Transplant Infectious Disease最新文献

Background: The efficacy and safety of nucleos(t)ide analogs is currently a critical issue in the treatment of hepatitis B virus infection. We aimed to investigate the long-term efficacy and safety profile of tenofovir alafenamide (TAF) treatment in the liver transplant recipients (LTRs).

Methods: This retrospective study was conducted with 72 LTRs who received TAF as sequential therapy after tenofovir disoproxil fumarate (TDF). The renal, metabolic outcomes, and efficacy of TAF were evaluated. In addition, some parameters were evaluated separately according to the use of calcineurin inhibitors.

Results: Following TAF treatment, median serum phosphorus levels and estimated glomerular filtration rate (eGFR) increased significantly in the overall cohort (from 2.4 to 2.85 mg/dL [p < 0.001]; from 66 to 74 mL/min/1.73 m² [p = 0.028], respectively). These improvements were more pronounced in patients with baseline hypophosphatemia and reduced eGFR. However, no significant changes were observed in eGFR staging. A categorical worsening of lipid profile was noted based on the NCEP ATP-III criteria, with increases in some lipid parameters. No significant weight gain or increase in the incidence of posttransplant diabetes mellitus was observed. Antiviral efficacy was maintained following the switch from TDF to TAF. In addition, no significant changes in immunosuppressive drug dosing were required, and no adverse events related to TAF were reported.

Conclusion: TAF was well-tolerated and effective in LTRs. The long-term benefits of TAF on hypophosphatemia, renal function, and effective viral suppression were demonstrated. The patients with an increased risk of cardiovascular disease should receive more intensive monitoring for changes in their lipid profile.

Background: Community respiratory viruses, such as seasonal human coronavirus (HCoV), commonly infect hematopoietic cell transplant (HCT) recipients. Recognizing the risk factors and outcomes of HCoV infections in HCT recipients is essential for the future development of potentially lifesaving therapeutics.

Methods: We performed a retrospective review of all HCoV-infected HCT recipients from September 1, 2015 to August 31, 2017, at our institution. Patients were classified with upper respiratory tract infection (URI) or lower respiratory infection (LRI) based on predefined definitions for respiratory viral infections in HCT recipients. Patient data were collected to identify risk factors for HCoV LRI, and to calculate an immunodeficiency scoring index (ISI). Univariate and multivariate analysis were performed to identify risk factors for LRI.

Results: We identified 164 episodes in 138 HCT recipients (129 URI and 35 LRI) during the study period with an incidence of HCoV of 9%. Overall, 30-day mortality was 17% and 0%, among patients with HCoV LRI or URI, respectively. On multivariate analysis, low-albumin, coinfection with multiple respiratory viruses, and an ISI ≥ 5 were independent predictors of LRI and the latter was associated with increased risk of hospital admission, ICU admission, mechanical ventilation, and 30-day mortality.

Conclusions: We identified unique characteristics that were associated with HCoV LRI in HCT recipients. An ISI ≥ 5 predicted HCoV LRI in HCT recipients.

Background: Pneumocystis jiroveci pneumonia (PJP) prophylaxis is recommended indefinitely for lung transplant recipients (LTR). To mitigate the side effects of oral sulfamethoxazole-trimethoprim (SMX/TMP) in LTR, our center prescribes SMX/TMP single-strength (SS) twice weekly for PJP prophylaxis. To our knowledge, this regimen has not been evaluated in the literature. We sought to determine the incidence of PJP infection and SMX/TMP discontinuation in LTR taking this regimen.   METHODS: This retrospective review evaluated LTR first single or bilateral lung transplant at our center from June 1, 2014 to September 1, 2022. Data was obtained from the United Network of Organ Sharing Data Reports and chart review. The primary outcome was the incidence of PJP infection in LTR taking SMX/TMP SS twice weekly at index discharge until 5 years post-lung transplant, graft failure, or last data point, whichever came first. Secondary outcomes assessed SMX/TMP discontinuation, provider rationale for discontinuation, and alternative PJP prophylaxis.

Results: A total of 105 patients were included in the analysis. No cases of PJP were seen with SMX/TMP SS twice weekly. SMX/TMP was discontinued in 23 LTR during the study period. By the end of the study period, 43% transitioned back to SMX/TMP SS twice weekly. The overall incidence of indefinite SMX/TMP discontinuation was 12%. Leukopenia was the most common reason for discontinuation. Dapsone was the most common alternative prophylactic agent.

Conclusion: Our retrospective review of SMX/TMP SS twice weekly for PJP prophylaxis resulted in no PJP infection and may reduce indefinite SMX/TMP discontinuation in LTR.

Background: Cytomegalovirus reactivation (CMV-react) is an indicator for the worse non-relapse mortality (NRM) and overall survival (OS) after allogeneic hematopoietic stem cell transplantation using HLA-matched related donor (MRD) and unrelated donor (URD) for adult T-cell leukemia/lymphoma (ATL). However, it remains unclear whether CMV-react correlates with outcomes after unrelated cord blood (U-CB) transplantation.

Methods: We conducted a retrospective nationwide study to evaluate the impact of CMV-react on the outcomes after posttransplant 100 days. Data were collected from 205, 461, and 268 patients who used MRD, URD, and U-CB, respectively, between 2001 and 2022 and survived without relapse for over 100 days after transplantation.

Results: In multivariate analyses, CMV-react correlated with worse OS in the MRD (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.02-2.39; p = 0.04) and URD groups (HR, 1.45; 95% CI, 1.00-2.09; p = 0.05), but not in the U-CB group (HR, 1.34; 95% CI, 0.88-2.03; p = 0.2). CMV-react correlated with higher NRM in the MRD (HR, 1.79; 95% CI, 1.01-3.16; p = 0.05) and URD groups (HR, 1.68; 95% CI, 1.01-2.82; p = 0.05), but not in the U-CB group (HR, 1.16; 95% CI, 0.62-2.19; p = 0.6). CMV-react did not correlate with the incidence of relapse in any group.

Conclusion: CMV-react was not associated with the outcomes in the U-CB group, while CMV-react correlates with worse OS and NRM in the MRD and URD groups, indicating the need for a more intensive strategy for late-phase complications in U-CB transplantation for ATL with and without CMV-react.

Background: Vancomycin-resistant enterococci (VRE) are multidrug-resistant microorganisms (MDRO) commonly isolated in liver transplant recipients and potentially associated with worse outcomes. We aimed to identify risk factors associated with VRE colonization in liver transplantation (LT) and its impact on posttransplant survival.

Methods: This is a retrospective cohort that included all adults who underwent LT between 2010 and 2022 at a tertiary-level hospital in São Paulo, Brazil. Multivariate analyses were performed using logistic regression for VRE colonization risk and Cox regression for 180-day survival.

Results: A total of 1209 patients were included, 119 patients (9.8%) were colonized with VRE at LT, while 175 (14.5%) were colonized after LT, 77 (6.4%) patients developed VRE infection after LT. In the multivariate analysis, use of SBP prophylaxis, presence of acute-on-chronic liver failure, hepatitis B virus infection, ASA score, length of hospital stay and MELD score were all associated with VRE colonization before LT. For VRE colonization after LT, the predictors were length of hospital stay before LT, MELD score, carbapenem-resistant Gram-negative colonization, intraoperative bleeding and re-transplantation. Note that 180-day mortality rate among VRE colonization and infection was, respectively, 33.6% and 50.6% compared to 17.8% of non-colonized patients, and this difference was not statistically significant after adjustment for confounders in multivariate analysis.

Conclusion: VRE colonization or infection had no impact on survival in a large cohort of liver transplantrecipients.

Background: Trimethoprim-sulfamethoxazole prophylaxis effectively prevents opportunistic and non-opportunistic infections in kidney transplantation, but optimal duration remains uncertain. This study investigated whether extending TMP-SMX prophylaxis is associated with lower infection rates.

Methods: This target trial emulation using observational data from the Swiss Transplant Cohort Study compared short (< 7 months) versus long (≥ 7 months) TMP-SMX prophylaxis. The primary outcome was bacterial infection potentially susceptible to TMP-SMX up to 12-months post-transplant. Inverse probability weighting (IPW) adjusted for confounders including age, living donation, lymphocyte counts, use of antithymocyte globulin, acute rejection, CMV infection, and transplant center. All bacterial and opportunistic infections, kidney function, and patient and allograft survival were summarized descriptively.

Results: A total of 1700 KTRs fulfilled inclusion criteria; 1325 (78%) participants received a short prophylaxis and 375 (22%) received a long prophylaxis. Median TMP-SMX duration was 179 days in the short group and 280 days in the long group. At 12-month post-transplant, the primary outcome was observed in 120/1325 (9.1%) in the short group and 43/375 (11.5%) in the long group. IPW analysis estimated an adjusted risk difference of 2.11% (95% CI -0.47% to 5.27%). Center, rejection, and use of ATG were associated with longer TMP-SMX duration, but risk difference was similar before and after weighting. Urinary tract infection was the most common bacterial infection. Opportunistic and overall infection rates, kidney function, and patient and graft survival were similar among groups.

Conclusions: In this target trial emulation, no differences in bacterial infection rates at 12-month post-transplant was observed between short and long TMP-SMX prophylaxis.

Trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis can prevent Pneumocystis jirovecii pneumonia (PJP) and other opportunistic infections (OI). We sought to assess the frequency, causative factors, and impact of early TMP/SMX discontinuation in abdominal solid organ transplant (SOT). This is a single-center, retrospective cohort study of abdominal SOT recipients at Mayo Clinic Arizona (MCA) between January 2021 and June 2023. Primary study goals were to determine the rate and reasons behind early TMP/SMX discontinuation and whether TMP/SMX prophylaxis was reinitiated. Secondary outcomes included mean duration of therapy, alternative prophylactic agent utilized, and incidence of TMP/SMX-preventable OI. A total of 930 abdominal SOT recipients were included (592 kidney, 253 liver, 85 multiorgan transplants). TMP/SMX was discontinued early in 184 (20%) patients: 77 kidney, 84 liver, 23 multiorgan. Predominant reasons for discontinuation were hyperkalemia (39%) and cytopenias (35%). Median duration of TMP/SMX prophylaxis before discontinuation was 54.5 (18.0, 93.2) days. TMP/SMX was not resumed in 62% of cases (36% kidney, 89% liver, 52% multi-organ). The predominant reason for non-resumption was alternative prophylaxis with no clear intent to rechallenge TMP/SMX (70%). Alternative prophylaxis included pentamidine (43%), none (30%), dapsone (22%), and atovaquone (5%). Of patients reinitiated, 86% (59/69) successfully remained on TMP/SMX through the prophylaxis period. One TMP-SMX-preventable OI (nocardiosis) was observed in the TMP/SMX discontinuation group. TMP/SMX is often discontinued prematurely in SOT recipients without resumption despite resolution of the offending cause. TMP/SMX prophylaxis should be maintained where possible, as alternative therapy may not offer the same broad spectrum of protection against OI.