symptom onset compared to 4 days (IQR 4) (p = 0.006). Conclusion SOT recipients were more likely to be hospitalized or visit the ED due to COVID-19 after mAb if they were receiving antimetabolite IS or received mAb later after symptom onset. These data stress the importance of early mAb administration in all SOT patients, particularly in those on antimetabolite therapy. Disclosures Lyndsey Bowman, PharmD, Veloxis Pharmaceuticals (Advisor or Review Panel member, Speaker’s Bureau) Kami Kim, MD, Regeneron Pharmaceuticals Inc. (Scientific Research Study Investigator)Sanford Guide (Other Financial or Material Support, Editorial Board Member)

scholarly journals Safety of Valganciclovir Dosed 450 MG Three Times Weekly for Cytomegalovirus Prophylaxis in Solid Organ Transplant Recipients Requiring Hemodialysis

2021 ◽  
Author(s):  
Danielle Ecabert ◽  
Christine Pham ◽  
Brett J Pierce ◽  
William L Musick ◽  
Duc T Nguyen ◽  
...  
Keyword(s):  
Renal Function ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Severe Neutropenia ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cmv Infection ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

Abstract Background Valganciclovir is the most commonly used antiviral for cytomegalovirus (CMV) prophylaxis in solid organ transplant recipients. However, there are limited clinical outcomes-supported data available to guide valganciclovir dosing in patients on hemodialysis (HD). This study aimed to assess the safety of our institution’s current dosing strategy of valganciclovir 450 mg three times weekly post-HD. Methods This was a single-center retrospective review of all adult non-kidney transplant recipients between May 2016 and June 2018. Patients with end stage renal disease requiring HD for >28 days post-transplant receiving valganciclovir 450 mg three times weekly post-HD were matched with non-HD patients receiving valganciclovir prophylaxis dosed per renal function. The primary endpoints were incidence of leukopenia, neutropenia, and thrombocytopenia while on valganciclovir prophylaxis. Results A total of 465 non-kidney transplants were performed during the study period, with 37 patients included in the HD group who were matched to 111 control patients in the non-HD group. Liver transplant recipients comprised 84% and 72% of each group, with none being CMV D+/R-. The rates of leukopenia (51.4% vs. 51.4%, p = 1.00), severe neutropenia (ANC <500 cells/µL, 15.8% vs. 14.0%, p = 0.85), and thrombocytopenia (24.3% vs. 20.7%, p = 0.64) were similar in both HD and non-HD groups. There were no cases of CMV infection while on valganciclovir prophylaxis in either group. Conclusions Valganciclovir 450 mg three times weekly was found to have similar rates of leukopenia, neutropenia, thrombocytopenia, and CMV infection in comparison to valganciclovir dosed per renal function in non-HD transplant recipients.

scholarly journals Association between history of bariatric surgery and graft rejection among solid organ transplant recipients

2021 ◽  
Vol 6 (1) ◽  
pp. 100071
Author(s):  
Claire R. Harrington ◽  
Max Soghikian ◽  
Dyanna Gregory ◽  
Jane E. Wilcox ◽  
Aneesha Shetty ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Graft Rejection ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
History Of ◽  
Solid Organ Transplant Recipients

scholarly journals SARS-CoV-2 serologic immune response in exogenously immunosuppressed patients

2020 ◽  
Author(s):  
Megan L Zilla ◽  
Christian Keetch ◽  
Gretchen Mitchell ◽  
Jeffery McBreen ◽  
Michael R Shurin ◽  
...  
Keyword(s):  
Immune Response ◽  
Antibody Response ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Organ Transplant Recipient ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Immunosuppressed Patients ◽  
Solid Organ Transplant Recipients

Abstract Background While it is presumed that immunosuppressed patients, such as solid organ transplant recipients on immunosuppression, are at greater risk from SARS-CoV-2 infection than the general population, the antibody response to infection in this patient population has not been studied. Methods In this report, we follow the anti-SARS-CoV-2 antibody levels in patients with COVID-19 who are undergoing exogenous immunosuppression. Specifically, we studied the antibody response of three solid organ transplant recipient patients, three patients who take daily inhaled fluticasone, and a patient on etanercept and daily inhaled fluticasone, and compared them to five patients not on exogenous immunosuppression. Results We found that the solid organ transplant patients on full immunosuppression are at risk of having a delayed antibody response and poor outcome. We did not find evidence that inhaled steroids nor etanercept predispose patients to delayed immune response to SARS-CoV-2. Conclusion The data presented here suggest that solid organ transplant recipients may be good candidates for early targeted intervention against SARS-CoV-2.

scholarly journals Severe COVID-19 by SARS-CoV-2 Lineage B.1.1.7 in Vaccinated Solid-Organ Transplant Recipients: New Preventive Strategies Needed to Protect Immunocompromised Patients

Vaccines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 806
Author(s):  
Daniela Loconsole ◽  
Emma Diletta Stea ◽  
Anna Sallustio ◽  
Giulia Fontò ◽  
Virginia Pronzo ◽  
...  
Keyword(s):  
Organ Transplant ◽  
Vaccination Strategy ◽  
High Viral Load ◽  
Heart Transplant Recipient ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Protein Subunit

Background: Solid-organ transplant (SOT) recipients are at a high risk of severe COVID-19, and are priority for vaccination. Here, we describe three cases of severe COVID-19 caused by SARS-CoV-2 B.1.1.7 lineage in vaccinated SOT recipients. Methods: Three SOT patients were hospitalized in the Policlinico Hospital of Bari (southern Italy) and underwent nasopharyngeal swabs for molecular detection of SARS-CoV-2 genes and spike protein mutations by real-time PCR. One sample was subjected to whole-genome sequencing. Results: One patient was a heart transplant recipient and two were kidney transplant recipients. All were hospitalized with severe COVID-19 between March and May 2021. Two patients were fully vaccinated and one had received only one dose of the BNT162b2 mRNA vaccine. All the patients showed a high viral load at diagnosis, and molecular typing revealed the presence of B.1.1.7 lineage SARS-CoV-2. In all three cases, prolonged viral shedding was reported. Conclusions: The three cases pose concern about the role of the B.1.1.7 lineage in severe COVID-19 and about the efficacy of COVID-19 vaccination in immunocompromised patients. Protecting immunocompromised patients from COVID-19 is a challenge. SOT recipients show a suboptimal response to standard vaccination, and thus, an additive booster or a combined vaccination strategy with mRNA, protein/subunit, and vector-based vaccines may be necessary. This population should continue to practice strict COVID-19 precautions post-vaccination, until new strategies for protection are available.

Impact of a Clinical Solid Organ Transplant Pharmacist on Tacrolimus Nephrotoxicity, Therapeutic Drug Monitoring, and Institutional Revenue Generation in Adult Kidney Transplant Recipients

2016 ◽  
Vol 26 (4) ◽  
pp. 314-321 ◽  
Author(s):  
Shawn P. Griffin ◽  
Joelle E. Nelson
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Kidney Transplant ◽  
Drug Monitoring ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Therapeutic Drug ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Adult Kidney

Context: Tacrolimus requires close therapeutic drug monitoring (TDM) to ensure efficacy and minimize adverse effects. Pharmacists are uniquely positioned on transplant teams to interpret levels and recommend therapy modifications. Their impact in the immediate postoperative setting has not been described previously. Objective: To evaluate the impact of a clinical solid organ transplant pharmacist on nephrotoxicity, TDM, and revenue generation in adult kidney transplant recipients on tacrolimus. Design, Setting, and Patients: Retrospective assessment of adult kidney transplant recipients at University of Florida Health Shands Hospital. Intervention: A transplant pharmacist rounded 5 days a week and made medication recommendations on transplant recipients—including tacrolimus dose modifications based on levels. Pharmacy services were expanded to include medication reconciliation, medication counseling, and delivery of discharge medications to bedside. Main Outcome Measure: Incidence of nephrotoxicity during tacrolimus exposure. Results: Of the 70 kidney transplant recipients in the postpharmacist cohort, 18 (25.7%) experienced nephrotoxicity while on tacrolimus, compared to 18 (25%) of the 72 in the prepharmacist cohort ( P = .922). A significantly greater proportion of recipients who experienced nephrotoxicity were male, had hypertension, or experienced delayed or slow graft function. The rate of appropriately drawn tacrolimus troughs significantly increased from 23.4% to 30.3% in the postpharmacist cohort ( P < .001). The median outpatient pharmacy revenue generated per recipient significantly increased from US$345.49 (interquartile range [IQR]: 0-4727.56) to US$4834.95 per recipient (IQR: 3592.78-6224.60; P < .001). The length of stay (7 days, IQR: 6-9, vs 8 days, IQR: 6-9; P = .107) and the 30-day readmission rate were similar between groups (20.8% vs 21.4%; P = .931).

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