scholarly journals COVID-19 Severity and Mortality in Solid Organ Transplantation: Differences between Liver, Heart, and Kidney Recipients

2021 ◽  
Vol 2 (3) ◽  
pp. 296-303 ◽  
Author(s):  
Ricardo Wesley Alberca ◽  
Gabriela Gama Freire Alberca ◽  
Lucas Chaves Netto ◽  
Raquel Leão Orfali ◽  
Sarah Cristina Gozzi-Silva ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Kidney Transplant ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Control Group ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Solid Organ Transplant Recipients ◽  
Liver Transplant Recipients

The infection by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can generate a wide spectrum of clinical manifestations ranging from asymptomatic to severe respiratory and systemic disease with coagulation disorder named coronavirus disease 2019 (COVID-19). Patients with comorbidities have been identified as risk groups for severe COVID-19, also having a higher death risk. Previous reports have conflicting results regarding if solid organ transplant recipients present an increased risk for COVID-19. Nevertheless, previous investigations failed to distinguish between different organs received or made a longitudinal investigation on those patients. We recruited 39 solid organ transplant recipients: 25 kidney transplant recipients, 7 heart transplant recipients, and 7 liver transplant recipients and 25 age-matched non-transplant COVID-19 patients without comorbidities (control group) and compared daily laboratory data in addition to performing survival analysis. Heart and kidney transplant recipients presented an increase in several COVID-19 severity-associated biomarkers, such as neutrophil-to-lymphocyte ratio and thrombocytopenia, in comparison to the control group and liver transplant recipients. Heart and kidney transplant recipients also presented an increase in the need for intensive care and invasive mechanical ventilation during the disease’s course. Importantly, heart and kidney transplant recipients presented a higher mortality rate in comparison to liver transplant recipients and non-transplant recipients. In our cohort, heart and kidney transplant recipients presented a difference in clinical characteristics and survival rate in comparison to liver transplant recipients. Further investigation involving immune response to SARS-CoV-2 in solid organ recipients should consider and separate patients according to the organ grafted.

scholarly journals Humoral Response to SARS-Cov-2 Vaccination in Liver Transplant Recipients–A Single-Center Experience

Vaccines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 738
Author(s):  
Jassin Rashidi-Alavijeh ◽  
Alexandra Frey ◽  
Moritz Passenberg ◽  
Johannes Korth ◽  
Jaqueline Zmudzinski ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Organ Transplant ◽  
Humoral Response ◽  
Solid Organ Transplant ◽  
Control Group ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Single Center Experience ◽  
Solid Organ Transplant Recipients

Vaccination against SARS-CoV-2 infection is currently approved and shows favorable outcomes, but little known about antibody responses in solid organ transplant recipients, since these patients are known to have an impaired immune response upon vaccination and have not been included in admission studies. We therefore analyzed immunogenicity in 43 liver transplant (LT) recipients in a median of 15 days (IQR, 12–24) after receiving two doses of the mRNA-based SARS-CoV-2 vaccine BNT162b2 following the standard protocol, and compared these results to a control group consisting of 20 healthcare workers (HCWs). Thirty-four of the 43 (79%) LT recipients developed antibodies, compared to 20 out of 20 (100%) in the control group (p = 0.047). The median SARS-CoV-2 IgG titer was significantly lower in the LT recipients compared to the control group (216 vs. >2080 BAU/mL, p = 0.0001). Age and sex distribution was similar in the LT patients that developed antibodies after vaccination compared to those who did not. Interestingly, the patients who received mycophenolate mofetil exhibited a reduced vaccination response compared to the other LT patients (5 of 11 (45.5%) vs. 29 of 32 (90.6%), p = 0.004). In conclusion, our data reveal lower immunogenicity of SARS-CoV-2 vaccine BNT162b2 in LT patients compared to the control group, but still show superior results compared to other solid organ transplant recipients reported so far.

scholarly journals Combination checkpoint blockade for metastatic cutaneous malignancies in kidney transplant recipients

2020 ◽  
Vol 8 (1) ◽  
pp. e000908 ◽  
Author(s):  
Megan H Trager ◽  
Shana M Coley ◽  
Geoffrey Dube ◽  
Shaheer Khan ◽  
Matthew Ingham ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Function ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Cutaneous Squamous Cell Carcinoma ◽  
Solid Organ ◽  
Combination Immunotherapy ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Solid Organ Transplant Recipients

BackgroundImmune checkpoint blockade has emerged as a highly effective treatment for patients with metastatic melanoma and cutaneous squamous cell carcinoma. Nivolumab blocks the interactions between programmed cell death protein 1 and programmed death ligand 1 allowing for activation of a latent immune response against the malignancy. Ipilimumab binds to and blocks cytotoxic T-lymphocyte-associated protein 4, alleviating the negative regulation of T-cell activation that is mediated by that checkpoint. Combination therapy with nivolumab and ipilimumab is associated with longer overall survival at 5 years compared with nivolumab monotherapy. Solid organ transplant recipients have a significantly higher risk of malignancies compared with the general population. There is limited data surrounding the efficacy of combination immunotherapy in solid organ transplant recipients, as these patients were excluded from seminal trials due to risk of organ rejection.Case presentationsHere we present four cases of combination immunotherapy in kidney transplant recipients. Three patients had metastatic melanoma, and one patient had metastatic cutaneous squamous cell carcinoma. Two patients had radiographic responses from immunotherapy, one patient had stable disease, and one patient had disease progression. Only one patient had biopsy-proven rejection. At last follow-up, three patients had functioning grafts, though one required hemodialysis after treatment, and one patient succumbed to disease, but graft function remained intact throughout her course.ConclusionsThese cases describe the use of ipilimumab and nivolumab combination immunotherapy for cutaneous malignancies in kidney transplant recipients. They highlight the potential to preserve kidney graft function while effectively treating the disease.Trial Registration numberNCT03816332.

scholarly journals FusariumInfection in a Kidney Transplant Recipient Successfully Treated with Voriconazole

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Ahmed M. Alkhunaizi ◽  
Ali M. Bazzi ◽  
Ali A. Rabaan ◽  
Elwaleed A. Ahmed
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
High Mortality ◽  
Kidney Transplant Recipient ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

Fusariuminfections in solid-organ transplant recipients are rare and carry high mortality. We report a case of a kidney transplant recipient who developed infection withFusariumspecies. The patient received treatment with oral voriconazole for five months with good response.

scholarly journals Safety of Valganciclovir Dosed 450 MG Three Times Weekly for Cytomegalovirus Prophylaxis in Solid Organ Transplant Recipients Requiring Hemodialysis

2021 ◽  
Author(s):  
Danielle Ecabert ◽  
Christine Pham ◽  
Brett J Pierce ◽  
William L Musick ◽  
Duc T Nguyen ◽  
...  
Keyword(s):  
Renal Function ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Severe Neutropenia ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cmv Infection ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

Abstract Background Valganciclovir is the most commonly used antiviral for cytomegalovirus (CMV) prophylaxis in solid organ transplant recipients. However, there are limited clinical outcomes-supported data available to guide valganciclovir dosing in patients on hemodialysis (HD). This study aimed to assess the safety of our institution’s current dosing strategy of valganciclovir 450 mg three times weekly post-HD. Methods This was a single-center retrospective review of all adult non-kidney transplant recipients between May 2016 and June 2018. Patients with end stage renal disease requiring HD for >28 days post-transplant receiving valganciclovir 450 mg three times weekly post-HD were matched with non-HD patients receiving valganciclovir prophylaxis dosed per renal function. The primary endpoints were incidence of leukopenia, neutropenia, and thrombocytopenia while on valganciclovir prophylaxis. Results A total of 465 non-kidney transplants were performed during the study period, with 37 patients included in the HD group who were matched to 111 control patients in the non-HD group. Liver transplant recipients comprised 84% and 72% of each group, with none being CMV D+/R-. The rates of leukopenia (51.4% vs. 51.4%, p = 1.00), severe neutropenia (ANC <500 cells/µL, 15.8% vs. 14.0%, p = 0.85), and thrombocytopenia (24.3% vs. 20.7%, p = 0.64) were similar in both HD and non-HD groups. There were no cases of CMV infection while on valganciclovir prophylaxis in either group. Conclusions Valganciclovir 450 mg three times weekly was found to have similar rates of leukopenia, neutropenia, thrombocytopenia, and CMV infection in comparison to valganciclovir dosed per renal function in non-HD transplant recipients.

Impact of a Clinical Solid Organ Transplant Pharmacist on Tacrolimus Nephrotoxicity, Therapeutic Drug Monitoring, and Institutional Revenue Generation in Adult Kidney Transplant Recipients

2016 ◽  
Vol 26 (4) ◽  
pp. 314-321 ◽  
Author(s):  
Shawn P. Griffin ◽  
Joelle E. Nelson
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Kidney Transplant ◽  
Drug Monitoring ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Therapeutic Drug ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Adult Kidney

Context: Tacrolimus requires close therapeutic drug monitoring (TDM) to ensure efficacy and minimize adverse effects. Pharmacists are uniquely positioned on transplant teams to interpret levels and recommend therapy modifications. Their impact in the immediate postoperative setting has not been described previously. Objective: To evaluate the impact of a clinical solid organ transplant pharmacist on nephrotoxicity, TDM, and revenue generation in adult kidney transplant recipients on tacrolimus. Design, Setting, and Patients: Retrospective assessment of adult kidney transplant recipients at University of Florida Health Shands Hospital. Intervention: A transplant pharmacist rounded 5 days a week and made medication recommendations on transplant recipients—including tacrolimus dose modifications based on levels. Pharmacy services were expanded to include medication reconciliation, medication counseling, and delivery of discharge medications to bedside. Main Outcome Measure: Incidence of nephrotoxicity during tacrolimus exposure. Results: Of the 70 kidney transplant recipients in the postpharmacist cohort, 18 (25.7%) experienced nephrotoxicity while on tacrolimus, compared to 18 (25%) of the 72 in the prepharmacist cohort ( P = .922). A significantly greater proportion of recipients who experienced nephrotoxicity were male, had hypertension, or experienced delayed or slow graft function. The rate of appropriately drawn tacrolimus troughs significantly increased from 23.4% to 30.3% in the postpharmacist cohort ( P < .001). The median outpatient pharmacy revenue generated per recipient significantly increased from US$345.49 (interquartile range [IQR]: 0-4727.56) to US$4834.95 per recipient (IQR: 3592.78-6224.60; P < .001). The length of stay (7 days, IQR: 6-9, vs 8 days, IQR: 6-9; P = .107) and the 30-day readmission rate were similar between groups (20.8% vs 21.4%; P = .931).

scholarly journals A unique case of Miller Fisher-Guillain-Barré overlap syndrome in a liver transplant recipient

2021 ◽  
Author(s):  
Claudia Ramirez-Sanchez ◽  
Rehan Syed ◽  
Angela Meier ◽  
Jamie Nicole LaBuzetta ◽  
Diana J. Hylton ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Overlap Syndrome ◽  
Guillain Barre Syndrome ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients ◽  
Guillain Barré

AbstractGuillain-Barré syndrome (GBS) is an ascending demyelinating polyneuropathy often associated with recent infection. Miller Fisher syndrome represents a variant with predominant facial and cranial nerve involvement, although Miller Fisher and Guillain-Barré overlap syndromes can occur. Guillain-Barré spectrum syndromes have been thought to be rare among solid organ transplant recipients. We describe an immunocompromised patient with a liver transplant who presented with ophthalmoplegia and bulbar deficits. His symptoms rapidly progressed to a state of descending paralysis involving the diaphragm; he then developed acute respiratory failure and eventually developed quadriparesis. Electromyography and a nerve conduction study demonstrated a severe sensorimotor axonal polyneuropathy consistent with Miller Fisher variant Guillain-Barré syndrome. Despite several negative nasopharyngeal swabs for COVID-19 polymerase chain reaction, a serology for SARS-CoV-2 IgG was positive. He was diagnosed with Miller Fisher-Guillain-Barré overlap syndrome with rapid recovery following treatment with plasma exchange. Although Guillain-Barré is a rare complication in solid organ transplant recipients, this case highlights the importance of rapid diagnosis and treatment of neurologic complications in transplant patients. Furthermore, it demonstrates a possible case of neurological complications from COVID-19 infection.

Single Center Analysis of Incidence and Outcome of COVID-19 Infection in Solid Organ Transplant Recipients

2021 ◽  
Vol 15 (5) ◽  
pp. 1064-1067
Author(s):  
M Asim Rana ◽  
M Ahad Qayyum ◽  
Amer Latif ◽  
M Afzal Bhatti ◽  
Syed Arsalan Khalid ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Interquartile Range ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Transplant Patients ◽  
Solid Organ Transplant Recipients ◽  
Overall Mortality

Aim: To determine overall mortality, outcome and mortality of COVID 19 infection in solid organ transplant pts. Study design: Retrospective study. Place and duration of study: Department of Medicine, Bahria International Hospital, Lahore, Pakistan15thApril 2020 to 31stDecember 2020. Methodology: Twenty-three patients 18 out of which were kidney transplant recipients while 5 were liver transplant recipients. All the solid organ transplant patients who were admitted with Sars CoV2 (Corona virus) infection were recorded. Their charts were reviewed regarding clinical course, management, and outcome of COVID-19 infection in recipients of solid organ (liver and kidney) transplant. Results: Mean age was 44.8±10.9 years. Median time lapsed from transplant surgery to admission was 2.88 years (interquartile range 2.25, 7.33). Median hospital stay was 15 days (interquartile range 13, 28). All 23 patients were admitted and managed, with 17 (73.91%) admitted in ICU. Over half of the cases (58.2%) presented with raised serum creatinine due to acute kidney injury. 80% received azithromycin, Tocilizumab and 50% received Remdesivir.Antimetabolites with or without calcineurin inhibitors were held or reduced. A total of 5 patients had died while the others 18 patients (78.26%) were discharged home. Conclusion: There is a theoretical high risk of getting Sars CoV-2 infection in post-transplant patients but we did not find any increase in overall mortality in solid organ transplant recipients receiving immunosuppressive therapy who acquired Sars CoV2 infection as compared with mortality in the general patients with SARS-CoV-2. We had favorable outcome in solid organ transplant COVID 19 patients in our center. Keywords: Incidence, Outcome, COVID-19, Infection

scholarly journals A randomized controlled trial of comparative effectiveness between the 2 dose and 3 dose regimens of hepatitis a vaccine in kidney transplant recipients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Thaninee Prasoppokakorn ◽  
Jakapat Vanichanan ◽  
Roongruedee Chaiteerakij ◽  
Kamonwan Jutivorakool ◽  
Suwasin Udomkarnjananun ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Dose Regimen ◽  
Hepatitis A ◽  
Controlled Trial ◽  
Seroconversion Rate ◽  
Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Solid Organ Transplant Recipients

AbstractHepatitis A virus (HAV) is able to cause a spectrum of illnesses ranging from no symptom to fulminant hepatitis which may lead to acute kidney injury. Although hepatitis A vaccine is recommended in non-immune solid organ transplant recipients who live in or travel to endemic areas, the standard 2-dose vaccination regimen demonstrated less favorable immunogenicity among these population. The 3-dose regimen showed higher response rate and immune durability in patients with human immunodeficiency virus. However, this strategy has never been studied in solid organ transplant recipients. A single-center, open-labeled, computer-based randomized controlled trial (RCT) with a 2:1 allocation ratio was conducted from August 2017 to December 2018. The study compared the seroconversion rate after receiving 2- or 3-dose regimen of hepatitis A vaccine at 0, 6 and 0, 1, 6 months, respectively, in non-immune kidney transplant recipients. A total of 401 adult kidney transplant recipients were screened for anti-HAV IgG and 285 subjects had positive results so the seroprevalence was 71.1%. Of 116 seronegative recipients, 93 (80.2%) completed vaccination; 60 and 33 participants completed 2- and 3-dose vaccination, respectively. The baseline characteristics were comparable between both groups. The seroconversion rate at 1 month after vaccination was 51.7% in the standard 2-dose regimen and 48.5% in the 3-dose regimen (p = 0.769). Overall, the seroconversion rate appeared to be associated with high estimated glomerular infiltration rate, high serum albumin, and low intensity immunosuppressive regimen. Seroconversion rate after hepatitis A vaccination in kidney transplant recipients was less favorable than healthy population. Three-dose regimen did not show superior benefit over the standard 2-dose regimen. Other strategies of immunization may increase immunogenicity among kidney transplant recipients.

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