Transplant Infectious Disease最新文献

Background: A 4-month course of rifampin is one of the recommended first-line regimens for latent tuberculosis infection (LTBI). However, data on its use among kidney transplant candidates (KTC) remain limited.

Methods: We conducted a retrospective study of all KTC treated with either 4-month rifampin or 9-month isoniazid (INH) for LTBI at a transplant infectious disease clinic in Miami from January 1, 2021 to December 31, 2024. We assessed rates of treatment completion, adverse reactions leading to discontinuation of therapy, and transaminase elevation (> 2 times the upper limit of normal). The potential impact of rifampin on blood pressure (BP) in patients on antihypertensive drugs (AHD) known to interact with rifampin was also evaluated.

Results: A total of 66 patients were analyzed (49 [74%] in the INH group and 17 [26%] in the rifampin group). There was a trend towards higher treatment completion in the rifampin group compared to the INH group (16 [94%] vs. 34 [69%], p = 0.05). There was no difference in adverse reactions leading to treatment discontinuation. Transaminase elevations were not observed in the rifampin group, whereas they occurred in 3 (6%) of the INH group. Three patients experienced an increase in BP while receiving rifampin, leading to treatment discontinuation in one case.

Conclusion: A 4-month rifampin course is an excellent option for LTBI among KTC due to its high completion rate and favorable liver safety profile; however, close monitoring for AHD interactions is essential.

Introduction: Studies evaluating the incidence of infections after belatacept as a substitute for calcineurin inhibitors (CNI) or antimetabolite in kidney transplant (KT) yielded conflicting results. We compared infectious outcomes after belatacept-use to no belatacept-use in KT recipients.

Methods: We included patients with primary KT between January 1, 2018, and December 31, 2022. We compared outcomes between those who received belatacept and those who did not. Cox proportional hazards models were used with belatacept as a time-varying covariate and adjusted for gender, age at transplant, donor type, underlying disease, CMV serostatus, and organ transplant type. Anderson-Gill hazard of the first Cox models was used to examine the recurrence of DNAemia.

Results: Of 401 KT recipients, 25 received belatacept. Belatacept-use had a higher hazard for EBV and CMV first infection (3.71 [95% CI 1.57, 8.72; p = 0.003] and 2.63 [95% CI 1.04, 6.70; p = 0.042], respectively), and for allograft failure (14.5 [95% CI 5.15, 41.0; p < 0.001]) and acute cellular rejection (5.08 [95% CI 2.56, 11.5; p < 0.001]). Each year increase in zage had a higher hazard for first EBV (3.71 [1.01, 1.05]; p = 0.005) and CMV infection (1.02 [1.00, 1.04]; p = 0.019). D+/R- CMV serostatus had a higher hazard for first CMV infection relative to other serostatuses (4.96 [3.14, 7.85]; p < 0.001).

Conclusion: Careful selection of KT for belatacept-use is recommended in older recipients (≥ 55 years) due to the increased hazard of mortality, CMV, and EBV DNAemia.

Background: Parvovirus B19 (PVB19) is a clinically important cause of refractory anemia in kidney transplant recipients (KTRs). Data from low- and middle-income settings remain scarce despite high transplant volumes. This study evaluated the clinical spectrum, management practices, and outcomes of PVB19 infection across major transplant programs in India.

Methods: We conducted a retrospective multicenter cohort study across 14 tertiary transplant centers. All KTRs with PCR-confirmed PVB19 infection and complete clinical data were included. Clinical features, bone marrow findings, immunosuppressive (IS) adjustments, intravenous immunoglobulin (IVIG) use, and patient and graft outcomes were analyzed.

Results: A total of 135 KTRs were identified. Median time to infection was 11 weeks posttransplant. Anemia was universal, not frequently accompanied by leukopenia (17.7%) or thrombocytopenia (14.8%). Bone marrow examinations (n = 34) demonstrated giant proerythroblasts or pure red cell aplasia. IS reduction was implemented in all patients; most commonly, complete MMF withdrawal (61.5%). IVIG was administered to 90% (median cumulative dose 100 g). Overall, 97% achieved hematologic recovery, with a median response time of 20 days. Recurrence occurred in 4.4%. At a median follow-up of 18 months, graft survival was 92.6%; graft loss (n = 10) was primarily due to antibody-mediated rejection, and no deaths were attributable to PVB19.

Conclusions: PVB19 infection represents an important consideration in the differential diagnosis of early posttransplant anemia in KTRs. Timely PCR testing and pragmatic treatment strategies can achieve favorable hematologic and graft outcomes in resource-constrained settings.

Background: Pneumocystis jirovecii pneumonia (PCP) is a significant opportunistic infection in solid organ transplant (SOT) recipients. However, the impact of respiratory coinfections on outcomes in this population remains unclear.

Methods: We retrospectively analyzed 112 SOT recipients diagnosed with PCP from April 2018 to March 2024. Respiratory coinfections were defined as identification of significant pathogens in respiratory specimens within 3 days of PCP diagnosis.

Results: Among 112 SOT recipients with PCP, 50.0% required intensive care unit (ICU) admission, and the 30-day and 90-day mortality rates were 12.5% and 17.9%, respectively. Respiratory coinfections were identified in 46 patients (41.1%), including cytomegalovirus (CMV, 30.4%), bacteria (14.3%), and non-CMV viruses (13.4%). Bacterial coinfection was significantly associated with increased 30-day mortality (adjusted odds ratio [aOR], 5.27; 95% confidence interval [CI], 1.15-26.27; p = 0.03) and 90-day mortality (aOR, 4.84; 95% CI, 1.29-19.35; p = 0.02). CMV coinfection was independently associated with prolonged hospital stay (adjusted ratio, 2.42; 95% CI, 1.67-3.50; p < 0.001), higher ICU admission rates (aOR, 2.95; 95% CI, 1.04-9.03; p = 0.05), and increased need for mechanical ventilation (aOR, 3.01; 95% CI, 1.10-8.83; p = 0.04), but not with mortality. Non-CMV viral coinfection was associated with significantly increased odds of ICU admission (aOR, 19.03; 95% CI, 2.67-254.90; p = 0.01) and mechanical ventilation (aOR, 21.21; 95% CI, 2.96-298.12; p = 0.01), without a significant impact on mortality.

Conclusion: In SOT recipients with PCP, bacterial coinfection was associated with higher mortality, while CMV and non-CMV viral coinfections were mainly associated with morbidity. Respiratory co-pathogens may indicate illness severity; whether pathogen-directed strategies can modify outcomes requires further study.

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.