1
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Thomas SJ, Ouellette CP. Viral meningoencephalitis in pediatric solid organ or hematopoietic cell transplant recipients: a diagnostic and therapeutic approach. Front Pediatr 2024; 12:1259088. [PMID: 38410764 PMCID: PMC10895047 DOI: 10.3389/fped.2024.1259088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
Neurologic complications, both infectious and non-infectious, are frequent among hematopoietic cell transplant (HCT) and solid organ transplant (SOT) recipients. Up to 46% of HCT and 50% of SOT recipients experience a neurological complication, including cerebrovascular accidents, drug toxicities, as well as infections. Defects in innate, adaptive, and humoral immune function among transplant recipients predispose to opportunistic infections, including central nervous system (CNS) disease. CNS infections remain uncommon overall amongst HCT and SOT recipients, compromising approximately 1% of total cases among adult patients. Given the relatively lower number of pediatric transplant recipients, the incidence of CNS disease amongst in this population remains unknown. Although infections comprise a small percentage of the neurological complications that occur post-transplant, the associated morbidity and mortality in an immunosuppressed state makes it imperative to promptly evaluate and aggressively treat a pediatric transplant patient with suspicion for viral meningoencephalitis. This manuscript guides the reader through a broad infectious and non-infectious diagnostic differential in a transplant recipient presenting with altered mentation and fever and thereafter, elaborates on diagnostics and management of viral meningoencephalitis. Hypothetical SOT and HCT patient cases have also been constructed to illustrate the diagnostic and management process in select viral etiologies. Given the unique risk for various opportunistic viral infections resulting in CNS disease among transplant recipients, the manuscript will provide a contemporary review of the epidemiology, risk factors, diagnosis, and management of viral meningoencephalitis in these patients.
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Affiliation(s)
- Sanya J. Thomas
- Host Defense Program, Section of Infectious Diseases, Nationwide Children’s Hospital, Columbus, OH, United States
- Division of Infectious Diseases, Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, United States
| | - Christopher P. Ouellette
- Host Defense Program, Section of Infectious Diseases, Nationwide Children’s Hospital, Columbus, OH, United States
- Division of Infectious Diseases, Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, United States
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2
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Odenwald MA, Roth HF, Reticker A, Segovia M, Pillai A. Evolving challenges with long-term care of liver transplant recipients. Clin Transplant 2023; 37:e15085. [PMID: 37545440 DOI: 10.1111/ctr.15085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 08/08/2023]
Abstract
The number of liver transplants (LT) performed worldwide continues to rise, and LT recipients are living longer post-transplant. This has led to an increasing number of LT recipients requiring lifelong care. Optimal care post-LT requires careful attention to both the allograft and systemic issues that are more common after organ transplantation. Common causes of allograft dysfunction include rejection, biliary complications, and primary disease recurrence. While immunosuppression prevents rejection and reduces incidences of some primary disease recurrence, it has detrimental systemic effects. Most commonly, these include increased incidences of metabolic syndrome, various malignancies, and infections. Therefore, it is of utmost importance to optimize immunosuppression regimens to prevent allograft dysfunction while also decreasing the risk of systemic complications. Institutional protocols to screen for systemic disease and heightened clinical suspicion also play an important role in providing optimal long-term post-LT care. In this review, we discuss these common complications of LT as well as unique considerations when caring for LT recipients in the years after transplant.
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Affiliation(s)
- Matthew A Odenwald
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, USA
| | - Hannah F Roth
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, USA
| | - Anesia Reticker
- Department of Pharmacy, University of Chicago Medicine, Chicago, USA
| | - Maria Segovia
- Department of Medicine, Section of Gastroenterology, Duke University School of Medicine, Durham, USA
| | - Anjana Pillai
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, USA
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3
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Hu J, Yu YW, Han DS, Li XJ, Zhang YQ, Cai HL, Xiao YH, Zheng X. Case Report: Non-negligible Epstein-Barr virus-associated posttransplant lymphoproliferative disorders in a lung transplant recipient. Front Immunol 2023; 14:1244534. [PMID: 37781359 PMCID: PMC10540203 DOI: 10.3389/fimmu.2023.1244534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Background Posttransplant lymphoproliferative disorders (PTLDs) are uncommon but serious complications in patients following solid organ transplantation. Primary Epstein-Barr virus (EBV) infection is a risk factor for the development of PTLD, especially early-onset PTLD, in EBV-negative recipients. To date, however, there are no specific guidelines on the threshold of EBV-DNA load for therapeutic intervention, the source for measurement (e.g., blood, bronchoalveolar fluid), or the use of antiviral agents as prophylaxis for early PTLD prevention in EBV-mismatched patients. Methods The present study describes a 56-year-old male lung transplant recipient diagnosed with EBV-associated PTLD. Results This patient had a history of invasive fungal disease and Mucor and Aspergillus fumigatus infections in the early post-transplant period, necessitating antifungal therapy throughout the course of the disease. The patient was EBV-positive 15 days after transplantation, with lung CT showing multiple bilateral nodules of varying sizes beginning 98 days after transplantation. A lung biopsy showed PTLD, and next-generation sequencing (NGS) revealed EBV. This patient, however, did not receive any antiviral therapy for early PTLD prevention or any PTLD-related treatment. He died 204 days after lung transplantation. Conclusion The present study describes a lung transplant recipient who developed EBV-associated PTLD, a non-negligible disease, after solid organ transplantation. Monitoring EBV-DNA load is important, as a sudden increase may be a sensitive indicator of PTLD. An earlier diagnosis may increase the likelihood of successful treatment.
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Affiliation(s)
- Juan Hu
- Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yong-Wei Yu
- Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dong-Sheng Han
- Centre of Clinical Laboratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xue-Jie Li
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi-Qi Zhang
- Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong-Liu Cai
- Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yong-Hong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xia Zheng
- Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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4
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Sahu MK, Singh SP, Satsangi A, Gogia A, Hote MP, Seth S. Posttransplant lymphoproliferative disorder in a heart transplant recipient: a case report. Indian J Thorac Cardiovasc Surg 2023; 39:535-538. [PMID: 37609612 PMCID: PMC10441853 DOI: 10.1007/s12055-023-01524-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 08/24/2023] Open
Abstract
Malignancy in heart transplant recipients is a grave complication. Post-transplant lymphoproliferative disorder (PTLD) is the second most common tumour in adults and commonest in children. The incidence varies with the transplanted organ from 1 to 2% following kidney transplantation to as high as 10% following thoracic organ transplantation due to different immunosuppression intensity. PTLD include a wide spectrum of diseases ranging from benign proliferation of lymphoid tissue to frank malignancy with aggressive behaviour (lymphoma). Epstein-Barr virus (EBV) infection and prolonged immunosuppressant therapy are implicated in the pathogenesis of PTLD. The incidence of PTLD varies from 2.6% at 1 year to 28% at 10 years post-transplant. Seronegativity for EBV in recipients with seropositive donors increases the risk of PTLD in recipients. The majority of early-onset PTLDs (85%) are of B-cell origin and associated with EBV. Timely and accurate diagnosis with histological examination of lymphoid tissue is essential for early intervention. Reduction of immunosuppressive therapy (IST) and rituximab usually are effective in remission of PTLD. In resistant cases, chemotherapy is given with or without rituximab. Adoptive T-cell transfer represents a promising therapeutic approach. Early PTLD respond well to lowering immunosuppression and has a favourable prognosis compared to late PTLD. Five-year survival is 30% for high-grade lymphomas. The prognosis of EBV-negative lymphomas is worse. One out of 40 heart transplant recipients followed up in our centre developed PTLD. He was treated to remission and we describe this case here.
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Affiliation(s)
- Manoj Kumar Sahu
- Intensive Care for CTVS, Department of Cardiothoracic and Vascular Surgery, CTVS Office, 7th floor, CN Centre, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Sarvesh Pal Singh
- Intensive Care for CTVS, Department of Cardiothoracic and Vascular Surgery, CTVS Office, 7th floor, CN Centre, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Amitabh Satsangi
- Intensive Care for CTVS, Department of Cardiothoracic and Vascular Surgery, CTVS Office, 7th floor, CN Centre, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Ajay Gogia
- Department of Medical Oncology, IRCH, AIIMS, New Delhi, India
| | - Milind Padmakar Hote
- Intensive Care for CTVS, Department of Cardiothoracic and Vascular Surgery, CTVS Office, 7th floor, CN Centre, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Sandeep Seth
- Department of Cardiology, AIIMS, New Delhi, India
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5
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Quintero Bernabeu J, Juamperez J, Mercadal-Hally M, Larrarte King M, Gallego Melcon S, Gros Subias L, Sábado Álvarez C, Soler-Palacin P, Melendo Pérez S, Esperalba J, Navarro Jiménez A, Garrido Pontnou M, Camacho Soriano J, Hidalgo Llompart E, Bilbao Aguirre I, Charco Torra R. Epstein-Barr virus-associated risk factors for post-transplant lymphoproliferative disease in pediatric liver transplant recipients. Pediatr Transplant 2022; 26:e14292. [PMID: 35466492 DOI: 10.1111/petr.14292] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/11/2022] [Accepted: 03/23/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) are the most common de novo malignancies after liver transplantation (LT) in children. The aim of our study was to assess the role of pre-LT EBV status and post-LT EBV viral load as risk factors for developing PTLD in a cohort of pediatric LT recipients. METHODS Data of all children who underwent LT between January 2002 and December 2019 were collected. Two cohorts were built EBV pre-LT primary infected cohort and EBV post-LT primary infected cohort. Moreover, using the maximal EBV viral load, a ROC curve was constructed to find a cutoff point for the diagnosis of PTLD. RESULTS Among the 251 patients included in the study, fifteen PTLD episodes in 14 LT recipients were detected (2 plasmacytic hyperplasia, 10 polymorphic PTLD, 2 monomorphic PTLD, and 1 Classical-Hodgkin's lymphoma). Patients of the EBV post-LT primary infected cohort were 17.1 times more likely to develop a PTLD than patients of the EBV pre-LT primary infected cohort (2.2-133.5). The EBV viral load value to predict PTLD was set at 211 000 UI/mL (93.3% sensitivity and 77.1% specificity; AUC 93.8%; IC 0.89-0.98). In EBV post-LT primary infected cohort, patients with a viral load above 211 000 were 30 times more likely to develop PTLD than patients with a viral load below this value (OR 29.8; 3.7-241.1; p < 0.001). CONCLUSIONS The combination of pretransplant EBV serological status with EBV post-transplant viral load could be a powerful tool to stratify the risk of PTLD in pediatric LT patients.
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Affiliation(s)
- Jesus Quintero Bernabeu
- Pediatric Hepatology and Liver Transplant Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Javier Juamperez
- Pediatric Hepatology and Liver Transplant Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maria Mercadal-Hally
- Pediatric Hepatology and Liver Transplant Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mauricio Larrarte King
- Pediatric Hepatology and Liver Transplant Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Soledad Gallego Melcon
- Pediatric Oncology and Hematology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Luis Gros Subias
- Pediatric Oncology and Hematology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Susana Melendo Pérez
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Juliana Esperalba
- Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Ernest Hidalgo Llompart
- HPB Surgery and Transplantation Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Itxarone Bilbao Aguirre
- HPB Surgery and Transplantation Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ramón Charco Torra
- HPB Surgery and Transplantation Department, Vall d'Hebron University Hospital, Barcelona, Spain
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6
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Gajardo M, Delucchi A, Pérez D, Cancino JM, Gálvez C, Ledezma X, Ceballos ML, Lillo AM, Cano F, Guerrero JL, Rojo A, Azócar M, González G, Pinilla C, Correa R, Toro L. Long-term outcome of early steroid withdrawal in pediatric renal transplantation. Pediatr Transplant 2021; 25:e14096. [PMID: 34327777 DOI: 10.1111/petr.14096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/15/2021] [Accepted: 07/08/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Steroid use in renal transplant is related to multiple adverse effects. Long-term effects of early withdrawal steroids in pediatric renal transplant were assessed. METHODS Renal transplant children with low immunological risk treated on basiliximab, tacrolimus, and mycophenolate with steroid withdrawal or steroid control were evaluated between 2003 and 2019. Clinical variables, treatment adherence, acute rejection, graft loss, and death were analyzed through hazard ratios, and Kaplan-Meier and multivariate analyses. RESULTS The study included 152 patients, 71.1% steroid withdrawal, mean follow-up 8.5 years, 64.5% structural abnormalities, and 81.6% deceased donor. At 12 years of transplant, event-free survival analysis for graft loss or death showed no significant difference between steroid withdrawal and control steroid treatment (85.9% vs. 80.4%, p = .36) nor in acute rejection at 10 years (18.5% vs. 20.5%, p = .78) or in donor-specific antibody appearance (19.6% vs. 21.4%, p = .98). Delta height Z-score was increased in the steroid withdrawal group (p < .01). The main predictor of graft loss or death was non-adherence to treatment (p = .001; OR: 17.5 [3.3-90.9]). CONCLUSIONS Steroid withdrawal therapy was effective and safe for low-risk pediatric renal transplant in long-term evaluation. Non-adherence was the main predictor of graft loss or death.
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Affiliation(s)
- Macarena Gajardo
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile.,Division of Nephrology, Hospital Roberto del Río, Santiago, Chile
| | - Angela Delucchi
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile.,Division of Nephrology, Clínica Alemana, Santiago, Chile
| | - Diego Pérez
- Department of Pediatric, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - José M Cancino
- Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Carla Gálvez
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Ximena Ledezma
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - María L Ceballos
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile
| | - Ana M Lillo
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Francisco Cano
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile
| | - José L Guerrero
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Angélica Rojo
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Marta Azócar
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile
| | - Gloria González
- Renal transplant program, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Cesar Pinilla
- Renal transplant program, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Ramón Correa
- Renal transplant program, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Luis Toro
- Division of Nephrology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago, Chile.,Centro de Investigación Clínica Avanzada, Hospital Clinico Universidad de Chile, Santiago, Chile.,Critical Care Center, Clínica Las Condes, Santiago, Chile
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7
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Zaffiri L, Frankel C, Bush EJ, Neely ML, Pavlisko EN, Mokrova IL, Luftig MA, Palmer SM. Evidence of Epstein-Barr virus heterogeneous gene expression in adult lung transplant recipients with posttransplant lymphoproliferative disorder. J Med Virol 2021; 93:5040-5047. [PMID: 33704812 PMCID: PMC9208898 DOI: 10.1002/jmv.26936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 11/10/2022]
Abstract
Epstein-Barr virus (EBV)-driven posttransplant lymphoproliferative disorder (PTLD) is a serious complication following lung transplant. The extent to which the presence of EBV in PTLD tissue is associated with survival is uncertain. Moreover, whether the heterogeneity in expression of EBV latency programs is related to the timing of PTLD onset remains unexplored. We retrospectively performed a comprehensive histological evaluation of EBV markers at the tissue level in 34 adult lung transplant recipients with early- and late-onset PTLD. Early-onset PTLD, occurring within the first 12 months posttransplant, had higher odds to express EBV markers. The presence of EBV in PTLD was not associated with a difference in survival relative to EBV-negative tumors. However, we found evidence of heterogeneous expression of EBV latency programs, including type III, IIb, IIa, and 0/I. Our study suggests that the heterogeneous expression of EBV latency programs may represent a mechanism for immune evasion in patients with PLTD after lung transplants. The recognition of multiple EBV latency programs can be used in personalized medicine in patients who are nonresponsive to traditional types of chemotherapy and can be potentially evaluated in other types of solid organ transplants.
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Affiliation(s)
- Lorenzo Zaffiri
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Courtney Frankel
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Erika J Bush
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Megan L Neely
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | | | - Irina L Mokrova
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Micah A Luftig
- Department of Molecular Genetics and Microbiology, Duke Center for Virology, Duke University, Durham, North Carolina, USA
| | - Scott M Palmer
- Department of Medicine, Duke University, Durham, North Carolina, USA
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8
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Proteomic approaches to investigate gammaherpesvirus biology and associated tumorigenesis. Adv Virus Res 2020; 109:201-254. [PMID: 33934828 DOI: 10.1016/bs.aivir.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The DNA viruses, Kaposi's sarcoma-associated herpesvirus (KSHV) and Epstein-Barr virus (EBV), are members of the gammaherpesvirus subfamily, a group of viruses whose infection is associated with multiple malignancies, including cancer. The primary host for these viruses is humans and, like all herpesviruses, infection with these pathogens is lifelong. Due to the persistence of gammaherpesvirus infection and the potential for cancer formation in infected individuals, there is a driving need to understand not only the biology of these viruses and how they remain undetected in host cells but also the mechanism(s) by which tumorigenesis occurs. One of the methods that has provided much insight into these processes is proteomics. Proteomics is the study of all the proteins that are encoded by a genome and allows for (i) identification of existing and novel proteins derived from a given genome, (ii) interrogation of protein-protein interactions within a system, and (iii) discovery of druggable targets for the treatment of malignancies. In this chapter, we explore how proteomics has contributed to our current understanding of gammaherpesvirus biology and their oncogenic processes, as well as the clinical applications of proteomics for the detection and treatment of gammaherpesvirus-associated cancers.
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9
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Affiliation(s)
- Peter Cosgrove
- Department of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Kartik Pillutla
- Department of Pediatric Nephrology, Dell Children's Medical Center, Austin, Texas
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10
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Anderson-Smits C, Baker ER, Hirji I. Coinfection rates and clinical outcome data for cytomegalovirus and Epstein-Barr virus in post-transplant patients: A systematic review of the literature. Transpl Infect Dis 2020; 22:e13396. [PMID: 32603496 PMCID: PMC7816247 DOI: 10.1111/tid.13396] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/23/2020] [Indexed: 12/16/2022]
Abstract
Background In transplant recipients, cytomegalovirus (CMV) infection increases morbidity and mortality; furthermore, coinfection with other human herpesviruses like the Epstein‐Barr virus (EBV) may complicate their management. This systematic literature review aimed to summarize rates of CMV‐EBV coinfection and associated clinical outcomes among solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. Methods An electronic literature search was performed using pre‐specified search strategies (January 1, 2010‐October 31, 2018) and following established/best practice methodology. Of 316 publications identified, 294 did not report CMV‐EBV coinfection and were excluded. Studies meeting the inclusion criteria were further analyzed. Due to limited reporting/heterogeneity, data were not meta‐analyzable. Results Nine studies (six SOT; three HSCT) reported CMV‐EBV coinfection; rates of coinfection post transplantation varied between 2.6% and 32.7%. Two studies indicated CMV reactivation to be an independent variable associated with EBV reactivation. Among SOT studies, higher rates of graft dysfunction (47.4% vs 22.9%), rejection episodes (20.0% vs 8.9%), or acute rejection (50.0% vs 31.0%) were reported for patients with coinfection than without. In HSCT studies, patients with graft‐vs‐host disease were not reported separately for coinfection. Two studies described cases of post‐transplant lymphoproliferative disorder (PTLD) in patients with CMV‐EBV coinfection and reported rates of PTLD of 92% and 100%. Conclusion The CMV‐EBV coinfection rate in HSCT and SOT recipients varied and was associated with increased graft rejection and PTLD compared with patients without coinfection. Further research may improve understanding of the burden of CMV‐EBV coinfection among transplant recipients.
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Affiliation(s)
| | - Erin R Baker
- CTI Clinical Trial & Consulting Services, Covington, KY, USA
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11
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Zaffiri L, Long A, Neely ML, Cherikh WS, Chambers DC, Snyder LD. Incidence and outcome of post-transplant lymphoproliferative disorders in lung transplant patients: Analysis of ISHLT Registry. J Heart Lung Transplant 2020; 39:1089-1099. [PMID: 32654913 DOI: 10.1016/j.healun.2020.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/02/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication following lung transplant. We studied incidence and risk factors for PTLD in adult lung transplant recipients (LTRs) using the International Society for Heart and Lung Transplantation Registry. METHODS The International Society for Heart and Lung Transplantation Registry was used to identify adult, first-time, single and bilateral LTRs with at least 1 year of follow-up between 2006 and 2016. Kaplan-Meier method was used to describe the timing and distribution of PTLD. Univariable and multivariable Cox proportional hazards regression models were used to examine clinical characteristics associated with PTLD. RESULTS Of 19,309 LTRs in the analysis cohort, we identified 454 cases of PTLD. Cumulative incidence of PTLD was 1.1% (95% CI = 1.0%-1.3%) at 1 year and 4.1% (95% CI = 3.6%-4.6%) at 10 years. Of the PTLD cases, 47.4% occurred within the first year following lung transplantation. In the multivariable model, independent risk factors for PTLD included age, Epstein-Barr virus serostatus, restrictive lung diseases, and induction. Risk of PTLD during the first year after transplant increased with increasing age in patients between 45 and 62 years at time of transplantation; the inverse was true for ages <45 years or >62 years. Finally, receiving a donor organ with human leukocyte antigen types A1 and A24 was associated with an increased risk of PTLD, whereas the recipient human leukocyte antigen type DR11 was associated with a decreased risk. CONCLUSIONS Our study indicates that PTLD is a relatively rare complication among adult LTRs. We identified clinical characteristics that are associated with an increased risk of PTLD.
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Affiliation(s)
- Lorenzo Zaffiri
- Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, North Carolina.
| | - Alex Long
- Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Megan L Neely
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | | | - Daniel C Chambers
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Laurie D Snyder
- Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, North Carolina
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12
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Haji HA, Corwin DS, So JY, Reed RM. Lymphoproliferative disorder in a lung transplant recipient. BMJ Case Rep 2020; 13:13/3/e234532. [PMID: 32234858 DOI: 10.1136/bcr-2020-234532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Post-transplantation lymphoproliferative disorder (PTLD) is uncommon following solid organ transplantation. We present a case of PTLD presenting as hematochezia and abdominal pain in a 66-year-old man, who had undergone bilateral lung transplantation with alemtuzumab induction 7 months prior to presentation. The transplant serologic status was "high-risk" for the presence of both Epstein-Barr virus (EBV) serologies in the donor and negative serologies in the recipient. Biopsies taken during colonoscopy stained strongly positive for EBV-encoded RNA. Mediastinal lymph node biopsies also showed atypical, EBV-positive lymphohistiocytic infiltration with focal necrosis. The patient's hospital course was complicated by treatment side effects, most notably bowel perforation following rituximab. In this case report the topic of PTLD is reviewed and consideration is given to whether alemtuzumab induction may have contributed to the patient's development of PTLD.
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Affiliation(s)
- Hassan A Haji
- Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Douglas S Corwin
- Pulmonary and Critical Care Medicine, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Jennifer Y So
- Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robert M Reed
- Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Clausen ES, Zaffiri L. Infection prophylaxis and management of viral infection. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:415. [PMID: 32355859 PMCID: PMC7186616 DOI: 10.21037/atm.2019.11.85] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Viral infections are associated with significant morbidity and mortality in lung transplant recipients. Importantly, several viral infections have been associated with the development of chronic lung allograft dysfunction (CLAD). Community-acquired respiratory viruses (CARV) such as influenza and respiratory syncytial virus (RSV), are frequently associated with acute and chronic rejection. Cytomegalovirus (CMV) remains a significant burden in regards to morbidity and mortality in lung transplant recipients. Epstein-Barr virus (EBV) is mostly involved with the development of post-transplant lymphoproliferative disorder (PTLD), a lymphoid proliferation that occurs in the setting of immunosuppression. On the other hand, the development of direct acting antivirals for hepatitis C virus (HCV) is changing the use of HCV-positive organs in transplantation. In this article we will focus on reviewing common viral infections that have a significant impact on lung transplant recipients looking at epidemiology, prevention and potential treatment.
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Affiliation(s)
- Emily S Clausen
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Lorenzo Zaffiri
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
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Qin T, Gu XQ, Jeong SS, Song YY, Liu JC, Zheng JX, Xue F, Xia Q. Impact of EBV infection and immune function assay for lymphoproliferative disorder in pediatric patients after liver transplantation: A single-center experience. Hepatobiliary Pancreat Dis Int 2020; 19:3-11. [PMID: 31932195 DOI: 10.1016/j.hbpd.2019.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/20/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) is a lethal complication after pediatric liver transplantation, but information regarding risk factors for the development of PTLD remains unclear. This study was to identify characteristics and risk factors of PTLD. METHODS A total of 705 pediatric patients who underwent liver transplantation between January 2017 and October 2018 were studied. Impact of clinical characteristics and Epstein-Barr virus (EBV) infection on the development of PTLD was evaluated. In addition, ImmuKnow assay was adopted in partial patients to analyze the immune status. RESULTS Twenty-five (3.5%) patients suffered from PLTD with a median time of 6 months (3-14 months) after transplantation. Extremely high tacrolimus (TAC) level was found in 2 fatal cases at PTLD onset. EBV infection was found in 468 (66.4%) patients. A higher peak EBV DNA loads (>9590 copies/mL) within 3 months was a significant indicator for the onset of PTLD. In addition, the ImmuKnow assay demonstrated that overall immune response was significantly lower in patients with EBV infection and PTLD (P<0.0001). The cumulative incidence of PTLD was also higher in patients with lower ATP value (≤187 ng/mL, P<0.05). CONCLUSIONS A careful monitoring of EBV DNA loads and tacrolimus concentration might be supportive in prevention of PTLD in pediatric patients after liver transplantation. In addition, application of the ImmuKnow assay may provide guidance in reducing immunosuppressive agents in treatment of PTLD.
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Affiliation(s)
- Tian Qin
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Xiang-Qian Gu
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Seog-Song Jeong
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yan-Yan Song
- Department of Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Jin-Chuan Liu
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Jian-Xin Zheng
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Feng Xue
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
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Kim HB, Hong R, Na YS, Choi WY, Park SG, Lee HJ. Isolated peritoneal lymphomatosis defined as post-transplant lymphoproliferative disorder after a liver transplant: A case report. World J Clin Cases 2019; 7:4299-4306. [PMID: 31911911 PMCID: PMC6940333 DOI: 10.12998/wjcc.v7.i24.4299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/31/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) is a fatal complication of solid organ transplantation or allogenic hematopoietic stem cell transplantation that is associated with immunosuppressive therapy. Potential manifestations are diverse, ranging from reactive lymphoid hyperplasia to high-grade lymphoma. PTLD is usually of B-cell origin and associated with Epstein-Barr virus (EBV) infection. Herein, we describe a case of PTLD involving the peritoneal omentum. There has been only case of PTLD as a diffuse large B-cell lymphoma (DLBCL) in the peritoneum.
CASE SUMMARY The patient was a 62-year-old man who had been receiving immunosuppressive therapy with tacrolimus since undergoing a liver transplant 15 years prior. He reported that he had experienced abdominal discomfort and anorexia 1 month prior to the current admission. Abdominal pelvic computed tomography (CT) revealed peritoneal and omental mass-like lesions without bowel obstruction. Ultrasonography-guided biopsy was performed, and he was histologically diagnosed with EBV-negative DLBCL. Positron emission tomography (PET)-CT depicted peritoneum and omentum involvement only, without any lymphadenopathy or organ masses, including in the gastrointestinal tract. Six cycles of chemotherapy with a “R-CHOP“ regimen (rituximab-cyclophosphamide, doxorubicin, vincristine, prednisolone) were administered, and PET-CT performed thereafter indicated complete remission.
CONCLUSION This is the first report of isolated peritoneal lymphomatosis defined as PTLD in a liver transplant recipient.
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Affiliation(s)
- Hong Beum Kim
- Department of Premedical Course, Chosun University School of Medicine, Gwangju 501-717, South Korea
| | - Ran Hong
- Department of Pathology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, South Korea
| | - Yung Sub Na
- Department of Internal Medicine, Pulomonology, Chosun University Hospital, Gwangju 501-717, South Korea
| | - Woo Young Choi
- Department of Plastic and Reconstructive Surgery, Chosun University Hospital, Gwangju 501-717, South Korea
| | - Sang Gon Park
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 501-717, South Korea
| | - Hee Jeong Lee
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 501-717, South Korea
- MD, PhD, Department of HematoOncology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, South Korea
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Ose N, Minami M, Funaki S, Kanou T, Fukui E, Morii E, Shintani Y. Late-Onset Central Nervous System Posttransplant Lymphoproliferative Disorder After Lung Transplantation:A Case Report. Transplant Proc 2019; 51:3163-3166. [PMID: 31619339 DOI: 10.1016/j.transproceed.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/28/2019] [Indexed: 11/26/2022]
Abstract
Posttransplant lymphoproliferative disorder (PTLD) is caused by uncontrolled proliferation of lymphoid cells after a hematopoietic stem cell or solid organ transplant procedure related to the Epstein-Barr virus (EBV) infection. A primary central nervous system (CNS) PTLD (CNS-PTLD) is rare and important to distinguish from an intracranial lesion after transplantation. A 66-year-old man with pulmonary arterial hypertension who underwent living-donor lung transplantation 9 years prior noticed disorientation regarding route and dates. Brain magnetic resonance imaging revealed multiple white matter lesions and fluorodeoxyglucose (FDG) positron emission tomography showed FDG uptake in the brain and skin. CNS-PTLD was diagnosed by craniotomy biopsy and EBV-encoded RNA was positive in in situ hybridization findings and elevated in brain tissue. The treatment was started with immunosuppressant reduction and whole brain radiotherapy. But the condition progressed rapidly over 2 months after the first symptom and the patient was passed away 25 days after hospitalization. CNS-PTLD can occur several years after transplantation and it is necessary to keep in mind to distinguish brain disease because early diagnosis and treatment are important.
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Affiliation(s)
- Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eriko Fukui
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Sečník P, Jabor A, Lavríková P, Sečník J, Malíková P, Pokorná E, Franeková J. Immunoglobulin abnormalities in 1677 solid organ transplant recipients. Implications for posttransplantation follow-up. Transpl Immunol 2019; 57:101229. [PMID: 31398462 DOI: 10.1016/j.trim.2019.101229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Posttransplant lymphoproliferative disorder (PTLD) is a severe complication of solid organ transplantation (SOT). However, there is no consensus on PTLD screening methods. Gammopathies (GP), which occur in 10-25% of SOT recipients, have been linked to subsequent development of PTLD. Therefore, GP detection methods, such as serum protein electrophoresis (SPE), serum protein immunofixation (SIFE), urine protein immunofixation (UIFE) and the quantitative measurement of serum free light chains (SFLC) are candidate methods for PTLD screening. OBJECTIVE We aimed to assess the frequency of PTLD and GP, association of GP with subsequent PTLD, allograft loss or death and the diagnostic performance of SPE/SIFE in PTLD screening. The main objective was to explore, whether GP detection methods can be used to enhance the efficiency of PTLD screening and to formulate a concise algorithm for posttransplantation (post-Tx) follow-up. METHODS We performed a cohort study on 1677 SOT recipients with SPE/SIFE data who underwent kidney, liver, heart, pancreas, Langerhans islets or multiple organ transplantation at the Institute of Clinical and Experimental Medicine between 1966 and 2015. The median (IQR) of follow-up time was 8.0 (4.0-12.0) years. RESULTS The frequencies of PTLD and GP in SOT recipients were 2.8% and 6.4%, respectively. The frequencies of transient GP, GP of undetermined significance and malignant GP were 33%, 63% and 4% respectively. The median time between SOT and GP detection was 2.0 (interquartile range 1.0-7.0) years. GP was associated with a significantly higher risk of PTLD, allograft loss and death, with hazard ratios (95% confidence intervals) of a 6.06 (2.51-14.64), 2.61 (1.49-4.6) and 1.99 (1.2-3.3), respectively. Additionally, GP was associated with 2.98-fold increased risk of allograft loss in kidney transplant patients. SPE diagnostic sensitivity and specificity for PTLD were 14.8% and 93.9%, respectively. PTLD was diagnosed more often and earlier if SPE/SIFE was included in the post-Tx follow-up. CONCLUSIONS GP after SOT is associated with a high risk of PTLD, allograft loss and poor survival. The combination of SPE, SIFE, SFLC and UIFE is optimal for GP detection. These methods aid in identifying patients who are at risk for PTLD or allograft damage and should be included in regular post-Tx follow-up.
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Affiliation(s)
- Peter Sečník
- 3rd Faculty of Medicine, Charles University, Ruská 2411/87, Prague, Czech Republic.
| | - Antonín Jabor
- 3rd Faculty of Medicine, Charles University, Ruská 2411/87, Prague, Czech Republic; Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague, Czech Republic
| | - Petra Lavríková
- 3rd Faculty of Medicine, Charles University, Ruská 2411/87, Prague, Czech Republic; Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague, Czech Republic
| | - Juraj Sečník
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Neo, Blickagången 16, Sweden
| | - Pavlína Malíková
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague, Czech Republic
| | - Eva Pokorná
- Department of Organ Harvesting and Transplantation Databases, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague, Czech Republic
| | - Janka Franeková
- 3rd Faculty of Medicine, Charles University, Ruská 2411/87, Prague, Czech Republic; Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague, Czech Republic
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Piening N, Saurabh S, Munoz Abraham AS, Osei H, Fitzpatrick C, Greenspon J. Sterile necrotizing and non-necrotizing granulomas in a heart transplant patient with history of PTLD: A unique finding. Int J Surg Case Rep 2019; 60:8-12. [PMID: 31185455 PMCID: PMC6556822 DOI: 10.1016/j.ijscr.2019.05.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/07/2019] [Accepted: 05/27/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Posttransplant lymphoproliferative disease (PTLD) is a known complication in patients with solid organ transplant. It can present as localized or disseminated tumor. The cornerstone of management consists of reduced immunosuppression (RI). In select cases, localized disease can potentially be curative with surgical excision. PRESENTATION OF CASE Here we present a case of a 19-year-old female with orthotopic heart transplant with two episodes of recurrent PTLD. After the second episode she was found to have asymptomatic splenic lesions which were refractory to RI and chemotherapy. She subsequently underwent splenectomy that showed sterile necrotizing and non-necrotizing granulomas with no evidence of PTLD. DISCUSSION Based on our literature search this is the first ever reported case of sterile granulomas in a patient with recurrent PTLD which could potentially be diagnosed with minimally invasive biopsy rather than diagnostic splenectomy. CONCLUSION This report is an attempt to create awareness regarding potential for presence of sterile granulomas in patients with recurrent PTLD and discuss the use of percutaneous biopsy before splenectomy.
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Affiliation(s)
| | - Saxena Saurabh
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, United States
| | | | - Hector Osei
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, United States
| | - Colleen Fitzpatrick
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, United States
| | - Jose Greenspon
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, United States
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Avery RK, Yen-Lieberman B. Viral Diagnostics. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7115029 DOI: 10.1007/978-1-4939-9034-4_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This chapter discusses recent developments in diagnostics for cytomegalovirus (CMV), Epstein-Barr virus (EBV), BK virus (BKV), community respiratory viruses (CRVs), parvovirus, hepatitis viruses, HIV, and other viral agents of importance in solid organ and hematopoietic stem cell transplantation.
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20
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Respiratory Tract Diseases That May Be Mistaken for Infection. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7119916 DOI: 10.1007/978-1-4939-9034-4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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A case of idiopathic inflammatory myopathy complicated by Epstein-Barr virus-associated lymphoma. HONG KONG BULLETIN ON RHEUMATIC DISEASES 2018. [DOI: 10.2478/hkbrd-2018-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
We report a male patient who had refractory idiopathic inflammatory myopathy (IIM) presented with antisynthetase syndrome, being treated by potent immunosuppressants for years, developed Epstein-Barr virus (EBV)-associated lymphoma. Despite the stepping down of the immunosuppressives and active lymphoma therapy, the patient died. On top of the typical association of IIM and malignancy, rare EBV-associated tumors related to EBV infection secondary to the use of potent immunosuppressive therapies could occur. Further investigations are advisable if there are new symptoms and signs or in refractory IIM cases. This report serves as a diagnostic alert that the causation by EBV infection in unusual tumors found in patients with IIM should be considered, as both the treatment and prognosis may differ. A balance between the risks and benefits of immunosuppressive therapies should always be achieved.
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22
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Marinho-Dias J, Lobo J, Henrique R, Baldaque I, Pinho-Vaz C, Regadas L, Branca R, Campilho F, Campos A, Medeiros R, Sousa H. Post‑transplant lymphoproliferative disorder in hematopoietic stem cell transplant patients: A single center retrospective study between 2005 and 2012. Mol Med Rep 2018; 18:4650-4656. [PMID: 30221663 DOI: 10.3892/mmr.2018.9433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/06/2018] [Indexed: 11/06/2022] Open
Abstract
Post‑transplant lymphoproliferative disorder (PTLD), despite its rarity, is an important mortality/morbidity event in transplant patients. The purpose of the present study was to retrospectively examine the clinical and pathologic characteristics, and outcomes of PTLD at the Portuguese Oncology Institute of Porto. A retrospective review of patient information was performed for patients that developed PTLD following allogeneic hematopoietic stem cell transplant (aHSCT) and were diagnosed between 2005 and 2012. The present study included a total of 15 patients, 8 females (53.3%) and 7 males (46.7%), with different clinicopathological characteristics. The most frequent clinical condition inducing aHSCT was acute lymphocytic leukemia (40.0%). Conditioning regimens consisted primarily in busulfan and cyclophosphamide, with anti‑thymocyte globulin, and myeloablation was the preferential treatment. Epstein‑Barr virus (EBV) was present in all patients with a median time of diagnosis following transplant of 75 days (range, 25‑485 days) and a median viral load of 4.75 log10 copies/ml (range, 3.30‑6.26 log10 copies/ml). PTLD diagnosis was mainly assessed by clinical findings, and histological confirmation was available for 5 patients: 3 monomorphic, 1 polymorphic and 1 with early lesions of PTLD. To the best of our knowledge, this is the first study to describe PTLD cases in HSCT patients in Portugal. The data reinforces the importance of performing EBV monitoring in high‑risk patients, particularly those receiving a transplant from mismatch/unrelated donors, and those with myeloablative conditioning regimen including antithymocyte globulin. The results also suggested that EBV viral load may be significant for the prediction of PTLD development.
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Affiliation(s)
- Joana Marinho-Dias
- Virology Service, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - João Lobo
- Abel Salazar Institute for The Biomedical Sciences (ICBAS), University of Porto, 4050‑313 Porto, Portugal
| | - Rui Henrique
- Abel Salazar Institute for The Biomedical Sciences (ICBAS), University of Porto, 4050‑313 Porto, Portugal
| | - Inês Baldaque
- Virology Service, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - Carlos Pinho-Vaz
- Bone Marrow Transplantation Unit, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - Luísa Regadas
- Bone Marrow Transplantation Unit, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - Rosa Branca
- Bone Marrow Transplantation Unit, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - Fernando Campilho
- Bone Marrow Transplantation Unit, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - António Campos
- Bone Marrow Transplantation Unit, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - Rui Medeiros
- Virology Service, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - Hugo Sousa
- Virology Service, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
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Ramirez CGB, McCauley J. Infection in Kidney Transplantation. CONTEMPORARY KIDNEY TRANSPLANTATION 2018. [PMCID: PMC7123753 DOI: 10.1007/978-3-319-19617-6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infection is an important cause of morbidity and mortality after kidney transplantation. It has been estimated that 70% of kidney transplant recipients will experience an infection episode within the first 3 years after transplantation (Dharnidharka et al. 2007). After cardiovascular disease, infection is the second leading cause of death in recipients with allograft function (Snyder et al. 2009). The immunosuppressive therapy required to prevent organ rejection places the kidney transplant recipient at increased risk for donor-derived, nosocomial, and community-acquired infections as well as reactivation of latent pathogens. Pretransplant screening, immunizations, and optimal antibacterial and antiviral prophylaxis can help to reduce the impact of infection. Awareness of the approach to infection in the transplant recipient including diagnostic and management strategies is essential to optimizing outcomes.
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Affiliation(s)
- Carlo Gerardo B. Ramirez
- Transplant Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania USA
| | - Jerry McCauley
- Division of Nephrology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA
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Karakoyun M, Önen Ş, Baran M, Çakır M, Ecevit ÇÖ, Kılıç M, Kantar M, Aksoylar S, Özgenç F, Aydoğdu S. Post-transplant malignancies in pediatric liver transplant recipients: Experience of two centers in Turkey. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2018; 29:89-93. [PMID: 29391313 PMCID: PMC6322611 DOI: 10.5152/tjg.2017.17089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/15/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIMS A liver transplant is the preferred treatment for patients with end-stage liver disease, as it usually results in longterm survival. However, due to the use of chronic immunosuppressive therapy, which is necessary to prevent rejection, de novo cancer is a major risk after transplantation. The aim of this study was to assess the incidence of post-transplant malignancies in children after liver transplantations. MATERIALS AND METHODS The study group consisted of 206 liver transplant recipients, with no history of cancer, including hepatocellular carcinoma, in two liver transplantation centers in Turkey between 1997 and 2015. Data were obtained from patient's data chart. RESULTS In the study group, de novo cancer was diagnosed in 13 of the 206 patients. Post-transplant lymphoproliferative disease (PTLD) occurred in seven (53.8%) patients and other malignancies in six of the 13 patients. The types of PTLD were as follows: B-cell origin (n=2), Epstein-Barr virus (EBV)-related (n=2), T-cell origin (n=1), and Hodgkin's lymphoma (n=2). EBV DNA was isolated from seven patients, three of whom developed PTLD. The others developed Kaposi's sarcomas, Burkitt's lymphomas, cutaneous large-cell lymphomas, Hodgkin's lymphomas, and liver sarcomas. CONCLUSION After transplantation, immunosuppressive treatment is unavoidable, increasing the risk of malignancies. However, a close follow-up and periodic screening can reduce cancer-related mortality and morbidity.
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Affiliation(s)
- Miray Karakoyun
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Şebnem Önen
- Department of Pediatrics, Ege University School of Medicine, İzmir, Turkey
| | - Maşallah Baran
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Katip Celebi University School of Medicine, İzmir, Turkey
| | - Murat Çakır
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karadeniz Technical University School of Medicine, Trabzon Turkey
| | - Çiğdem Ömür Ecevit
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Prof. Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
| | - Murat Kılıç
- Department of Transplantation and General Surgery, Kent Hospital, İzmir, Turkey
| | - Mehmet Kantar
- Department of Pediatric Oncology, Ege University School of Medicine, İzmir, Turkey
| | - Serap Aksoylar
- Department of Pediatric Oncology, Ege University School of Medicine, İzmir, Turkey
| | - Funda Özgenç
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ege University School of Medicine, İzmir, Turkey
| | - Sema Aydoğdu
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ege University School of Medicine, İzmir, Turkey
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Comparison of Abbott Architect ®, Siemens Immulite ®, and Diasorin Liaison ® for determination of Epstein-Barr virus serological diagnosis. Diagn Microbiol Infect Dis 2017; 90:96-101. [PMID: 29198371 DOI: 10.1016/j.diagmicrobio.2017.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 02/08/2023]
Abstract
This study compared the performance of 3 automated immunoassays, Architect® (Abbott), Immulite® (Siemens) and Liaison® (Diasorin), for Epstein-Barr virus (EBV) serology. Ninety-one serum samples collected in Amiens University Hospital were analyzed for the presence of Viral Capsid Antigen (VCA) IgG and IgM and Epstein-Barr Nuclear Antigen (EBNA) IgG. The agreement between the 3 assays was calculated for each marker individually and for determination of the EBV profile, based on interpretation of the combination of these 3 EBV markers. Although similar results were obtained with Architect® and Liaison®, several discordant results were observed with Immulite®, particularly for EBNA IgG. A large number of EBNA IgG-positive results were observed, which interfered with interpretation of the EBV profile. In contrast, Immulite® performed similarly to the 2 other assays for detection of VCA IgM.
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26
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Verghese PS, Schmeling DO, Filtz EA, Grimm JM, Matas AJ, Balfour HH. Transplantation of solid organ recipients shedding Epstein-Barr virus DNA pre-transplant: A prospective study. Clin Transplant 2017; 31. [PMID: 28915342 DOI: 10.1111/ctr.13116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 01/23/2023]
Abstract
Epstein-Barr virus (EBV) poses a significant threat to patient and graft survival post-transplant. We hypothesized that recipients who shed EBV at transplant had less immunologic control of the virus and hence were more likely to have active EBV infection and disease post-transplant. To test this hypothesis, we conducted a 5-year prospective study in primary solid organ transplant recipients. We measured EBV DNA in oral washes and blood samples by quantitative PCR before transplant and periodically thereafter for up to 4 years. Pre-transplant samples were available from 98 subjects. EBV DNA was detected pre-transplant in 32 of 95 (34%) and 5 of 93 subjects (5%) in oral wash and blood, respectively. Recipients with and without detectable pre-transplant EBV DNA were not significantly different demographically and had no significant difference in patient and graft survival (P = .6 for both comparisons) or post-transplant EBV viremia-free survival (P = .8). There were no cases of EBV-related disease or post-transplant lymphoproliferative disorder (PTLD) in any of the patients with detectable EBV DNA pre-transplant. In conclusion, detectable EBV DNA pre-transplant was not associated with differences in patient/graft survival, post-transplant EBV viremia, or EBV-related diseases including PTLD.
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Affiliation(s)
- Priya S Verghese
- Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - David O Schmeling
- Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Emma A Filtz
- Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Jennifer M Grimm
- Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Arthur J Matas
- Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Henry H Balfour
- Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, MN, USA.,Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN, USA
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27
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Maylin S, Feghoul L, Salmona M, Herda A, Mercier-Delarue S, Simon F, Legoff J. Evaluation the Architect EBV VCA IgM, VCA IgG, and EBNA-1 IgG chemiluminescent immunoassays to assess EBV serostatus prior transplantation. J Med Virol 2017; 89:2003-2010. [PMID: 28661055 DOI: 10.1002/jmv.24889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 06/10/2017] [Indexed: 11/11/2022]
Abstract
Prior to transplantation of hematopoietic stem cells or solid organ, donor and recipient EBV serostatus has to be determined to assess risks of post-transplant lymphoproliferative disorders. Sensitivity of EBV Viral capsid antigens (VCA) IgG and EBV nuclear antigen-1 (EBNA-1) is critical to define past infection and a good specificity of VCA IgM is required to avoid any disqualification of cord blood (CB) units. Architect™ EBV antibody panel (Architect assay) providing a high throughput was compared to a semi-automated ELISA (Etimax assays Diasorin) to assess sensitivities and specificities of VCA and EBNA-1 IgG and VCA IgM on 419 sera collected from immunocompromised patients (n = 184) and from pregnant women who agreed to give CB cells (n = 235). Intra and inter-assay coefficient of variations ranged from 1.63% to 4.8% for VCA IgM, VCA IgG, and EBNA-1 IgG. Index of VCA IgG and IgM and EBNA IgG of the two assays were highly correlated. The concordance in the interpretation between the two assays was moderate for VCA IgM (kappa = 0.5), substantial for VCA IgG (kappa = 0.60) and good for EBNA-1 IgG (kappa = 0.75). Using serial dilutions of positive controls and in accordance with clinical results VCA IgG and EBNA IgG were detected at lower dilutions with Architect than Etimax. Conversely, 96.1% (74/77) of samples negative with Architect and positive with Etimax for VCA IgM did not have any heterophile antibodies and had VCA IgG and EBNA IgG antibodies supporting past infections. Architect™ EBV serology panel provided good sensitivities and specificities for EBV serostatus determination prior to transplantation.
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Affiliation(s)
- Sarah Maylin
- APHP, Microbiology laboratory, Hôpital Saint-Louis, Paris, France
| | - Linda Feghoul
- APHP, Microbiology laboratory, Hôpital Saint-Louis, Paris, France
| | - Maud Salmona
- APHP, Microbiology laboratory, Hôpital Saint-Louis, Paris, France.,Paris Diderot University, Pres Sorbone Paris Cité, Paris, France
| | - Adel Herda
- APHP, Microbiology laboratory, Hôpital Saint-Louis, Paris, France
| | | | - François Simon
- APHP, Microbiology laboratory, Hôpital Saint-Louis, Paris, France.,Paris Diderot University, Pres Sorbone Paris Cité, Paris, France
| | - Jérôme Legoff
- APHP, Microbiology laboratory, Hôpital Saint-Louis, Paris, France.,Paris Diderot University, Pres Sorbone Paris Cité, Paris, France
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28
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Abstract
This review covers relevant clinical and laboratory information relating to Epstein-Barr virus (EBV) infections in immunocompromised hosts. It describes the epidemiology and clinical manifestations with a primary focus on disease in solid organ and stem cell transplant recipients. The review pays particular attention to diagnostic approaches, including serologic testing and imaging, with an expanded discussion on the role of measuring the EBV load in peripheral blood, identifying both strengths and limitations of this assay. Additional attention is paid to potential additional strategies of immunologic monitoring that may enhance the performance of EBV load monitoring.
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29
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Baker RJ, Mark PB, Patel RK, Stevens KK, Palmer N. Renal association clinical practice guideline in post-operative care in the kidney transplant recipient. BMC Nephrol 2017; 18:174. [PMID: 28571571 PMCID: PMC5455080 DOI: 10.1186/s12882-017-0553-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/16/2017] [Indexed: 02/08/2023] Open
Abstract
These guidelines cover the care of patients from the period following kidney transplantation until the transplant is no longer working or the patient dies. During the early phase prevention of acute rejection and infection are the priority. After around 3-6 months, the priorities change to preservation of transplant function and avoiding the long-term complications of immunosuppressive medication (the medication used to suppress the immune system to prevent rejection). The topics discussed include organization of outpatient follow up, immunosuppressive medication, treatment of acute and chronic rejection, and prevention of complications. The potential complications discussed include heart disease, infection, cancer, bone disease and blood disorders. There is also a section on contraception and reproductive issues.Immediately after the introduction there is a statement of all the recommendations. These recommendations are written in a language that we think should be understandable by many patients, relatives, carers and other interested people. Consequently we have not reworded or restated them in this lay summary. They are graded 1 or 2 depending on the strength of the recommendation by the authors, and AD depending on the quality of the evidence that the recommendation is based on.
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Affiliation(s)
- Richard J Baker
- Renal Unit, St. James's University Hospital, Leeds, England.
| | - Patrick B Mark
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Rajan K Patel
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Kate K Stevens
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
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30
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Postoperative Care of the Liver Transplant Recipient. ANESTHESIA AND PERIOPERATIVE CARE FOR ORGAN TRANSPLANTATION 2017. [PMCID: PMC7120127 DOI: 10.1007/978-1-4939-6377-5_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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31
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Schachtner T, Reinke P. Pretransplant prophylactic rituximab to prevent Epstein-Barr virus (EBV) viremia in EBV-seronegative kidney transplant recipients from EBV-seropositive donors: results of a pilot study. Transpl Infect Dis 2016; 18:881-888. [DOI: 10.1111/tid.12605] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 06/17/2016] [Accepted: 06/29/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Thomas Schachtner
- Department of Nephrology and Internal Intensive Care; Charité University Medicine Berlin; Campus Virchow Clinic; Berlin Germany
- Berlin-Brandenburg Center of Regenerative Therapies (BCRT); Berlin Germany
| | - Petra Reinke
- Department of Nephrology and Internal Intensive Care; Charité University Medicine Berlin; Campus Virchow Clinic; Berlin Germany
- Berlin-Brandenburg Center of Regenerative Therapies (BCRT); Berlin Germany
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32
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Huber M, Kemmner S, Renders L, Heemann U. Should belatacept be the centrepiece of renal transplantation? Nephrol Dial Transplant 2016; 31:1995-2002. [DOI: 10.1093/ndt/gfw226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 12/28/2022] Open
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33
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Ishihara H, Shimizu T, Unagami K, Hirai T, Toki D, Omoto K, Okumi M, Imai Y, Ishida H, Tanabe K. Post-Transplant Lymphoproliferative Disorder in Kidney Transplant Recipients: A Single-Center Experience in Japan. Ther Apher Dial 2016; 20:165-73. [DOI: 10.1111/1744-9987.12392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 09/07/2015] [Accepted: 10/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | | | - Kohei Unagami
- Department of Nephrology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | - Toshihito Hirai
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | - Daisuke Toki
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | - Kazuya Omoto
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | - Masayoshi Okumi
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | - Yoichi Imai
- Department of Hematology; Tokyo Women's Medical University; Tokyo Japan
| | - Hideki Ishida
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | - Kazunari Tanabe
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
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34
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35
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Jha B, Mohan N, Gajendra S, Sachdev R, Goel S, Sahni T, Raina V, Soin A. Prompt diagnosis and management of Epstein-Barr virus-associated post-transplant lymphoproliferative disorder and hemophagocytosis: A dreaded complication in a post-liver transplant child. Pediatr Transplant 2015; 19:E177-80. [PMID: 26184957 DOI: 10.1111/petr.12558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 12/19/2022]
Abstract
EBV-associated PTLD is increasingly recognized as an important cause of morbidity and mortality in both solid organ and hematopoietic stem cell transplant recipients. Mortality rates due to PTLD and virus-induced HLH are reported to be quite high. We report a case of EBV-associated PTLD and HLH in a child after liver transplantation who was successfully managed due to timely intervention. This case highlights that measurement of EBV load by quantitative polymerase chain reaction assays is an important aid in the surveillance and diagnosis of PTLD and early detection of EBV-induced PTLD, and aggressive treatment with rituximab is a key to survival in patients who have undergone liver transplantation.
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Affiliation(s)
- Bhawna Jha
- Department of Pathology and Laboratory Medicine, Medanta, The Medicity, Gurgaon, Delhi NCR, India
| | - Neelam Mohan
- Department of Pathology and Laboratory Medicine, Medanta, The Medicity, Gurgaon, Delhi NCR, India
| | - Smeeta Gajendra
- Department of Pathology and Laboratory Medicine, Medanta, The Medicity, Gurgaon, Delhi NCR, India
| | - Ritesh Sachdev
- Department of Pathology and Laboratory Medicine, Medanta, The Medicity, Gurgaon, Delhi NCR, India
| | - Shalini Goel
- Department of Pathology and Laboratory Medicine, Medanta, The Medicity, Gurgaon, Delhi NCR, India
| | - Tushar Sahni
- Department of Pathology and Laboratory Medicine, Medanta, The Medicity, Gurgaon, Delhi NCR, India
| | - Vimarsh Raina
- Department of Pathology and Laboratory Medicine, Medanta, The Medicity, Gurgaon, Delhi NCR, India
| | - A Soin
- Department of Pathology and Laboratory Medicine, Medanta, The Medicity, Gurgaon, Delhi NCR, India
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36
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Amorim Pellicioli AC, Luciano AA, Rangel ALCA, de Oliveira GR, Santos Silva AR, de Almeida OP, Vargas PA. Epstein-Barr virus (EBV)--associated posttransplant lymphoproliferative disorder appearing as mandibular gingival ulcers. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 121:e80-6. [PMID: 26321430 DOI: 10.1016/j.oooo.2015.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/15/2015] [Accepted: 07/20/2015] [Indexed: 12/13/2022]
Abstract
Posttransplant lymphoproliferative disorders (PTLDs) comprise a spectrum of complications that affect immunocompromised patients following hematopoietic stem cell transplantation or solid organ transplantation. Its incidence varies depending on the transplanted organ, occurring in approximately 2.3% of kidney transplantations. A 31-year-old woman was referred to the Dental Clinic of the State University of Western Paraná for evaluation of an oral lesion. Her medical history revealed a previous diagnosis of hypertension, Epstein-Barr virus (EBV) seropositivity, and kidney transplantation 12 years prior. She was under standard immunosuppressive therapy. Intraoral examination identified a gingival necrotic lesion with extension to the posterior right lower alveolar bone. An incisional biopsy was performed. Histologic examination showed lymphocytic proliferation of cells with small and hyperchromatic nuclei, atypical mitosis, and cells with large and pale nuclei showing prominent nucleoli permeating connective tissue, muscle fibers, and adipocytes. Correlation of clinical, histologic, and immunohistochemical findings led to a diagnosis of polymorphic EBV-associated PTLD rich in B and T cells.
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37
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Talawila N, Pengel LHM. Does belatacept improve outcomes for kidney transplant recipients? A systematic review. Transpl Int 2015; 28:1251-64. [PMID: 25965549 DOI: 10.1111/tri.12605] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/19/2015] [Accepted: 05/07/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Belatacept was intended to provide better outcomes for kidney transplant (KT) recipients by allowing minimization/withdrawal of calcineurin inhibitors (CNI) and steroids. METHODS We searched for randomized controlled trials (RCTs) in adult KT comparing belatacept with CNIs. Methodological quality was assessed. Meta-analyses were performed to calculate odds ratios (OR) and mean differences (MD). RESULTS Six RCTs were included. Pooled analyses found no differences for acute rejection at any time point. Renal function [Calculated glomerular filtration rate (cGFR)] was better with belatacept at 12 and 24 months (MD = 11.7 and 13.7 ml/min/1.73 m(2) ). New onset diabetes after transplantation was lower with belatacept at 12 months (OR = 0.43). Systolic and diastolic blood pressures were lower at 12 months (MD -7.2 and -3.1 mmHg) as were triglycerides at 12 and 24 months (MD = -32.9 and -41.7 mg/dl). Total and low-density lipoprotein cholesterol were lower with belatacept at 24 months (MD = -19.8 and -10.6 mg/dl). There were no differences for other outcomes. CONCLUSION Limited available data suggest a potential benefit for belatacept by reducing the risk of CNI toxicity, especially renal function, without evidence of increased acute rejection. There were no safety issues apart from a possible risk of post-transplant lymphoproliferative disorder in Epstein-barr virus-seronegative recipients. Further studies are required to confirm this benefit.
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Affiliation(s)
- Nishanthi Talawila
- Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England and the London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Liset H M Pengel
- Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England and the London School of Hygiene and Tropical Medicine, University of London, London, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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38
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San-Juan R, Manuel O, Hirsch HH, Fernández-Ruiz M, López-Medrano F, Comoli P, Caillard S, Grossi P, Aguado JM. Current preventive strategies and management of Epstein-Barr virus-related post-transplant lymphoproliferative disease in solid organ transplantation in Europe. Results of the ESGICH Questionnaire-based Cross-sectional Survey. Clin Microbiol Infect 2015; 21:604.e1-9. [PMID: 25686696 DOI: 10.1016/j.cmi.2015.02.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/18/2014] [Accepted: 02/01/2015] [Indexed: 11/25/2022]
Abstract
There is limited clinical evidence on the utility of the monitoring of Epstein-Barr virus (EBV) DNAemia in the pre-emptive management of post-transplant lymphoproliferative disease (PTLD) in solid organ transplant (SOT) recipients. We investigated current preventive measures against EBV-related PTLD through a web-based questionnaire sent to 669 SOT programmes in 35 European countries. This study was performed on behalf of the ESGICH study group from the European Society of Clinical Microbiology and Infectious Diseases. A total of 71 SOT programmes from 15 European countries participated in the study. EBV serostatus of the recipient is routinely obtained in 69/71 centres (97%) and 64 (90%) have access to EBV DNAemia assays. EBV monitoring is routinely used in 85.9% of the programmes and 77.4% reported performing pre-emptive treatment for patients with significant EBV DNAemia levels. Pre-emptive treatment for EBV DNAemia included reduction of immunosuppression in 50.9%, switch to mammalian target of rapamycin inhibitors in 30.9%, and use of rituximab in 14.5% of programmes. Imaging by whole-body 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) is used in 60.9% of centres to rule out PTLD and complemented computer tomography is used in 50%. In 10.9% of centres, FDG-PET is included in the first-line diagnostic workup in patients with high-risk EBV DNAemia. Despite the lack of definitive evidence, EBV load measurements are frequently used in Europe to guide diagnostic workup and pre-emptive reduction of immunosuppression. We need prospective and controlled studies to define the impact of EBV monitoring in reducing the risk of PTLD in SOT recipients.
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Affiliation(s)
- R San-Juan
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
| | - O Manuel
- Transplantation Centre and Service of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland
| | - H H Hirsch
- Transplantation & Clinical Virology, Department Biomedicine, Infectious Diseases & Hospital Epidemiology, University of Basel, Basel, Switzerland
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - P Comoli
- Pediatric Haematology-Oncology and Research Laboratories Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Caillard
- Nephrology and Transplantation Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - P Grossi
- National Centre for Transplantation, Infectious and Tropical Diseases Department, University of Insubria, Varese, Italy
| | - J M Aguado
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
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39
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Pedersen M, Seetharam A. Infections after orthotopic liver transplantation. J Clin Exp Hepatol 2014; 4:347-60. [PMID: 25755581 PMCID: PMC4298628 DOI: 10.1016/j.jceh.2014.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 07/05/2014] [Indexed: 02/06/2023] Open
Abstract
Opportunistic infections are a leading cause of morbidity and mortality after orthotopic liver transplantation. Systemic immunosuppression renders the liver recipient susceptible to de novo infection with bacteria, viruses and fungi post-transplantation as well to reactivation of pre-existing, latent disease. Pathogens are also transmissible via the donor organ. The time from transplantation and degree of immunosuppression may guide the differential diagnosis of potential infectious agents. However, typical systemic signs and symptoms of infection are often absent or blunted after transplant and a high index of suspicion is needed. Invasive procedures are often required to procure tissue for culture and guide antimicrobial therapy. Antimicrobial prophylaxis reduces the incidence of opportunistic infections and is routinely employed in the care of patients after liver transplant. In this review, we survey common bacterial, fungal, and viral infections after orthotopic liver transplantation and highlight recent developments in their diagnosis and management.
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Key Words
- BAL, bronchoalveolar lavage
- CMV, cytomegalovirus
- EBV, epstein–Barr virus
- ELISA, enzym linked immunosorbent assay
- FCN2, ficolin-2
- GM, galactomannan
- HAT, hepatic artery thrombosis
- HBIG, hepatitis B immune globulin
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HHV, human herpesvirus
- LDLT, live donor liver transplantation
- MASP2, MBL-associated serine protease
- MBL, mannan-binding lectin
- MDR, multi-drug resistant
- MELD, model for end-stage liver disease
- NAS, non-anastomotic stricture
- OLT, orthotopic liver transplantation
- PPD, purified protein derivative
- PTLD, post-transplant lymphoproliferative disorder
- SNP, single nucleotide polymorphism
- TLR, toll-like receptor
- U, unit
- cytomegalovirus
- donor transmission
- infection
- liver transplantation
- prophylaxis
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Affiliation(s)
| | - Anil Seetharam
- Address for correspondence: Anil Seetharam, Clinical Assistant Professor of Medicine, University of Arizona College of Medicine Phoenix, Banner Transplant and Advanced Liver Disease Center, 1300 N. 12th Street Suite 404, Phoenix, AZ 85006, USA. Tel.: +1 602 839 7000; fax: +1 602 839 7050.
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40
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Mahapatra S, Chin CC, Iagaru A, Heerema-McKenney A, Twist CJ. Successful treatment of systemic and central nervous system post-transplant lymphoproliferative disorder without the use of high-dose methotrexate or radiation. Pediatr Blood Cancer 2014; 61:2107-9. [PMID: 25066638 DOI: 10.1002/pbc.25129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 05/08/2014] [Indexed: 12/22/2022]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) describes a spectrum of conditions with highest incidence in the first year post-solid organ transplant in pediatric patients. Central nervous system (CNS) involvement with PTLD carries high mortality risk with no consensus on optimal therapeutic regimen. We present the case of a 7-year old heart transplant patient diagnosed with widespread monomorphic, CD20+, Epstein-Barr virus-positive PTLD, including CNS involvement. In addition to immunosuppression reduction and rituximab, she was treated with multiagent systemic and intrathecal chemotherapy. She achieved a prompt and complete clinical and radiologic remission, which has been sustained for over 46 months since diagnosis.
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Affiliation(s)
- Sidharth Mahapatra
- Department of Pediatrics, Lucile Packard Children's Hospital, Palo Alto, California
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41
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Baychelier F, Achour A, Nguyen S, Raphael M, Toubert A, Besson C, Arnoux A, Roos-Weil D, Marty M, Chapelier A, Samuel D, Debré P, Vieillard V. Natural killer cell deficiency in patients with non-Hodgkin lymphoma after lung transplantation. J Heart Lung Transplant 2014; 34:604-12. [PMID: 25476847 DOI: 10.1016/j.healun.2014.09.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 09/22/2014] [Accepted: 09/24/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Post-transplant non-Hodgkin lymphoma (NHL) is a well-recognized complication of solid-organ transplantation, and pharmacologic suppression of adaptive immunity plays a major role in its development. However, the role of natural killer (NK) cells in post-lung transplant de novo NHL is unknown. METHODS Extensive phenotypic analyses of NK cells from patients diagnosed with NHL after liver or lung transplantation were conducted with multicolor flow cytometry. Polyfunctionality assays simultaneously assessed NK cell degranulation (CD107a) and intracellular cytokine production (interferon-γ and tumor necrosis factor-α) in the presence of NHL target cells. RESULTS The development of de novo NHL is linked to NK-cell maturation defects, including overexpression of NKG2A and CD62L and down-modulation of inhibitory killer immunoglobulin-like receptors and CD57 receptors. More importantly, in patients who developed NHL after lung transplantation, we observed a specific down-modulation of the activating receptors (NKp30, NKp46, and NKG2D) and a sharp decrease in perforin expression and degranulation against NHL target cells. CONCLUSIONS Our results suggest that accumulation of abnormal NK cells could play a role in the outgrowth of NHL after lung transplantation, independently of the immunosuppressive regimen.
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Affiliation(s)
- Florence Baychelier
- Sorbone Universités, University Pierre et Marie Curie, Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France; Institut National de la Recherche Médicale, U1135, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France; Centre National de la Recherche Scientifique, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France
| | - Abla Achour
- Sorbone Universités, University Pierre et Marie Curie, Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France; Institut National de la Recherche Médicale, U1135, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France; Centre National de la Recherche Scientifique, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France
| | - Stéphanie Nguyen
- Sorbone Universités, University Pierre et Marie Curie, Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France; Institut National de la Recherche Médicale, U1135, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France; Centre National de la Recherche Scientifique, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital La Pitié-Salpêtrière, Service Hématologie Clinique, Paris, France
| | - Martine Raphael
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Départementd'Hématologie et d'Immunologie, Le Kremlin-Bicêtre, Paris, France; Univ Paris-Sud, UFR Médecine, Le Kremlin-Bicêtre, France
| | - Antoine Toubert
- Institut National de la Recherche Médicale, UMR-S1160, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, Institut Université d'Hématologie, Paris, France
| | - Caroline Besson
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Hématologie, Le Kremlin-Bicêtre, Paris, France
| | - Armelle Arnoux
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Unité de Recherche Clinique, Le Kremlin-Bicêtre, Paris, France
| | - Damien Roos-Weil
- Assistance Publique-Hôpitaux de Paris, Hôpital La Pitié-Salpêtrière, Service Hématologie Clinique, Paris, France
| | - Michel Marty
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Centre des Innovations Thérapeutiques en Oncologie et Hématologie, Paris, France
| | - Alain Chapelier
- Hôpital Foch, Service de Chirurgie Thoracique et de Transplantation Pulmonaire, Suresnes, France
| | - Didier Samuel
- Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Centre Hépatobiliaire, Villejuif, France
| | - Patrice Debré
- Sorbone Universités, University Pierre et Marie Curie, Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France; Institut National de la Recherche Médicale, U1135, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France; Centre National de la Recherche Scientifique, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France
| | - Vincent Vieillard
- Sorbone Universités, University Pierre et Marie Curie, Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France; Institut National de la Recherche Médicale, U1135, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France; Centre National de la Recherche Scientifique, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France.
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Ramirez-Avila L, Garner OB, Cherry JD. Relative EBV antibody concentrations and cost of standard IVIG and CMV-IVIG for PTLD prophylaxis in solid organ transplant patients. Pediatr Transplant 2014; 18:599-601. [PMID: 25041939 DOI: 10.1111/petr.12315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
Abstract
Some centers prefer CMV-IVIG over IVIG for the prophylaxis of EBV-related PTLD in solid organ transplant patients. Our objective was to compare the relative dose-related EBV ELISA antibody concentrations and cost of standard IVIG and CMV-IVIG. The concentration of EBV IgG to VCA was analyzed via ELISA in four lots of IVIG and four lots of CMV-IVIG. Relative EBV ELISA antibody concentrations and cost were compared assuming an IVIG dose of 0.5 gm/kg and CMV-IVIG dose of 0.15 gm/kg in a 50-kg patient. The price of IVIG was $70/gm and CMV-IVIG $430/gm. IVIG contains the same EBV antibody concentrations (20 790 ELISA antibody units/mL) than CMV-IVIG (17 430 ELISA antibody units/mL, p > 0.2) in the four lots of each product sampled. When factoring in the dosing scheme for a 50-kg patient, IVIG contains two times more EBV antibody than CMV-IVIG. Yet, CMV-IVIG is 1.8 times more expensive than IVIG ($3225 vs. $1750). In the four lots of each product sampled, IVIG contains more EBV antibodies and costs less than CMV-IVIG when factoring in the dosing scheme. Studies are needed to determine whether there is clinical efficacy of immunoglobulin products for EBV-related PTLD prophylaxis.
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Affiliation(s)
- L Ramirez-Avila
- Mattel Children's Hospital, David Geffen School of Medicine, UCLA, University of California, Los Angeles, CA, USA
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Graziadei I. [Intensive care treatment before and after liver transplantation]. Med Klin Intensivmed Notfmed 2014; 109:411-7. [PMID: 25142222 DOI: 10.1007/s00063-014-0364-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 06/21/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Liver transplantation (LT) has become an established therapeutic option for patients with acute and chronic liver failure. Overall survival has dramatically increased over the last decades, mainly due to improved surgical techniques, the introduction of new immunosuppressive and anti-infective drugs but also due to continuous progress in the pre- and post-operative intensive care management of these patients. AIM This article aims to give a short overview of the main aspects regarding pre- and post-LT critical care issues. RESULTS Intensive care treatment plays a major role in the management of patients with acute and acute-on-chronic liver failure in order to enable a life-saving LT for these patients. Severe infections/sepsis mostly accompanied by multi-organ failure represent the major challenges for intensive care specialists. The immediate postoperative care takes place in the intensive care unit (ICU) in almost all patients. The expected ICU stay has been significantly shortened over the years to an average of about 1-2 days. Infections as well as acute kidney injury are the main complications in the first post-operative weeks being responsible for prolonged ICU stays. Immunologic and surgical complications are additional important issues in the post-LT intensive care setting. CONCLUSION The intensive care management pre and post LT is an important, multidisciplinary challenge in the successful treatment of patients with acute and chronic liver failure.
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Affiliation(s)
- I Graziadei
- Abteilung für Innere Medizin, Landeskrankenhaus Hall i.T., Milserstr. 10, 6060, Hall, Österreich,
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Florescu DF, Langnas AN, Sandkovsky U. Opportunistic viral infections in intestinal transplantation. Expert Rev Anti Infect Ther 2014; 11:367-81. [DOI: 10.1586/eri.13.25] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Maguire O, Tario JD, Shanahan TC, Wallace PK, Minderman H. Flow cytometry and solid organ transplantation: a perfect match. Immunol Invest 2014; 43:756-74. [PMID: 25296232 PMCID: PMC4357273 DOI: 10.3109/08820139.2014.910022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In the field of transplantation, flow cytometry serves a well-established role in pre-transplant crossmatching and monitoring immune reconstitution following hematopoietic stem cell transplantation. The capabilities of flow cytometers have continuously expanded and this combined with more detailed knowledge of the constituents of the immune system, their function and interaction and newly developed reagents to study these parameters have led to additional utility of flow cytometry-based analyses, particularly in the post-transplant setting. This review discusses the impact of flow cytometry on managing alloantigen reactions, monitoring opportunistic infections and graft rejection and gauging immunosuppression in the context of solid organ transplantation.
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Affiliation(s)
- Orla Maguire
- Laboratory of Flow and Image Cytometry, Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Joseph D. Tario
- Laboratory of Flow and Image Cytometry, Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Thomas C. Shanahan
- Department of Microbiology and Immunology, State University of New York at Buffalo, Buffalo, New York, USA
| | - Paul K. Wallace
- Laboratory of Flow and Image Cytometry, Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Hans Minderman
- Laboratory of Flow and Image Cytometry, Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA
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Poovorawan K, Linlawan S, Wisedopas N, Komolmit P. Post liver transplantation lymphoproliferative disorder mimics recurrence of hepatocellular carcinoma. BMJ Case Rep 2013; 2013:bcr-2013-200837. [PMID: 24351512 DOI: 10.1136/bcr-2013-200837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of Epstein-Barr virus (EBV)-related postliver transplantation lymphoproliferative disorder (PTLD) in a patient with post liver transplant which initially presented in a CT scan image mimicking recurrence of hepatocellular carcinoma. Histopathology showed atypical plasma cell-like infiltration, and immunohistochemistry confirmed diagnosis of EBV-associated diffuse large B-cell lymphoma. Typical imaging from dynamic phases contrast CT scan might not accurately diagnose recurrent HCC in postorthotropic liver transplantation. Liver biopsy should be performed for accurate diagnosis and proper treatment.
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Longmore DK, Conwell LS, Burke JR, McDonald SP, McTaggart SJ. Post-transplant lymphoproliferative disorder: no relationship to recombinant human growth hormone use in Australian and New Zealand pediatric kidney transplant recipients. Pediatr Transplant 2013; 17:731-6. [PMID: 24164826 DOI: 10.1111/petr.12167] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 11/27/2022]
Abstract
PTLD is a potentially life-limiting complication of pediatric transplantation. Previous registry-based studies in renal transplantation have suggested a link between rhGH use and PTLD. In this study, demographic and transplant data on those aged <18 yr and transplanted between 1991 and 2008 were collected from the ANZDATA Registry. Associations between gender, age at time of transplant, recipient CMV and EBV status, use of monoclonal antibody therapy, and use of rhGH were studied as potential predictors of PTLD. Among 650 transplants, there were 20 cases (3.1%) of PTLD, with half presenting within two yr post-transplant. Eight patients exposed to rhGH at any time developed PTLD, and this association was not statistically significant (RR = 1.5[0.6-3.4], p = 0.36). On multivariate analysis, there were no significant predictors for PTLD. In this study, previously identified potential risk factors were not identified as significant predictors for the development of PTLD. Although limited sample size may affect our ability to infer safety, this large retrospective cohort study does not suggest an increased risk of PTLD in pediatric kidney transplant recipients who received rhGH treatment.
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Affiliation(s)
- Danielle K Longmore
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Brisbane, Qld, Australia
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Affiliation(s)
- Daire T O'Shea
- Transplant Infectious Diseases, Alberta Transplant Institute, University of Alberta, 6-030 Katz Center for Health Research, 11361-87 Ave, Edmonton, Alberta T6G 2E1, Canada
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Kelly DA, Bucuvalas JC, Alonso EM, Karpen SJ, Allen U, Green M, Farmer D, Shemesh E, McDonald RA. Long-term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl 2013; 19:798-825. [PMID: 23836431 DOI: 10.1002/lt.23697] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/15/2013] [Indexed: 12/15/2022]
Affiliation(s)
- Deirdre A Kelly
- Liver Unit, Birmingham Children's Hospital, National Health Service Trust, Birmingham, United Kingdom.
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