Pub Date : 2024-08-01Epub Date: 2024-07-05DOI: 10.1111/tid.14326
Rebecca N Kumar, Chelsea A Gorsline, Theodore Rader, Helen W Boucher, Maricar Malinis, Alan Koff, Courtney E Harris
Transplant infectious disease (TID) clinicians are integral to the pre-transplantation evaluation. Pre-transplant evaluations allow clinicians to assess risk factors for latent infections and relevant exposures to potential pathogens, address immunizations, and optimize patients' health and understanding of life after transplant. However, there is not a standardized approach to the pre-transplant evaluation. This article reviews the details of performing successful pre-transplant evaluations, including updated recommendations on available vaccines and contemporary opinions on marijuana use. This resource can be used for teaching with trainees or for early career TID clinicians.
移植传染病 (TID) 临床医生是移植前评估不可或缺的一部分。通过移植前评估,临床医生可以评估潜伏感染的风险因素和潜在病原体的相关暴露,解决免疫接种问题,并优化患者的健康状况和对移植后生活的理解。然而,移植前评估并没有标准化的方法。本文回顾了成功进行移植前评估的细节,包括有关可用疫苗的最新建议和有关大麻使用的当代观点。本资料可用于受训人员的教学或早期 TID 临床医生的职业生涯。
{"title":"The pre-transplant evaluation: Considerations for trainees and early career transplant infectious diseases clinician.","authors":"Rebecca N Kumar, Chelsea A Gorsline, Theodore Rader, Helen W Boucher, Maricar Malinis, Alan Koff, Courtney E Harris","doi":"10.1111/tid.14326","DOIUrl":"10.1111/tid.14326","url":null,"abstract":"<p><p>Transplant infectious disease (TID) clinicians are integral to the pre-transplantation evaluation. Pre-transplant evaluations allow clinicians to assess risk factors for latent infections and relevant exposures to potential pathogens, address immunizations, and optimize patients' health and understanding of life after transplant. However, there is not a standardized approach to the pre-transplant evaluation. This article reviews the details of performing successful pre-transplant evaluations, including updated recommendations on available vaccines and contemporary opinions on marijuana use. This resource can be used for teaching with trainees or for early career TID clinicians.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-07-16DOI: 10.1111/tid.14343
Inderjit Mann, Oscar Morado-Aramburo, Rodrigo Hasbun
Human herpesviruses (HHVs) cause a wide variety of central nervous system (CNS) infections including meningitis and encephalitis. While HHV-8 is not typically associated with neurological diseases, several studies have indicated a relationship, such as secondary central nervous system (CNS) metastases and a few isolated cases of HHV-8 encephalitis in acquired immunodeficiency syndrome (HIV). However, it has not been previously linked to encephalitis in solid organ transplantation (SOT). This case presents the first-ever instance of HHV-8 encephalitis in a SOT recipient. Our case highlights the association of HHV-8-related diseases, such as post-transplant Kaposi's Sarcoma (KS), with encephalitis. The patient was diagnosed with KS before developing neurological symptoms and received a prompt clinical response through intravenous foscarnet and ganciclovir treatment for 14 days. It is important to note that HHV-8 is a rare cause of encephalitis, and diagnosis requires a high index of suspicion in the appropriate clinical context, allowing for the use of antiviral therapy. This case also underscores the importance of considering the possibility of HHV-8-related diseases in SOT recipients, as they are at risk of developing such infections.
{"title":"Emerging shadows: HHV-8-associated encephalitis unveiled in a solid organ transplant recipient.","authors":"Inderjit Mann, Oscar Morado-Aramburo, Rodrigo Hasbun","doi":"10.1111/tid.14343","DOIUrl":"10.1111/tid.14343","url":null,"abstract":"<p><p>Human herpesviruses (HHVs) cause a wide variety of central nervous system (CNS) infections including meningitis and encephalitis. While HHV-8 is not typically associated with neurological diseases, several studies have indicated a relationship, such as secondary central nervous system (CNS) metastases and a few isolated cases of HHV-8 encephalitis in acquired immunodeficiency syndrome (HIV). However, it has not been previously linked to encephalitis in solid organ transplantation (SOT). This case presents the first-ever instance of HHV-8 encephalitis in a SOT recipient. Our case highlights the association of HHV-8-related diseases, such as post-transplant Kaposi's Sarcoma (KS), with encephalitis. The patient was diagnosed with KS before developing neurological symptoms and received a prompt clinical response through intravenous foscarnet and ganciclovir treatment for 14 days. It is important to note that HHV-8 is a rare cause of encephalitis, and diagnosis requires a high index of suspicion in the appropriate clinical context, allowing for the use of antiviral therapy. This case also underscores the importance of considering the possibility of HHV-8-related diseases in SOT recipients, as they are at risk of developing such infections.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-06-09DOI: 10.1111/tid.14317
Alyssa K Mezochow, Douglas E Schaubel, Eliot G Peyster, James D Lewis, David S Goldberg, Therese Bittermann
Background: Opportunistic infections (OIs) are a significant cause of morbidity and mortality after organ transplantation, though data in the liver transplant (LT) population are limited.
Methods: We performed a retrospective cohort study of LT recipients between January 1, 2007 and Deceber 31, 2016 using Medicare claims data linked to the Organ Procurement and Transplantation Network database. Multivariable Cox regression models evaluated factors independently associated with hospitalizations for early (≤1 year post transplant) and late (>1 year) OIs, with a particular focus on immunosuppression.
Results: There were 11 320 LT recipients included in the study, of which 13.2% had at least one OI hospitalization during follow-up. Of the 2638 OI hospitalizations, 61.9% were early post-LT. Cytomegalovirus was the most common OI (45.4% overall), although relative frequency decreased after the first year (25.3%). Neither induction or maintenance immunosuppression were associated with early OI hospitalization (all p > .05). The highest risk of early OI was seen with primary sclerosing cholangitis (aHR 1.74; p = .003 overall). Steroid-based and mechanistic target of rapamycin inhibitor-based immunosuppression at 1 year post LT were independently associated with increased late OI (p < .001 overall).
Conclusion: This study found OI hospitalizations to be relatively common among LT recipients and frequently occur later than previously reported. Immunosuppression regimen may be an important modifiable risk factor for late OIs.
背景:机会性感染(OIs)是器官移植后发病和死亡的重要原因:机会性感染(OIs)是器官移植后发病和死亡的一个重要原因,但肝移植(LT)人群的数据有限:我们利用与器官采购和移植网络数据库相连的医疗保险理赔数据,对 2007 年 1 月 1 日至 2016 年 12 月 31 日期间的 LT 受者进行了一项回顾性队列研究。多变量 Cox 回归模型评估了与早期(移植后≤1 年)和晚期(>1 年)OIs 住院独立相关的因素,尤其关注免疫抑制:研究共纳入了11 320名LT受者,其中13.2%的受者在随访期间至少有一次OI住院。在2638例OI住院病例中,61.9%是在LT术后早期。巨细胞病毒是最常见的 OI(占总数的 45.4%),但在第一年后相对发生率有所下降(25.3%)。诱导性或维持性免疫抑制均与早期 OI 住院无关(均 p > .05)。原发性硬化性胆管炎的早期 OI 风险最高(aHR 1.74;总体 p = .003)。LT术后1年内基于类固醇和雷帕霉素抑制剂机理靶点的免疫抑制与晚期OI增加有独立相关性(p 结论:OI住院率与OI发生率之间存在显著相关性:本研究发现,OI住院在LT受者中较为常见,且发生时间往往晚于之前的报道。免疫抑制方案可能是晚期 OI 的一个重要可调节风险因素。
{"title":"Hospitalizations for opportunistic infections following transplantation and associated risk factors: A national cohort study of Medicare beneficiaries.","authors":"Alyssa K Mezochow, Douglas E Schaubel, Eliot G Peyster, James D Lewis, David S Goldberg, Therese Bittermann","doi":"10.1111/tid.14317","DOIUrl":"10.1111/tid.14317","url":null,"abstract":"<p><strong>Background: </strong>Opportunistic infections (OIs) are a significant cause of morbidity and mortality after organ transplantation, though data in the liver transplant (LT) population are limited.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of LT recipients between January 1, 2007 and Deceber 31, 2016 using Medicare claims data linked to the Organ Procurement and Transplantation Network database. Multivariable Cox regression models evaluated factors independently associated with hospitalizations for early (≤1 year post transplant) and late (>1 year) OIs, with a particular focus on immunosuppression.</p><p><strong>Results: </strong>There were 11 320 LT recipients included in the study, of which 13.2% had at least one OI hospitalization during follow-up. Of the 2638 OI hospitalizations, 61.9% were early post-LT. Cytomegalovirus was the most common OI (45.4% overall), although relative frequency decreased after the first year (25.3%). Neither induction or maintenance immunosuppression were associated with early OI hospitalization (all p > .05). The highest risk of early OI was seen with primary sclerosing cholangitis (aHR 1.74; p = .003 overall). Steroid-based and mechanistic target of rapamycin inhibitor-based immunosuppression at 1 year post LT were independently associated with increased late OI (p < .001 overall).</p><p><strong>Conclusion: </strong>This study found OI hospitalizations to be relatively common among LT recipients and frequently occur later than previously reported. Immunosuppression regimen may be an important modifiable risk factor for late OIs.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-06-17DOI: 10.1111/tid.14297
Sara W Dong, Jeremey Walker, Saman Nematollahi, Nathanial S Nolan, Jonathan H Ryder
Organic digital education (ODE) includes online medical education content that can take various forms, such as blogs, social media, videos, podcasts, or infographics. Multimedia ODE platforms have unique benefits and have quickly become an essential part of medical education. Modern medical educators with competency in digital teaching modalities can leverage these for teaching as well as career development and dissemination of scientific research. The ID Digital Institute is a digital education program with a curriculum designed to equip infectious diseases (ID) professionals with the skills to appraise, create, curate, and integrate ODE into their teaching and career. We share the structure, content, and lessons learned from the ID Digital Institute program. We also illustrate how digital education skills can present unique opportunities to align with current and future transplant and immunocompromised host infectious diseases education efforts.
有机数字教育(ODE)包括各种形式的在线医学教育内容,如博客、社交媒体、视频、播客或信息图表。多媒体 ODE 平台具有独特的优势,已迅速成为医学教育的重要组成部分。具备数字教学模式能力的现代医学教育工作者可以利用这些平台进行教学、职业发展和科学研究传播。传染病数字研究所是一个数字教育项目,其课程旨在培养传染病(ID)专业人员的技能,使他们能够评估、创建、策划并将 ODE 融入其教学和职业生涯。我们分享了 ID 数字学院项目的结构、内容和经验教训。我们还说明了数字教育技能如何为当前和未来的移植和免疫受损宿主传染病教育工作提供独特的机会。
{"title":"The ID Digital Institute: Building a digital education toolset and community.","authors":"Sara W Dong, Jeremey Walker, Saman Nematollahi, Nathanial S Nolan, Jonathan H Ryder","doi":"10.1111/tid.14297","DOIUrl":"10.1111/tid.14297","url":null,"abstract":"<p><p>Organic digital education (ODE) includes online medical education content that can take various forms, such as blogs, social media, videos, podcasts, or infographics. Multimedia ODE platforms have unique benefits and have quickly become an essential part of medical education. Modern medical educators with competency in digital teaching modalities can leverage these for teaching as well as career development and dissemination of scientific research. The ID Digital Institute is a digital education program with a curriculum designed to equip infectious diseases (ID) professionals with the skills to appraise, create, curate, and integrate ODE into their teaching and career. We share the structure, content, and lessons learned from the ID Digital Institute program. We also illustrate how digital education skills can present unique opportunities to align with current and future transplant and immunocompromised host infectious diseases education efforts.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher Alexander Hinze, Felix Nikolaus Lennartz, Jan Christoph Gras, Susanne Simon, Jens Gottlieb
{"title":"A rapid point-of-care polymerase chain reaction test in suspected viral respiratory tract infection after lung transplantation - A single-center experience.","authors":"Christopher Alexander Hinze, Felix Nikolaus Lennartz, Jan Christoph Gras, Susanne Simon, Jens Gottlieb","doi":"10.1111/tid.14349","DOIUrl":"https://doi.org/10.1111/tid.14349","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Preservation techniques that maintain the viability of an organ graft between retrieval from the donor and implantation into the recipient remain a critical aspect of solid organ transplantation. While traditionally preservation is accomplished with static cold storage, advances in ex vivo dynamic machine perfusion, both hypothermic and normothermic, have allowed for prolongation of organ viability and recovery of marginal organs effectively increasing the usable donor pool. However, the use of these novel machine perfusion technologies likely exposes the recipient to additional infectious risk either through clonal expansion of pathogens derived during organ recovery or de novo exogenous acquisition of pathogens while the organ remains on the machine perfusion circuit. There is a paucity of high-quality studies that have attempted to quantify infection risk, although it appears that prolonging the time on the machine perfusion circuit and normothermic parameters increases the risk of infection. Conversely, the use of ex vivo machine perfusion unlocks new opportunities to detect and treat donor-derived infections before implantation into the recipient. This review seeks to reveal how the use of ex vivo machine perfusion strategies may augment the risk of infection in the organ recipient as well as outline ways that this technology could be leveraged to enhance our ability to manage donor-derived infections.
{"title":"Impact of machine perfusion on transplant infectious diseases: New challenges and opportunities.","authors":"Andrew Purssell, Deepali Kumar","doi":"10.1111/tid.14348","DOIUrl":"https://doi.org/10.1111/tid.14348","url":null,"abstract":"<p><p>Preservation techniques that maintain the viability of an organ graft between retrieval from the donor and implantation into the recipient remain a critical aspect of solid organ transplantation. While traditionally preservation is accomplished with static cold storage, advances in ex vivo dynamic machine perfusion, both hypothermic and normothermic, have allowed for prolongation of organ viability and recovery of marginal organs effectively increasing the usable donor pool. However, the use of these novel machine perfusion technologies likely exposes the recipient to additional infectious risk either through clonal expansion of pathogens derived during organ recovery or de novo exogenous acquisition of pathogens while the organ remains on the machine perfusion circuit. There is a paucity of high-quality studies that have attempted to quantify infection risk, although it appears that prolonging the time on the machine perfusion circuit and normothermic parameters increases the risk of infection. Conversely, the use of ex vivo machine perfusion unlocks new opportunities to detect and treat donor-derived infections before implantation into the recipient. This review seeks to reveal how the use of ex vivo machine perfusion strategies may augment the risk of infection in the organ recipient as well as outline ways that this technology could be leveraged to enhance our ability to manage donor-derived infections.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ines Ushiro‐Lumb, Christie Geoghegan, Olive McGowan, Richard Baker
BackgroundA biovigilance program that has oversight of the entire organ and tissue donation and transplantation pathways underpins the quality and safety system in the United Kingdom.MethodA synopsis of the microbiological characterization of potential deceased organ donors and the processes for notification and investigation of possible donor‐derived infections are described. A summary of the outcome of investigations performed over a 10‐year period and a subset data frame of 5 years showing the proportion of infection incidents in relation to other incident types are also presented.ConclusionA single, centralized system overseeing the entire donation and transplantation pathway has become an essential part of transplantation practice across the United Kingdom. Revision of processes and management options, awareness of clinical conditions, and review of guidance are some examples of benefits gained over time. Transmission figures provided reflect the UK setting; these should be interpreted in context, as donor and recipient epidemiology differs across regions and nations. Despite a well‐established system in place, under reporting of cases continues to occur, with ongoing efforts to reassure professionals and patients of the true benefits of biovigilance in driving improvements in practice and patient outcomes. image
{"title":"Perspectives on biovigilance and transmission of infection of donor origin in deceased organ donation—The evolving scenario in the United Kingdom","authors":"Ines Ushiro‐Lumb, Christie Geoghegan, Olive McGowan, Richard Baker","doi":"10.1111/tid.14351","DOIUrl":"https://doi.org/10.1111/tid.14351","url":null,"abstract":"BackgroundA biovigilance program that has oversight of the entire organ and tissue donation and transplantation pathways underpins the quality and safety system in the United Kingdom.MethodA synopsis of the microbiological characterization of potential deceased organ donors and the processes for notification and investigation of possible donor‐derived infections are described. A summary of the outcome of investigations performed over a 10‐year period and a subset data frame of 5 years showing the proportion of infection incidents in relation to other incident types are also presented.ConclusionA single, centralized system overseeing the entire donation and transplantation pathway has become an essential part of transplantation practice across the United Kingdom. Revision of processes and management options, awareness of clinical conditions, and review of guidance are some examples of benefits gained over time. Transmission figures provided reflect the UK setting; these should be interpreted in context, as donor and recipient epidemiology differs across regions and nations. Despite a well‐established system in place, under reporting of cases continues to occur, with ongoing efforts to reassure professionals and patients of the true benefits of biovigilance in driving improvements in practice and patient outcomes. <jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http://www.w3.org/1999/xlink\" mimetype=\"image/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic/tid14351-gra-0001-m.png\"><jats:alt-text>image</jats:alt-text></jats:graphic></jats:boxed-text>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141770557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Russell Leong, Trey Richardson, Richard LaRue, Beatrice P. Concepcion
{"title":"Mystery lung mass in a kidney transplant recipient","authors":"Russell Leong, Trey Richardson, Richard LaRue, Beatrice P. Concepcion","doi":"10.1111/tid.14353","DOIUrl":"https://doi.org/10.1111/tid.14353","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141770556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jan Van Slambrouck, Katrien Lagrou, Laurens J Ceulemans
{"title":"A role for extensive SARS-CoV-2 virological assessment of donor and recipient in lung transplantation.","authors":"Jan Van Slambrouck, Katrien Lagrou, Laurens J Ceulemans","doi":"10.1111/tid.14339","DOIUrl":"https://doi.org/10.1111/tid.14339","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katya Prakash, Kapil K Saharia, Andrew Karaba, Nancy Law, Fritzie S Albarillo, Tirdad T Zangeneh, Paolo Grossi, Rachel Miller, Monica Slavin, Shmuel Shoham, Michael Ison, Ricardo M La Hoz, John W Baddley
Background: The purpose of this study was to understand how transplant infectious disease (TID) physicians assess a potential donor with known or suspected infection and describe posttransplant management.
Methods: We designed a survey of 10 organ offer scenarios and asked questions pertaining to organ acceptability for transplantation and management posttransplant. The survey was distributed to TID clinicians via transplant society listservs and email. Responses were recorded in REDCap, and descriptive statistics were employed.
Results: One hundred thirteen infectious disease physicians responded to the survey, of whom 85 completed all cases. Respondents were generally in agreement regarding organ acceptability, although some divergence was seen when evaluating lungs from donors with influenza, tuberculosis, or multidrug-resistant Acinetobacter infection. Posttransplant management showed more variation. Areas of optimization were identified: (1) Further understanding of where risk-mitigation strategies within the donor offer process may improve donor acceptability and therefore organ utilization; (2) importance of recipient considerations in assessing degree of infectious risk; and (3) gaps in evidenced-based data regarding optimal posttransplant management of recipients.
Conclusion: Evaluation of donor offers by TID clinicians is a complex process. Although the survey does not itself serve to make recommendations regarding best practices, it highlights areas where generation of data to inform acceptance and management practices may allow for improved organ utilization and recipient management.
背景:本研究旨在了解移植感染性疾病(TID)医生如何评估已知或疑似感染的潜在供体,并描述移植后的管理:本研究的目的是了解移植传染病(TID)医生如何评估已知或疑似感染的潜在供体并描述移植后的管理:我们设计了一份包含 10 种器官提供情况的调查表,并提出了与器官移植的可接受性和移植后管理相关的问题。调查表通过移植协会列表服务器和电子邮件分发给 TID 临床医生。调查结果:共有 113 名传染病医生回复了调查,其中 85 人完成了所有病例。受访者对器官可接受性的看法基本一致,但在评估患有流感、肺结核或耐多药醋酸杆菌感染的捐献者的肺时出现了一些分歧。移植后管理方面的差异更大。已确定的优化领域包括(1)进一步了解供体提供过程中的风险缓解策略可提高供体的可接受性,从而提高器官利用率;(2)受体因素在评估感染风险程度中的重要性;以及(3)有关受体移植后最佳管理的循证数据存在差距:TID 临床医生对捐献者意愿的评估是一个复杂的过程。虽然这项调查本身并不能为最佳实践提供建议,但它强调了一些领域,在这些领域中,数据的生成可以为接受和管理实践提供依据,从而提高器官利用率和受者管理水平。
{"title":"Minimizing risk while maximizing opportunity: The infectious disease organ offer process survey.","authors":"Katya Prakash, Kapil K Saharia, Andrew Karaba, Nancy Law, Fritzie S Albarillo, Tirdad T Zangeneh, Paolo Grossi, Rachel Miller, Monica Slavin, Shmuel Shoham, Michael Ison, Ricardo M La Hoz, John W Baddley","doi":"10.1111/tid.14342","DOIUrl":"https://doi.org/10.1111/tid.14342","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to understand how transplant infectious disease (TID) physicians assess a potential donor with known or suspected infection and describe posttransplant management.</p><p><strong>Methods: </strong>We designed a survey of 10 organ offer scenarios and asked questions pertaining to organ acceptability for transplantation and management posttransplant. The survey was distributed to TID clinicians via transplant society listservs and email. Responses were recorded in REDCap, and descriptive statistics were employed.</p><p><strong>Results: </strong>One hundred thirteen infectious disease physicians responded to the survey, of whom 85 completed all cases. Respondents were generally in agreement regarding organ acceptability, although some divergence was seen when evaluating lungs from donors with influenza, tuberculosis, or multidrug-resistant Acinetobacter infection. Posttransplant management showed more variation. Areas of optimization were identified: (1) Further understanding of where risk-mitigation strategies within the donor offer process may improve donor acceptability and therefore organ utilization; (2) importance of recipient considerations in assessing degree of infectious risk; and (3) gaps in evidenced-based data regarding optimal posttransplant management of recipients.</p><p><strong>Conclusion: </strong>Evaluation of donor offers by TID clinicians is a complex process. Although the survey does not itself serve to make recommendations regarding best practices, it highlights areas where generation of data to inform acceptance and management practices may allow for improved organ utilization and recipient management.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}