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Journal of the American Academy of... Jun 2018Graft-versus-host-disease (GVHD) after solid organ transplantation (SOT) is extremely rare.
BACKGROUND
Graft-versus-host-disease (GVHD) after solid organ transplantation (SOT) is extremely rare.
OBJECTIVE
To investigate the dermatologic manifestations and clinical outcomes of SOT GVHD.
METHODS
Systematic literature review of SOT GVHD.
RESULTS
After full-text article review, we included 61 articles, representing 115 patients and 126 transplanted organs. The most commonly transplanted organ was the liver (n = 81). Among 115 patients, 101 (87.8%) developed skin involvement. The eruption appeared an average of 48.3 days (range, 3-243 days) posttransplant and was pruritic in 5 of 101 (4.9%) cases. The eruption was described as morbilliform in 2 patients (1.9%), confluent in 6 (5.9%), and desquamative in 4 (3.9%) cases. In many cases, specific dermatologic descriptions were lacking. The mortality rate was 72.2%. Relative time of death was reported in 23 patients who died during the follow-up period. These patients died an average of 99.2 days (range, 22-270 days) posttransplant, or 50.9 days after the appearance of dermatologic symptoms. Frequent causes of death were sepsis and multiorgan failure.
LIMITATIONS
Incomplete descriptions of skin findings and potential publication bias resulting in publication of only the most severe cases.
CONCLUSIONS
GVHD is a potentially fatal condition that can occur after SOT and often presents with a skin rash. We recommend that dermatologists have a low threshold to consider and pursue this diagnosis in the setting of post-SOT skin eruption.
Topics: Female; Graft Rejection; Graft Survival; Graft vs Host Disease; Humans; Kidney Transplantation; Liver Transplantation; Lung Transplantation; Male; Organ Transplantation; Prognosis; Risk Assessment; Severity of Illness Index; Skin Diseases; Survival Analysis
PubMed: 29288097
DOI: 10.1016/j.jaad.2017.12.050 -
Cancers Mar 2021Immunosuppressive therapy after solid organ transplantation leads to the development of cancer in many recipients. Analysis of the occurrence of different types of de... (Review)
Review
Immunosuppressive therapy after solid organ transplantation leads to the development of cancer in many recipients. Analysis of the occurrence of different types of de novo carcinomas in relation to specific immunosuppressive drugs may give insight into their carcinogenic process and carcinogenesis in general. Therefore, a systematic search was performed in Embase and PubMed. Studies describing over five de novo carcinomas in patients using immunosuppressive drugs after solid organ transplantation were included. Incidence per 1000 person-years was calculated with DerSimonian-Laird random effects model and odds ratio for developing carcinomas with the Mantel-Haenszel test. Following review of 5606 papers by title and abstract, a meta-analysis was conducted of 82 studies. The incidence rate of de novo carcinomas was 8.41. Patients receiving cyclosporine developed more de novo carcinomas compared to tacrolimus (OR1.56, 95%CI 1.00-2.44) and mycophenolate (OR1.26, 95%CI 1.03-1.56). Patients receiving azathioprine had higher odds to develop de novo carcinomas compared to mycophenolate (OR3.34, 95%CI 1.29-8.65) and head and neck carcinoma compared to tacrolimus (OR3.78, 95%CI 1.11-12.83). To conclude, patients receiving immunosuppressive drugs after solid organ transplantation have almost a 20-fold increased likelihood of developing carcinomas, with the highest likelihood for patients receiving cyclosporine A and azathioprine. Looking into altered immune pathways affected by immunosuppressive drugs might lead to better understanding of carcinogenesis in general.
PubMed: 33807849
DOI: 10.3390/cancers13051122 -
Transplant International : Official... 2022Pregnancy after solid organ transplantation (SOT) has potential risks for the offspring. Most existing research focused on short-term pregnancy outcomes. The aim of this... (Review)
Review
Pregnancy after solid organ transplantation (SOT) has potential risks for the offspring. Most existing research focused on short-term pregnancy outcomes. The aim of this systematic review was to evaluate available data concerning longer term outcomes (>1 year) of these children. A systematic literature search, following PRISMA guidelines, of PubMed and Embase was performed from the earliest date of inception through to 6th April 2022. Publications on all types of (combined) SOT were eligible for inclusion. In total, 53 articles were included. The majority assessed offspring after kidney (78% of offspring) or liver transplantation (17% of offspring). 33 studies included offspring aged >4 years and five offspring aged >18 years. One study was included on fathers with SOT. The majority of the 1,664 included children after maternal SOT had normal intellectual, psychomotor, and behavioral development. Although prematurity and low birth weight were commonly present, regular growth after 1 year of age was described. No studies reported opportunistic or chronic infections or abnormal response to vaccinations. In general, pregnancy after SOT appears to have reassuring longer term outcomes for the offspring. However, existing information is predominantly limited to studies with young children. Longer prospective studies with follow-up into adulthood of these children are warranted.
Topics: Adult; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Organ Transplantation; Parents; Pregnancy; Pregnancy Outcome; Prospective Studies
PubMed: 35992748
DOI: 10.3389/ti.2022.10565 -
Journal of the Intensive Care Society Aug 2021Non-valvular cardiac aspergillosis is a rare infection of the pericardium, myocardium or endocardium and is associated with a high mortality. There is a paucity of... (Review)
Review
INTRODUCTION
Non-valvular cardiac aspergillosis is a rare infection of the pericardium, myocardium or endocardium and is associated with a high mortality. There is a paucity of reports of non-valvular cardiac aspergillosis in critically ill and solid organ transplant (SOT) patients. The majority of cases have been reported in haemato-oncology patients, some of whom have undergone a bone marrow transplant.
OBJECTIVES
We describe four cases affected by non-valvular cardiac aspergillosis in the intensive care setting including a systematic review of this extremely rare infection which is associated with high mortality.
RESULTS
All four-patients died but presented with varying clinical, radiological and microbiological evidence of the disease. Three patients presented following complications after solid organ transplantation, two in the context of acute liver failure and emergency liver transplant and one several years after a double lung transplant. The last patient presented with necrotising gall stone pancreatitis, multi-organ failure and subsequently a prolonged intensive care unit (ICU) stay. On review of the literature, January 1955 to July 2019, 45 cases were identified, with different risk factors, clinical and radiological manifestations, treatment regimen and outcome.
CONCLUSION
Antemortem diagnosis of cardiac aspergillosis is difficult and rare, with no cases reporting positive blood culture results. Galactomannan serology has poor sensitivity in solid organ transplant patients, further reduced by prophylactic antimicrobial treatment, which is common in the ICU setting especially post-transplant patients. Due to the scarcity of cases, treatment is extrapolated from invasive aspergillosis management, with emphasis on early treatment with combination therapy.
PubMed: 34422107
DOI: 10.1177/1751143720936821 -
Revista Panamericana de Salud Publica =... 2018To evaluate contraindications and precautions for the yellow fever vaccine (YFV) in risk populations. (Review)
Review
OBJECTIVE
To evaluate contraindications and precautions for the yellow fever vaccine (YFV) in risk populations.
METHODS
A literature review was conducted by searching PubMed for "yellow fever vaccine" and "adverse events" (AEs); 207 studies were found, and 43 of them met the inclusion criteria and were included in a systematic review.
RESULTS
The results for first dose of YFV in elderly patients were conflicting-some showed AEs while some showed benefits. Therefore, precaution and case-by-case decisionmaking for YFV in this population are advised. The same precautions are warranted for YFV in infants 6-8 months, with the vaccine contraindicated in those < 6 months old and safe after 9 months of age. YFV seems safe in the first trimester of pregnancy, and probably throughout gestation, as it was not associated with increased malformations. During breastfeeding, YFV continues to be controversial. The vaccine seems safe in people being treated with immunomodulatory or immunosuppressive therapy, people with immunosuppressive diseases, and solid organ and hematopoietic stem cell transplant patients; in stem cell transplants, however, a booster dose should only be applied once immunity is recovered. HlV-infected patients with a CD4+ count > 200 cells/mm do not have increased risk of AEs from YFV. Egg allergy vaccination protocols seem to provide a safe way to immunize these patients.
CONCLUSIONS
YFV safety has been confirmed based on data from many vaccination campaigns and multiple studies. AEs seem more frequent after a first-time dose, mainly in risk groups, but this review evaluated YFV in several of the same risk groups and the vaccine was found to be safe in most of them.
PubMed: 31093103
DOI: 10.26633/RPSP.2018.75 -
Vaccines Jun 2023Solid organ transplant (SOT) recipients are at increased risk of COVID-19 infection because of their suppressed immunity. The available data show that COVID-19 vaccines... (Review)
Review
Solid organ transplant (SOT) recipients are at increased risk of COVID-19 infection because of their suppressed immunity. The available data show that COVID-19 vaccines are less effective in SOT recipients. We aimed to assess the cellular and humoral immunogenicity with an increasing the number of doses of COVID-19 vaccines in SOT recipients and to identify factors affecting vaccine response in this population. A systematic review and meta-analysis were conducted to identify ongoing and completed studies of humoral and cellular immunity following COVID-19 vaccines in SOT recipients. The search retrieved 278 results with 45 duplicates, and 43 records did not match the inclusion criteria. After title and abstract screening, we retained 189 records, and 135 records were excluded. The reasons for exclusion involved studies with immunocompromised patients (non-transplant recipients), dialysis patients, and individuals who had already recovered from SARS-CoV-2 infection. After full-text reading, 55 observational studies and randomized clinical trials (RCTs) were included. The proportion of responders appeared higher after the third, fourth, and fifth doses. The risk factors for non-response included older age and the use of mycophenolate mofetil, corticosteroids, and other immunosuppressants. This systematic review and meta-analysis demonstrates the immunogenicity following different doses of COVID-19 vaccines among SOT patients. Due to the low immunogenicity of vaccines, additional strategies to improve vaccine response may be necessary.
PubMed: 37514982
DOI: 10.3390/vaccines11071166 -
Experimental and Clinical... Feb 2022Our aim was to perform a comprehensive literature review on the pathogenesis of squamous anal cancerin patients after solid-organ transplant. Medical databases were... (Review)
Review
Our aim was to perform a comprehensive literature review on the pathogenesis of squamous anal cancerin patients after solid-organ transplant. Medical databases were consulted until June 1, 2020, for potentially relevant publications.All studies on pathogenesis of de novo anal squamous cell carcinoma in solid-organ transplant recipients were included. Two researchers independently performed study selection, quality assessment, and data extraction and analysis. Twenty-one studies were included.None ofthe selected papers had been solely focused on carcinogenesis. Most ofthe studies identified human papillomavirus infection and immunosuppression to be significantly correlated with the development of de novo anal cancer in adult solid organ transplant recipients. CD4+ T-cell depletion and inactivation oftumor suppressor pathways were mainly implicated. All solid-organ transplant recipients, especially those who were human papillomavirus positive, were shown to be at increased risk for the development of posttransplant anal cancer. Further studies are needed to determine the specific mechanisms of pathogenesis according to different solid-organ transplant populations.
Topics: Adult; Anus Neoplasms; Carcinogenesis; Carcinoma, Squamous Cell; Humans; Organ Transplantation; Transplant Recipients; Treatment Outcome
PubMed: 35282809
DOI: 10.6002/ect.2021.0412 -
Pathogens (Basel, Switzerland) Dec 2022, a rare, highly virulent filamentous fungus with high rates of intrinsic resistance to antifungals, has been associated with different types of infections in... (Review)
Review
BACKGROUND
, a rare, highly virulent filamentous fungus with high rates of intrinsic resistance to antifungals, has been associated with different types of infections in immunocompromised as well as immunocompetent individuals.
OBJECTIVE
To systematically address all relevant evidence regarding disseminated infections in the literature.
METHODS
We searched Medline via PubMed and Scopus databases through July 2022. We performed a qualitative synthesis of published articles reporting disseminated infections from in humans.
RESULTS
A total of 87 studies describing 142 cases were included in our systematic review. The pathogen was most frequently reported in disseminated infections in Spain (n = 47), Australia (n = 33), the USA (n = 21), and Germany (n = 10). Among 142 reported cases, 48.5% were males. Underlying conditions identified for the majority of patients included malignancy (72.5%), hemopoietic stem cell transplantation (23.2%), solid organ transplantation (16%), and AIDS (2%). Lungs, central nervous system, skin, eyes, heart and bones/joints were the most commonly affected organs. Neutropenia was recorded in 52% of patients. The mortality rate was as high as 87.3%.
CONCLUSIONS
To the best of our knowledge, this is the first systematic review conducted on disseminated infections due to this rare microorganism. Physicians should be aware that can cause a diversity of infections with high mortality and primarily affects immunocompromised and neutropenic patients.
PubMed: 36678415
DOI: 10.3390/pathogens12010067 -
Clinical Microbiology and Infection :... Feb 2024Whether trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis prevents nocardiosis in solid organ transplant (SOT) recipients is controversial. (Meta-Analysis)
Meta-Analysis Review
Trimethoprim-sulfamethoxazole significantly reduces the risk of nocardiosis in solid organ transplant recipients: systematic review and individual patient data meta-analysis.
BACKGROUND
Whether trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis prevents nocardiosis in solid organ transplant (SOT) recipients is controversial.
OBJECTIVES
To assess the effect of TMP-SMX in the prevention of nocardiosis after SOT, its dose-response relationship, its effect on preventing disseminated nocardiosis, and the risk of TMP-SMX resistance in case of breakthrough infection.
METHODS
A systematic review and individual patient data meta-analysis.
DATA SOURCES
MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science Core Collection, and Scopus up to 19 September 2023.
STUDY ELIGIBILITY CRITERIA
(a) Risk of nocardiosis between SOT recipients with and without TMP-SMX prophylaxis, or (b) sufficient details to determine the rate of TMP-SMX resistance in breakthrough nocardiosis.
PARTICIPANTS
SOT recipients.
INTERVENTION
TMP-SMX prophylaxis versus no prophylaxis.
ASSESSMENT OF RISK OF BIAS
Risk Of Bias In Non-randomized Studies-of Exposure (ROBINS-E) for comparative studies; dedicated tool for non-comparative studies.
METHODS OF DATA SYNTHESIS
For our primary outcome (i.e. to determine the effect of TMP-SMX on the risk of nocardiosis), a one-step mixed-effects regression model was used to estimate the association between the outcome and the exposure. Univariate and multivariable unconditional regression models were used to adjust for the potential confounding effects. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
RESULTS
Individual data from three case-control studies were obtained (260 SOT recipients with nocardiosis and 519 uninfected controls). TMP-SMX prophylaxis was independently associated with a significantly decreased risk of nocardiosis (adjusted OR = 0.3, 95% CI 0.18-0.52, moderate certainty of evidence). Variables independently associated with an increased risk of nocardiosis were older age, current use of corticosteroids, high calcineurin inhibitor concentration, recent acute rejection, lower lymphocyte count, and heart transplant. Breakthrough infections (66/260, 25%) were generally susceptible to TMP-SMX (pooled proportion 98%, 95% CI 92-100).
CONCLUSIONS
In SOT recipients, TMP-SMX prophylaxis likely reduces the risk of nocardiosis. Resistance appears uncommon in case of breakthrough infection.
Topics: Humans; Breakthrough Infections; Nocardia Infections; Organ Transplantation; Retrospective Studies; Transplant Recipients; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 37865337
DOI: 10.1016/j.cmi.2023.10.008 -
Gland Surgery Apr 2022Solid organ transplantation (SOT), which is the best remedy for end-stage organ failure, is accompanied by the risk of developing a postoperative malignant tumor. To...
BACKGROUND
Solid organ transplantation (SOT), which is the best remedy for end-stage organ failure, is accompanied by the risk of developing a postoperative malignant tumor. To date, assessments of the changes in the increased risk of thyroid cancer (TC) after SOT remain controversial. This study sought to reevaluate the risk of TC after SOT based on the latest literature. Our findings could improve the early diagnosis of tumors and the overall prognosis of patients after SOT.
METHODS
A computerized search of four major English-language databases (i.e., PubMed, EMBASE, Cochrane Library, and Web of Science) was performed to retrieve cohort studies on the risk of developing TC after SOT. The standardized incidence ratio (SIR) was used as the pooled-effect size and expressed as the 95% confidence interval (CI).
RESULTS
In total, 20 cohort studies, comprising 362,079 patients who underwent SOT, were included in the meta-analysis. We found that the patients all had an increased risk of developing TC after the transplantation of different solid organs, including the kidney, heart, lung, and liver (P<0.05), and patients had the highest risk of developing TC after kidney transplantation (SIR =5.28, 95% CI: 4.03-6.92, P<0.01).
CONCLUSIONS
Patients have an increased risk of developing TC after SOT. Aggressive and regular tumor screenings after SOT for early detection and timely treatment may improve patient prognosis.
PubMed: 35531105
DOI: 10.21037/gs-22-137