Transplant Infectious Disease最新文献

Background: Prior studies and guidelines emphasize PTLD-risk for Epstein-Barr virus (EBV) mismatched (D+/R-) recipients. However, risk among D-/R- kidney recipients remains poorly defined. We evaluated PTLD-risk by donor-recipient EBV serostatus, including D-/R-, and time-varying impact of PTLD on mortality in kidney transplant recipients.

Methods: This retrospective cohort included deceased donor kidney transplants from the US Scientific Registry of Transplant Recipients (2003-2023). Recipient and donor-recipient EBV serostatus were categorical exposures. Time-to-PTLD was analyzed using Kaplan-Meier methods and adjusted Cox models, stratified into 0-1, 1-2, and 2-3 years to address non-proportional hazards. Secondary outcomes included mortality and all-cause graft failure (ACGF), with PTLD modeled as a time-dependent exposure. Effect modification across key subgroups was evaluated.

Results: Among 309 585 recipients (2.35 million person-years), 3147 PTLD events (1.1%) occurred, largely within the first year. Incidence was highest for D+/R- (3%) and D-/R- (1.8%) (p < 0.001). First-year PTLD-risk was highest for D+/R- (HR 17.8 [95% CI: 10.4, 30.5]) and D-/R- (HR 8.2 [95% CI: 4.2, 15.8]) recipients. PTLD was associated with increased mortality (HR 4.5 [95% CI: 4.3, 4.8]) and ACGF (HR 3.7 [95% CI: 3.5, 3.9]), with relatively higher mortality-risk for pediatric recipients (ratio of HRs 1.5). Among 82 detailed PTLD cases, most were B-cell (89%), monoclonal (63%), and EBV-positive (78%), with mixed WHO class and site-involvement.

Conclusions: EBV D+/R- recipients experienced highest and sustained 3-year PTLD-risk, while D-/R- recipients faced previously under-recognized early risk. PTLD was strongly linked to mortality and ACGF, refining counselling and supporting targeted surveillance for high-risk groups.

Antimicrobial resistance (AMR) is an escalating worldwide public health concern. Solid organ transplant recipients (SOTR) are disproportionately impacted by infection with multidrug-resistant bacteria, which has been associated with heightened morbidity and mortality in this population. Recent advances in AMR detection have given rise to the development of diagnostic assays capable of rapid AMR detection from clinical specimens. In the general population, many of these tests have been rigorously evaluated and are becoming increasingly incorporated into clinical diagnostic workflows. Data on the performance and clinical utility of assays for rapid AMR detection in SOTR are emerging, though they remain sparse compared to the general population. We provide an overview of Food and Drug Administration-approved, commercially available tests for rapid AMR detection, and review the available evidence regarding their performance and utility in SOTR.

Background: Solid organ transplant (SOT) recipients are at risk for Pneumocystis jirovecii pneumonia (PCP), yet how their clinical phenotype and outcomes compare with other immunocompromised patients without HIV remains poorly defined.

Methods: We conducted a multicenter retrospective cohort study of adults with proven or probable PCP from 2017 to 2025, including 95 SOT recipients and 588 non-SOT, non-HIV immunocompromised patients. The primary outcome was 90-day mortality, secondary outcomes included new renal failure requiring dialysis, and 30-day mortality. Outcomes were analyzed using inverse probability weighting (IPW) with winsorization to adjust for baseline differences.

Results: In unadjusted analysis, SOT recipients had lower 90-day mortality (hazard ratio [HR]: 0.62, 95% CI 0.39-0.97, p = 0.037). After IPW with winsorization of extreme weights, SOT status remained associated with lower 90-day mortality (HR: 0.32, 95% CI 0.13-0.76, p = 0.009), and 30-day mortality (HR: 0.35, 95% CI: 0.14-0.92, p = 0.034). SOT recipients had higher odds of renal failure requiring dialysis in unadjusted analysis (OR: 3.49, 95% CI 1.94-6.14, p < 0.001), which persisted after IPW adjustment (OR: 1.62, 95% CI: 1.04-2.51, p = 0.032).

Conclusions: Despite higher rates of renal failure requiring dialysis, SOT recipients with PCP experienced significantly improved short- and intermediate-term survival compared with other non-HIV immunocompromised patients, underscoring the need for further investigation into transplant-associated contributors to PCP outcomes.

Background: VEXAS is a relatively newly described immunocompromising condition with hematopoietic stem cell transplant increasingly being used. Little is known regarding infections in this high-risk population.

Methods: We conducted a retrospective review of ten adult patients diagnosed with VEXAS who underwent HSCT in the Mayo Clinic Rochester and the Arizona medical record system.

Results: Nine out of ten individuals developed bacterial infection with bacteremia found in eight individuals despite being on prophylaxis at the time of infection. Six of the ten individuals were found to have viral infection; there were no documented invasive fungal infections and only one individual had a parasitic infection.

Conclusion: Providers should have a high suspicion for infection, especially bacterial, in this patient population, regardless of prophylaxis use. Patients should also be educated on signs and symptoms of infection.

Candida auris is a multidrug-resistant yeast that poses a disproportionate threat to transplant recipients because of prolonged hospitalizations, intensive immunosuppression, frequent invasive procedures, and exposure to broad-spectrum antimicrobials. Despite growing recognition of its propensity for skin colonization, environmental persistence, and biofilm formation on healthcare devices, standardized screening practices for transplant donors and recipients remain poorly defined. Herein, we review published outbreak reports, surveillance studies, laboratory guidance, and public health recommendations to synthesize current approaches to C. auris screening relevant to transplant populations. Key domains included risk-based criteria for admission and response screening, diagnostic modalities (culture, chromogenic media, MALDI-TOF, and real-time PCR), and the applicability of ICU-derived data to transplant settings. Screening strategies include targeted admission or outbreak-driven response. Culture-based methods remain widely used but are slower and require confirmatory testing, whereas molecular assays enable rapid detection with high sensitivity and specificity and permit timely infection-control responses. Much of the data is extrapolated due to a paucity of transplant-specific evidence; available reports suggest frequent colonization in critically ill transplant recipients and high mortality among those who develop invasive disease. No validated decolonization protocols exist, and perioperative screening is not addressed in most guidelines, creating a gap in peri-transplant risk mitigation. Prospective, transplant-focused studies are needed to define optimal perioperative screening, quantify progression risk from colonization to invasive infection, and evaluate the clinical impact of screening on patient outcomes.

Background: Herpes simplex virus (HSV) infection is a significant risk in hematopoietic stem cell transplant (HSCT) recipients, and antiviral resistance poses many clinical challenges.

Methods: A retrospective case series of eight pediatric patients with acyclovir-resistant HSV infection, determined via genotypic sequencing, post allogeneic HSCT between 2012 and 2025.

Results: Indications for HSCT included primary immunodeficiency, sickle cell disease, myelodysplastic syndrome (MDS), and relapsed/refractory leukemia. All patients received acyclovir prophylaxis. TK mutations were most common (n = 7, 87.5%). Infections manifested as mucocutaneous disease, pneumonitis, keratitis, enterocolitis, and blood viremia. A total of 87.5% of patients (n = 7) were treated with second-line antivirals (foscarnet and/or cidofovir), and three patients were treated with third-line antivirals (pritelivir). Treatment was complicated by nephrotoxicity (n = 3, 37.5%). Adjunct treatments included intravenous immunoglobulin (n = 3, 37.5%) and donor lymphocyte infusion (n = 1, 12.5%). Poor outcomes were seen across the cohort, including death (n = 3, 37.5%). T-cell depletion was used in 50% of patients (n = 4). Concomitant immunosuppressive therapy was used in 100% of patients (n = 8) and high-dose steroids were used in 50% of patients (n = 4). Graft versus host disease occurred in four patients (50%). Secondary complications included transplant-associated thrombotic microangiopathy (n = 3, 37.5%), idiopathic pulmonary syndrome (n = 3, 37.5%), and graft failure (n = 1, 12.5%).

Conclusion: Acyclovir-resistant HSV infection in pediatric HSCT recipients is associated with high morbidity and mortality, limited therapeutic options, and significant treatment-related nephrotoxicity. Early recognition, early resistance testing, prompt initiation of second-line therapy, and weaning of immunosuppression are critical. Emerging therapies, such as helicase-primase inhibitors and adoptive T-cell therapy, hold promise but remain limited by access and pediatric data.