Transplant Infectious Disease最新文献

Background: Respiratory viral infections (RVIs) can have distinct clinical presentations and outcomes in non-lung solid organ transplant (SOT) recipients compared to non-transplant and lung transplant patients. Understanding their impact is crucial for improving patient care and outcomes.

Methods: This multicenter retrospective study analyzed adult non-lung SOT recipients with PCR-confirmed symptomatic RVIs from eight Dutch hospitals (January 2013-July 2024) to characterize clinical characteristics and outcomes of mono- and co-infections and identify risk factors for intensive care admission or 30-day mortality.

Results: In total, 603 RVIs were identified in 460 recipients (kidney: 501; liver: 75; pancreas/islet of Langerhans: 4; combined: 23). The most common viruses were SARS-CoV-2 (36%), influenza A/B (29%), rhinovirus (14%), and RSV (7%). Influenza cases showed higher rates of fever (72%), common cold symptoms (37%), and myalgia (29%) than other viruses. Hospitalization occurred in 68% (384/565). Factors independently associated with intensive care admission or 30-day mortality included higher CURB-65 score (OR 1.91; 95% CI 1.36-2.70; p < 0.01), radiologic infiltrates (OR 3.04; 95% CI 1.60-5.80; p < 0.01), and SARS-CoV-2 infection (OR 1.67; 95% CI 1.05-2.67; p = 0.03). In contrast, influenza infection was associated with a lower risk (OR 0.21; 95% CI 0.07-0.62; p < 0.01). Co-infections were not linked to worse outcomes compared to mono-infections.

Conclusion: Overall, RVIs in non-lung SOT recipients were associated with high hospitalization and mortality rates. SARS-CoV-2 posed the highest risk for complications, while influenza was associated with a lower risk of severe outcomes. No association was found between co-infection and poor outcomes.

Background: Malaria during hematopoietic stem cell transplant (HCT) poses serious risks. Historically, donors with potential exposure were deferred or treated empirically. Malaria PCR, the most sensitive diagnostic tool, is not routinely used. Patients with sickle cell disease (SCD) and their related donors may be disproportionately affected given endemic exposures and potential occult parasitemia.

Methods: Performed a single-center retrospective review of malaria screening and outcomes in patients with SCD undergoing allogeneic HCT and their related donors. In addition, reviewed the literature on HCT-related malaria cases.

Results: Among 57 HCT donors tested for malaria, three asymptomatic cases were identified. Two were identified prior to donation via blood smears and PCRs, while one-initially screened with smears alone-was diagnosed retrospectively after transmitting malaria to the recipient. Retrospective malaria PCR of the hematopoietic cell product was positive, suggesting the donor's pre-collection whole-blood malaria PCR may have been positive. Among 52 HCT recipients tested for malaria, two developed peri-HCT malaria-one diagnosed and treated pre-HCT, and another with donor-derived malaria. All cases diagnosed before collection and HCT proceeded successfully after treatment and negative PCR. Literature review identified 10 detailed malaria cases in HCT and two additional series lacking case specifics.

Discussion: Asymptomatic HCT donors and candidates with potential exposure to malaria should undergo screening. Malaria PCR offers greater diagnostic sensitivity than conventional methods. PCR utilization may prevent unnecessary donor deferrals and avoided empiric malaria treatment. Moreover, PCR negativity post-treatment may help confirm donor and candidate eligibility. These observations warrant validation in larger studies.

Background: Multidrug-resistant organism colonization and infections cause significant morbidity and mortality in solid organ transplantation, affecting the perioperative antibiotic management. Yet, international practices for screening and antibiotic prophylaxis in colonized donors and recipients remain poorly defined.

Methods: Self-administered, web-based survey conducted between February and July 2025 to assess global practices in multidrug-resistant organism screening and perioperative antibiotic management in SOT, developed by transplant infectious diseases experts and endorsed by the Transplant Infectious Diseases Section of the Transplantation Society and the European Society of Clinical Microbiology and Infectious Diseases Study Group for Infections in Compromised Hosts. Data collected included respondent and institution characteristics; screening and prophylaxis protocols; donor and recipient colonization management; and timeframes relevant for prophylaxis modification.

Results: Responses from 125 transplant centers across 24 countries and four continents were included. Most respondents were infectious disease physicians (73.6%). Antimicrobial stewardship programs and transplant infectious diseases consultation were available in 93.6% and 85.6% of centers, respectively. Over half (52.0%) modified prophylaxis based on donor multidrug-resistant organism colonization, mainly triggered by urine and respiratory cultures. Preservation fluid and surveillance cultures influenced decisions less often. Recipient screening protocols were reported by 61.6% of centers, primarily targeting carbapenem-resistant Enterobacterales (80.8%). About 41.6% routinely adjusted prophylaxis for colonized recipients, especially with recent (1-3 months) colonization.

Conclusion: Substantial international variability exists in multidrug-resistant organism screening and perioperative prophylaxis practices in solid organ transplantation. Evidence-based consensus guidelines are needed to standardize and improve prevention of donor-derived and recipient infections globally.

Background: The use of organs from donors at increased infectious risk represents an effort to broaden the donor pool, but case-by-case evaluation may be needed. The Italian National Transplant Center (CNT) is supported by a second opinion task force of experts consulted for donors with complicated infectious assessment.

Methods: Retrospective observational study to describe infectious disease second opinion (IDSO) activity between June 2022 and October 2023. We analyzed the distribution of the infectious risk level, assigned according to the CNT protocol in five categories.

Results: IDSO evaluation was requested for 1246 of the 4153 (30%) of the donors. The mean age was 58.2 years, 56.8% were male, and most of them were Italians (91%). Donors had on average 1.5 (SD 0.9, range 1-6) infectious problems, the most frequent being pneumonia (453, 36.4%), inflammatory marker elevation (299, 24%), and bacteremia (125, 10%). The infectious risk was classified in most cases as increased but acceptable risk (60.8%), followed by negligible risk (19.2%) and increased but acceptable risk only for critical recipients (12.4%). Only 5.2% of donors were unacceptable, the main reason being inappropriately treated multidrug-resistant organism bacteremia or candidemia (21/65, 32.3%). Lung was the most frequently excluded organ (18.2%). In 284 donors (24%), additional testing was recommended, and in 299 recipients (25.3%), a specific therapeutic indication was given.

Conclusions: IDSO activity allowed the acceptance of the donor pool in almost 95% of the reviewed cases. Prospective international studies are necessary to understand the real impact of donors at increased infectious risk on recipient outcomes.

Background: Neutropenia during valganciclovir (VGCV) prophylaxis for cytomegalovirus infection in pediatric solid organ transplant (pSOT) recipients is common, but it is uncertain if this toxicity is exposure-dependent.

Methods: To compare ganciclovir (GCV) exposures in children treated with VGCV with and without neutropenia, we performed a retrospective matched case-control study among pSOT prescribed VGCV, dosed based on body surface area. Cases were defined as an absolute neutrophil count (ANC) < 1000/µL. Controls without neutropenia were matched by age (+/-1 year), transplanted organ, and duration of VGCV prophylaxis. We used a published population pharmacokinetic model to inform predictions of GCV concentrations using Pmetrics, accounting for each subject's time-dependent variables (age, weight, creatinine clearance). We then calculated 24-h, 7-day, and cumulative area under the curve (AUC) in each subject and used conditional logistic regression to compare GCV exposures among cases and controls.

Results: Among 164 pSOT recipients prescribed VGCV, we identified 35 case-control matches. There were no statistically significant differences in the 24-h (odds ratio [OR] 0.990, 95% confidence interval [CI] 0.964-1.018), 7-day (OR 1.000, 95% CI 0.996-1.004), or cumulative AUCs (OR 1.00, 95% CI 0.9996-1.00) among all cases and controls. AUC metrics by SOT type also showed no statistically significant differences.

Conclusions: Predicted GCV exposures were similar among pSOT recipients with and without neutropenia, suggesting that differences in dosing and pharmacokinetics covariates did not drive toxicity in our population. Measurement of GCV concentrations may discern whether toxicity relates to exposures/concentrations or intrinsic factors (i.e., genetics) in the pSOT population.

Background: Infections are a common complication among lung transplant recipients (LuTR), particularly in the first year post-transplant, with respiratory tract infections (RTI) being predominant. Syndromic molecular panels have been suggested to reduce morbidity and mortality by providing a diagnosis quickly. However, integrating these panels into clinical practice remains debated.

Methods: An electronic search was conducted in PubMed, Scopus, and Embase to identify studies on applying syndromic panels for RTI diagnosis in LuTR. Three reviewers independently screened-extracted data from relevant studies, focusing on concordance between syndromic panels and standard microbiologic tests and reporting isolates not detected by syndromic panels.

Results: Four studies met the inclusion criteria, including 308 patients. The BioFire FilmArray Pneumonia Panel was the syndromic panel most frequently employed. In three studies, the syndromic panel was employed in LuTR with suspected RTI or during routine surveillance bronchoalveolar lavage; only in one case was the syndromic panel employed during the transplant procedure on samples from the donor. Agreement between syndromic panels and standard tests ranged from 0.56 to 0.98, with result turnaround times between 2.3 and 21.2 h. Sensitivity ranged from 58% to 94%, and specificity from 78% to 100%. Pathogens outside syndromic panels targets but identified by standard tests included Candida spp., unspecified gram-negative rods, and Aspergillus spp.

Conclusion: Syndromic panels offer a faster alternative to standard microbiologic tests. However, they miss numerous possible pathogens, highlighting the necessity for concurrent standard testing. Further research is needed to establish the most efficient integration of syndromic panels in LuTx infection diagnostic.

Background: Infection is a significant cause of morbidity and mortality among solid-organ transplant (SOT) recipients. Australasia currently has no standardized system for the surveillance of infection across organ-transplant groups nor SOT-specific infection prevention and control (IPC) guidelines. This sub-cohort analysis of the INTERACT study sought to understand existing IPC and infection monitoring practices in Australasian centers providing transplant care to guide consensus recommendations.

Methods: A cross-sectional survey was administered to infectious disease (ID), microbiology, and IPC specialists involved in the care of the high-risk immunocompromised host within Australasian healthcare facilities (HCFs).

Results: A total of 97 healthcare workers caring for SOT patients responded, predominantly employed by public HCFs. A total of 76.3% were practicing in transplant centers (primarily renal), with responses gained from all Australasian transplant jurisdictions. Although on-site IPC programs were customary (present in 96.9%), few had dedicated transplant-ID services (38.1%). Surveillance for healthcare-associated infections was reported by the majority (75.3%), with monitoring for opportunistic infections less frequent (23.7%). While 50.5% reported a staff mask-wearing mandate, and 22.7% a gown/glove policy on transplant wards, the timing of routine personal protective use post-transplantation was heterogeneous. Screening practices for multidrug-resistant organisms varied, with routine approaches more prevalent within facilities performing transplant surgery (38.1%-100.0% vs. 39.1%-46.4%). Just over half (58.8%) of respondents provided counselling to SOT recipients for safe-living post-discharge.

Conclusion: This is the first analysis of IPC/surveillance practice in the care of the Australasian SOT population, revealing practice variability and emphasizing the need for standardization to optimize transplant outcomes and reduce infection risk.