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Tang J, Zhou Y, Gong L, Deng J, Yuan Y, Zhong Y, Li J, Wang G. ARDS in solid organ transplant recipients hospitalized for COVID-19 based on the 2023 new definition. Heart Lung 2024; 66:103-107. [PMID: 38604053 DOI: 10.1016/j.hrtlng.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Solid organ transplant recipients (SOTRs) are more likely to suffer complications after being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). OBJECTIVES We aimed to describe the clinical features of SOTRs infected with SARS-CoV-2 and to assess independent risk factors associated with the development of acute respiratory distress syndrome (ARDS) following COVID-19 infection in SOTRs based on the new ARDS definition. METHODS 358 SOTRs infected with SARS-CoV-2 were recruited and divided into two groups, patients with ARDS (n = 81) and patients without ARDS (n = 277). Demographic data, initial laboratory findings, therapeutic measures, and outcome indicators were compared between the two groups. The association between the onset of ARDS and related factors was analyzed using a logistic regression model. A nomogram was created to estimate the probability of developing ARDS. RESULTS Approximately 22.6 % (81/358) of hospitalized SOTRs infected with SARS-CoV-2 developed ARDS. In comparison to patients without ARDS, those with ARDS presented with more underlying conditions, decreased lymphocyte counts and serum albumin levels, but increased levels of leukocytes, serum creatinine, nitrogen urea, uric acid, and inflammatory markers. Cerebrovascular disease, leukocyte counts, albumin levels, and IL-6 levels were independent risk factors for the development of ARDS in this population. Furthermore, a nomogram prediction model was created utilizing the aforementioned factors to facilitate early prediction of ARDS, exhibiting an AUC (area under curve) of 0.81. CONCLUSIONS Cerebrovascular disease, leukocyte counts, albumin levels, and IL-6 levels were independent risk factors for the development of ARDS following COVID-19 infection in SOTRs.
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Affiliation(s)
- Jun Tang
- Department of Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; Hunan Provincial Center for Intensive Care Medicine and Clinical Research in Smart Healthcare, Changsha, China; Center for Smart Intensive Care Clinical Medicine Research, Central South University, Changsha, China
| | - Yang Zhou
- Department of Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; Hunan Provincial Center for Intensive Care Medicine and Clinical Research in Smart Healthcare, Changsha, China; Center for Smart Intensive Care Clinical Medicine Research, Central South University, Changsha, China
| | - Linmei Gong
- Department of Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; Hunan Provincial Center for Intensive Care Medicine and Clinical Research in Smart Healthcare, Changsha, China; Center for Smart Intensive Care Clinical Medicine Research, Central South University, Changsha, China
| | - Jiayi Deng
- Department of Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; Hunan Provincial Center for Intensive Care Medicine and Clinical Research in Smart Healthcare, Changsha, China; Center for Smart Intensive Care Clinical Medicine Research, Central South University, Changsha, China
| | - Yihao Yuan
- Department of Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; Hunan Provincial Center for Intensive Care Medicine and Clinical Research in Smart Healthcare, Changsha, China; Center for Smart Intensive Care Clinical Medicine Research, Central South University, Changsha, China
| | - Yanjun Zhong
- Department of Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; Hunan Provincial Center for Intensive Care Medicine and Clinical Research in Smart Healthcare, Changsha, China; Center for Smart Intensive Care Clinical Medicine Research, Central South University, Changsha, China
| | - Jinxiu Li
- Department of Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; Hunan Provincial Center for Intensive Care Medicine and Clinical Research in Smart Healthcare, Changsha, China; Center for Smart Intensive Care Clinical Medicine Research, Central South University, Changsha, China
| | - Guyi Wang
- Department of Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; Hunan Provincial Center for Intensive Care Medicine and Clinical Research in Smart Healthcare, Changsha, China; Center for Smart Intensive Care Clinical Medicine Research, Central South University, Changsha, China.
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Mehta A. Managing dyslipidemia in solid organ transplant patients. Indian Heart J 2024; 76 Suppl 1:S93-S95. [PMID: 38199560 PMCID: PMC11019326 DOI: 10.1016/j.ihj.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/28/2023] [Accepted: 01/06/2024] [Indexed: 01/12/2024] Open
Abstract
Solid organ transplant recipients face an increased risk of dyslipidemia, which contributes to cardiovascular complications. Commonly used drugs such as ciclosporin and tacrolimus can aggravate and cause dyslipidemia. Immunosuppressive drugs particularly ciclosporin and tacrolimus are also known to worsen dyslipidemia in transplant recipients. Mammalian target of rapamycin (mTOR) inhibitors like sirolimus and everolimus also alter lipid metabolism. Lifestyle and dietary modifications should be encouraged. Careful consideration of immunosuppressant choices is also vital to control dyslipidemia. Statins are recommended as first-line agents for lipid-lowering therapy, with consideration for potential drug interactions. Other options, such as ezetimibe and nicotinic acid, may be considered as alternatives. The management of dyslipidemia in renal transplant patients mainly involves statin therapy, although the clinical effectiveness in this population is not well-documented. Lifestyle modifications, careful drug selection, and statin therapy are key components in managing dyslipidemia in solid organ transplant patients.
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Varley CD, Streifel AC, Bair AM, Winthrop KL. Nontuberculous Mycobacterial Pulmonary Disease in the Immunocompromised Host. Clin Chest Med 2023; 44:829-838. [PMID: 37890919 DOI: 10.1016/j.ccm.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
The immunocompromised host is at an increased risk for pulmonary and extrapulmonary NTM infections. Where data are available in these specific populations, increased mortality is observed with NTM disease. Prior to starting therapy for NTM disease, providers should ensure diagnostic criteria are met as treatment is long and often associated with significant side effects and toxicities. Treatment should involve 2 to 4 agents and be guided by cultures and antimicrobial susceptibilities. Drug interactions are important to consider, especially in those with HIV or transplant recipients. Whenever possible, immunosuppression should be reduced or changed.
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Affiliation(s)
- Cara D Varley
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University; Program in Epidemiology, Oregon Health & Science University-Portland State University School of Public Health.
| | - Amber C Streifel
- Department of Pharmacy Services, Oregon Health & Science University
| | - Amanda M Bair
- Department of Pharmacy Services, Oregon Health & Science University
| | - Kevin L Winthrop
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University; Program in Epidemiology, Oregon Health & Science University-Portland State University School of Public Health
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Ashokkumar C, Rohan V, Kroemer AH, Rao S, Mazariegos G, Higgs BW, Nadig S, Almeda J, Dhani H, Khan K, Yazigi N, Ekong U, Kaufman S, Betancourt-Garcia MM, Mukund K, Sethi P, Mehrotra S, Soltys K, Singh MS, Bond G, Khanna A, Ningappa M, Spishock B, Sindhi E, Atale N, Saunders M, Baliga P, Fishbein T, Subramaniam S, Sindhi R. Impaired Cellular and Antibody immunity after COVID-19 in Chronically Immunosuppressed Transplant Recipients. J Surg Res (Houst) 2023; 6:348-363. [PMID: 38606317 PMCID: PMC11007760 DOI: 10.26502/jsr.10020321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Assessment of cellular immunity to the SARS-CoV-2 coronavirus is of great interest in chronically immunosuppressed transplant recipients (Tr), who are predisposed to infections and vaccination failures. We evaluated CD154-expressing T-cells induced by spike (S) antigenic peptides in 204 subjects-103 COVID-19 patients and 101 healthy unexposed subjects. S-reactive CD154+T-cell frequencies were a) higher in 42 healthy unexposed Tr who were sampled pre-pandemic, compared with healthy NT (p=0.02), b) lower in Tr COVID-19 patients compared with healthy Tr (p<0.0001) and were accompanied by lower S-reactive B-cell frequencies (p<0.05), c) lower in Tr with severe COVID-19 (p<0.0001), or COVID-19 requiring hospitalization (p<0.05), compared with healthy Tr. Among Tr with COVID-19, cytomegalovirus co-infection occurred in 34%; further, incidence of anti-receptor-binding-domain IgG (p=0.011) was lower compared with NT COVID-19 patients. Healthy unexposed Tr exhibit pre-existing T-cell immunity to SARS-CoV-2. COVID-19 impairs anti-S T-cell and antibody and predisposes to CMV co-infection in transplant recipients.
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Affiliation(s)
- Chethan Ashokkumar
- Plexision Inc., Pittsburgh, PA, USA
- Hillman Center for Pediatric Transplantation, University of Pittsburgh, PA, USA
| | - Vinayak Rohan
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Sohail Rao
- DHR Health and DHR Health Institute for Research and Development, Edinburg, Tx, University of Houston, Houston, TX, USA
| | - George Mazariegos
- Hillman Center for Pediatric Transplantation, University of Pittsburgh, PA, USA
| | - Brandon W Higgs
- Hillman Center for Pediatric Transplantation, University of Pittsburgh, PA, USA
| | - Satish Nadig
- Medical University of South Carolina, Charleston, SC, USA
| | - Jose Almeda
- DHR Health and DHR Health Institute for Research and Development, Edinburg, Tx, University of Houston, Houston, TX, USA
| | - Harmeet Dhani
- Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Khalid Khan
- Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Nada Yazigi
- Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Udeme Ekong
- Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Stuart Kaufman
- Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Monica M Betancourt-Garcia
- DHR Health and DHR Health Institute for Research and Development, Edinburg, Tx, University of Houston, Houston, TX, USA
| | | | | | | | - Kyle Soltys
- Hillman Center for Pediatric Transplantation, University of Pittsburgh, PA, USA
| | - Manasi S Singh
- Medical University of South Carolina, Charleston, SC, USA
| | - Geoffrey Bond
- Hillman Center for Pediatric Transplantation, University of Pittsburgh, PA, USA
| | - Ajai Khanna
- Hillman Center for Pediatric Transplantation, University of Pittsburgh, PA, USA
| | - Mylarappa Ningappa
- Hillman Center for Pediatric Transplantation, University of Pittsburgh, PA, USA
| | | | | | | | | | | | - Thomas Fishbein
- Medstar Georgetown Transplant Institute, Washington, DC, USA
| | | | - Rakesh Sindhi
- Plexision Inc., Pittsburgh, PA, USA
- Hillman Center for Pediatric Transplantation, University of Pittsburgh, PA, USA
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Luo W, He Y, Wei MG, Lu GB, Yi Q. Paxlovid-tacrolimus drug-drug interaction caused severe diarrhea that induced combined diabetic ketoacidosis and a hyperglycemic hyperosmolar state in a kidney transplant patient: a case report. J Med Case Rep 2023; 17:406. [PMID: 37742028 PMCID: PMC10518083 DOI: 10.1186/s13256-023-04135-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/18/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Transplant recipients are at high risk of coronavirus disease 2019, and a timely supply of antivirals should be prioritized for those patients. Complicated drug‒drug interactions limit the use of Paxlovid (nirmatrelvir/ritonavir) coadministered with tacrolimus. Here, we report a patient with a kidney transplant who received Paxlovid and reduced-dose tacrolimus at the same time and suffered a severe tacrolimus toxicity. CASE PRESENTATION We present a 56-year-old man of Han ethnicity with a kidney transplant who suffered from coronavirus disease 2019 twice. For the first infection, the immunosuppressants were substituted by dexamethasone when the patient used Paxlovid, and everything went well. For the second time, tacrolimus at a reduced dose concomitant with Paxlovid caused severe diarrhea, inducing combined diabetic ketoacidosis and a hyperglycemic hyperosmolar state. CONCLUSION This case challenges the dose-adjustment strategy of managing drug‒drug interactions. We suggest that tacrolimus should be stopped when Paxlovid is applied and that corticosteroids could be a good substitution.
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Affiliation(s)
- Wei Luo
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Leshan, Leshan, 614000, Sichuan, People's Republic of China.
| | - Yu He
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Leshan, Leshan, 614000, Sichuan, People's Republic of China
| | - Mao Gang Wei
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Leshan, Leshan, 614000, Sichuan, People's Republic of China
| | - Guang Bing Lu
- Department of Critical Care Medicine, Meishan Traditional Chinese Medical Hospital, Meishan, 620010, Sichuan, People's Republic of China
| | - Qun Yi
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
- Department of Critical Care Medicine, Sichuan Cancer Hospital, Chengdu, 610041, Sichuan, People's Republic of China.
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Mafi S, Alain S, Hantz S. Evaluation of the fully automated LIAISON®XL chemiluminescence analyzer for QuantiFERON®-CMV testing in transplant recipients. J Clin Virol 2023; 166:105550. [PMID: 37527584 DOI: 10.1016/j.jcv.2023.105550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Monitoring CMV-specific cell-mediated immunity by the QuantiFERON®-CMV (QF-CMV) may be useful in predicting the risk of CMV infection in transplant recipients (TR). OBJECTIVES As the QuantiFERON-Tuberculosis (QFT®-Plus) became available on the fully automated LIAISON®XL chemiluminescence (CLIA) analyzer, we evaluated the performance of the QF-CMV on the LIAISON®XL analyzer using the QuantiFERON®-TB Gold Plus reagent. STUDY DESIGN Between 2018 and 2022, 81 samples from TR were collected at the Department of Virology of Limoges Hospital, France. Whole blood was collected into each of the three QF-CMV collection tubes: a CMV-antigen tube (QF-Ag), a mitogen tube (QF-Mg) (positive control), and a nil tube (negative control). The QF-CMV was performed on the LIAISON®XL analyzer, and results were compared with those obtained by conventional microplate ELISA. RESULTS Intra- and inter-assay coefficients of variation were inferior to 20%. No inter-sample contamination was found (p=0.366). The level of concordance between CLIA and the commonly used ELISA method was 88.9%. Positive and negative percent agreements were 92.3% and 85.7%, respectively, with a very good agreement between assays (κ=0.818). Most discordances were due to indeterminate- or negative-ELISA/positive-CLIA results (most of ELISA results were borderline). Linear regression analyses demonstrated a strong correlation between both assays (QF-Ag Pearson's r=0.978, QF-Mg Pearson's r=0.963). No significant difference was observed in median QF-CMV values between both assays (QF-Ag p=0.776; QF-Mg p=0.853; Mann-Whitney U test). The Bland-Altman plots showed a minor difference in IFN-γ release (QF-Ag -0.069 IU/ml, 95% limits of agreement (LoA): -1.589; 1.451; QF-Mg 0.190 IU/ml, 95% LoA: -2.070; 2.450). CONCLUSION Automated QF-CMV with CLIA is comparable to QF-CMV performed by ELISA with a presumably higher sensitivity for IFN-γ detection that may result in the conversion of samples close to the ELISA cut-off into positive results. Moreover, the use of a random-access analyzer allows to optimize the follow-up of TR.
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Affiliation(s)
- Sarah Mafi
- French National Reference Center for Herpesviruses, Bacteriology, Virology, Hygiene Department, CHU Limoges, F-87000 Limoges, France; INSERM, RESINFIT, U1092, F-87000, Limoges, France.
| | - Sophie Alain
- French National Reference Center for Herpesviruses, Bacteriology, Virology, Hygiene Department, CHU Limoges, F-87000 Limoges, France; INSERM, RESINFIT, U1092, F-87000, Limoges, France
| | - Sébastien Hantz
- French National Reference Center for Herpesviruses, Bacteriology, Virology, Hygiene Department, CHU Limoges, F-87000 Limoges, France; INSERM, RESINFIT, U1092, F-87000, Limoges, France.
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Uematsu H, Shinoda K, Saito A, Sakai K. Deep venous thrombosis in a kidney transplant recipient with COVID-19: a case report. CEN Case Rep 2023; 12:98-103. [PMID: 35972687 PMCID: PMC9379217 DOI: 10.1007/s13730-022-00724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/21/2022] [Indexed: 02/04/2023] Open
Abstract
The outcomes of COVID-19 in kidney transplant recipients have shown high mortality. In addition to their immunocompromised states, kidney transplant recipients frequently have certain exacerbation risk comorbidities of COVID-19, such as diabetes mellitus, hypertension, and chronic kidney disease. Several concomitant diseases develop during the course of COVID-19, one of which is thromboembolism, which can potentially lead to a critical condition. However, thromboembolic complications in kidney transplant recipients with COVID-19 have not been fully addressed in previous studies. A 62-year-old man, who underwent kidney transplantation 17 years ago, was diagnosed with COVID-19 and was admitted to our hospital. Although the patient was in remission at the start of the hospitalization, his condition became severe on day 7 after admission, with fever, elevated white blood cell counts (10,000/μL) and a high C-reactive protein level (6.9 mg/dL). Although the patient was not under forced bed rest, an ultrasound study on day 10 detected deep venous thrombosis (DVT), with an elevated D-dimer level (6.2 µg/dL). We withdrew the mycophenolate mofetyl and the tacrolimus dosage but did not administer any specific treatment for COVID-19. The patient achieved successful clearance of SARS-CoV-2 on day 16. The DVT disappeared after systematic heparin treatment and oral rivaroxaban for 2 months. DVT occurred in a kidney transplant recipient with COVID-19 who was not bedridden and might manifest when the clinical status was exacerbated during hospitalization.
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Affiliation(s)
- Hikaru Uematsu
- Department of Nephrology, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Tokyo, 143-8541, Japan
| | - Kazunobu Shinoda
- Department of Nephrology, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Tokyo, 143-8541, Japan.
| | - Akinobu Saito
- Department of Nephrology, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Tokyo, 143-8541, Japan
| | - Ken Sakai
- Department of Nephrology, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Tokyo, 143-8541, Japan
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Teimouri A, Goudarzi F, Goudarzi K, Alimi R, Sahebi K, Foroozand H, Keshavarz H. Toxoplasma gondii Infection in Immunocompromised Patients in Iran (2013-2022): A Systematic Review and Meta-Analysis. Iran J Parasitol 2022; 17:443-457. [PMID: 36694563 PMCID: PMC9825698 DOI: 10.18502/ijpa.v17i4.11271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/19/2022] [Indexed: 12/14/2022]
Abstract
Background Toxoplasma gondii infection (toxoplasmosis) has the potential to cause a serious disease in immunocompromised patients and can be fatal in this population. We conducted a systematic review and meta-analysis to assess comprehensively the pooled seroprevalence of toxoplasmosis among immunocompromised patients including HIV/AIDS patients, cancer patients, and transplant recipients in Iran. Methods PubMed, Web of Science, Scopus, Embase, and Google Scholar databases (international) and Scientific Information Database (SID), Magiran, IranMedex, and IranDoc databases (national) were systematically searched for all reports that possibly contained data for T. gondii prevalence in different immunocompromised populations in Iran between 2013 and 2022. Results Overall, IgG seroprevalence rate of toxoplasmosis in Iranian immunocompromised patients was 45.1% (95% confidence interval (CI), 37.4-52.9). IgG seroprevalence rate of toxoplasmosis in 12 studies that included 2279 cancer patients, 19 studies that included 2565 HIV/AIDS patients and in 3 studies that included 200 transplant recipients was 43.6% (95% CI, 30.2-57.0), 45.9% (95% CI, 34.8-57.1) and 45.8% (95% CI, 32.5-59.0), respectively. Moreover, IgM seroprevalence rate in the 26 studies was 2.6% (95% CI, 1.4-3.7). Conclusion Our findings represent a high seroprevalence rate of Toxoplasma IgG among immunocompromised patients. Health improvement and education toward prevention of toxoplasmosis is of great importance for these susceptible populations.
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Affiliation(s)
- Aref Teimouri
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Goudarzi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kimia Goudarzi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rasoul Alimi
- Department of Epidemiology and Biostatistics, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Keivan Sahebi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Foroozand
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Keshavarz
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
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Monfared A, Akhondzadeh L, Mousazadeh M, Jafari A, Khosravi M, Lebadi M, Aghajanzadeh P, Haghdar-Saheli Y, Movassaghi A, Ramezanzadeh E, Shobeirian F, Kazemnezhad E, Esmaeili S. COVID-19 in renal transplant recipients and general population: a comparative study of clinical, laboratory, and radiological features, severity, and outcome. Virol J 2021; 18:243. [PMID: 34876176 PMCID: PMC8649678 DOI: 10.1186/s12985-021-01713-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/27/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19), a novel disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to millions of deaths worldwide. Kidney transplant recipients (KTRs) are a fragile population due to their immunosuppressed status. However, there are limited studies available comparing this population with the general population regarding clinical symptoms, and laboratory and imaging features as well as disease severity and clinical outcomes. METHODS A total of 24 KTRs and 40 patients from the general population (control group) were enrolled after applying exclusion criteria. Clinical symptoms, laboratory values, and lung involvement patterns in high-resolution computed tomography (HRCT) were compared between KTRs with COVID-19 and their counterparts from the general population. Moreover, the category of disease severity and adverse outcomes such as intensive care unit (ICU) admission, mechanical ventilation (MV), and mortality rate were also compared between these two groups. RESULTS Hypertension was significantly higher among KTRs. Dyspnea was significantly more among the control group (P = 0.045). There was no significant difference in the rest of clinical symptoms (P > 0.05). There was no significant difference in CT features as well, except pleural effusion, which was more prevalent in the control group. A lower absolute lymphocytic count (ALC) and platelet count were observed in KTRs. Renal transplant recipients (RTRs) had a higher elevation in creatinine level than their counterparts. The ICU admission, MV, duration of hospital stay, and mortality as adverse outcomes were not significantly different between the KTR and control groups. CONCLUSION In conclusion, there was no significant difference in the severity and risk of adverse outcomes, including MV, ICU admission, and mortality between KTRs under chronic immunosuppression and the control group.
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Affiliation(s)
- Ali Monfared
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Leila Akhondzadeh
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahsa Mousazadeh
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Atefeh Jafari
- Department of Clinical Pharmacy, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoud Khosravi
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammadkazem Lebadi
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Pegah Aghajanzadeh
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Yalda Haghdar-Saheli
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Movassaghi
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Elham Ramezanzadeh
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Ehsan Kazemnezhad
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Esmaeili
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Paez-Nova M, Andaur K, García-Ballestas E, Bustos-Salazar D, Moscote-Salazar LR, Koller O, Valenzuela S. Primary intracranial smooth muscle tumor associated with Epstein-Barr virus in immunosuppressed children: two cases report and review of literature. Childs Nerv Syst 2021; 37:3923-3932. [PMID: 33884483 DOI: 10.1007/s00381-021-05173-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
Primary intracranial smooth muscle tumors are rare. Most cases are related to Epstein-Barr virus proliferation in immunocompromised patients such as organ solid recipients. Only a few cases have been reported in pediatric patients. The clinical features are very variable depending mainly on the location and size of the smooth muscle tumor (SMT) and the pathogenesis is poorly understood. We describe two cases of intracranial SMT localized in the temporal lobe and associated with EBV in immunosuppressed children. A review of the literature associated with intracranial leiomyomas was also done.
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Affiliation(s)
- Maximiliano Paez-Nova
- Pediatric Neurosurgery Department, Dr. Asenjo Neurosurgical Institute, Santiago, Chile. .,Radioneurosurgery and Functional Neurosurgery Unit, Sheba Medical Center, Ramat Gan, Israel. .,Sheba Medical Center at Tel HaShomer, Tel Aviv University, Tel Aviv, Israel.
| | - Karem Andaur
- Pediatric Neurology Department, University of Santiago de Chile, Santiago, Chile
| | - Ezequiel García-Ballestas
- Latin American Council of Neurocritical Care-CLaNi, Cartagena, Colombia.,Center of Biomedical Research-CIB, Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Diego Bustos-Salazar
- Center of Biomedical Research-CIB, Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Luis Rafael Moscote-Salazar
- Latin American Council of Neurocritical Care-CLaNi, Cartagena, Colombia.,Center of Biomedical Research-CIB, Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Osvaldo Koller
- Pediatric Neurosurgery Department, Dr. Asenjo Neurosurgical Institute, Santiago, Chile.,Pediatric Neurosurgery Department, Alemana Clinic, Santiago, Chile
| | - Sergio Valenzuela
- Pediatric Neurosurgery Department, Dr. Asenjo Neurosurgical Institute, Santiago, Chile.,Pediatric Neurosurgery Department, Alemana Clinic, Santiago, Chile
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Asghari A, Sadeghipour Z, Hassanipour S, Abbasali Z, Ebrahimzadeh-Parikhani H, Hashemzaei M, Alimardani V, Hatam G. Association between Blastocystis sp. infection and immunocompromised patients: a systematic review and meta-analysis. Environ Sci Pollut Res Int 2021; 28:60308-60328. [PMID: 34528202 DOI: 10.1007/s11356-021-16187-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
The significance of opportunistic infections in immunocompromised patients and the enigmatic pathogenicity of Blastocystis directed us to conduct the first global systematic review and meta-analysis on Blastocystis prevalence, odds ratios (ORs), and subtypes distribution in various immunocompromised patients (HIV/AIDS, cancer and hemodialysis patients, as well as transplant recipients). The systematic searching procedure was done in Web of Science, PubMed, Scopus, and Google Scholar databases for relevant published literature until November 11, 2020. Random-effects model was utilized to calculate the weighted estimates and 95% confidence intervals (95% CIs). The computed pooled prevalence of Blastocystis inferred from 118 papers (128 datasets) on immunocompromised patients was 10.3% (95% CI: 8.7-12.2%), with 16.1% (95% CI: 11.3-22.2%), 12.5% (95% CI: 8.5-18%), 8.4% (95 % CI: 6.6-10.6%), and 6% (95% CI: 2.6-13.3%) for hemodialysis patients, cancer patients, HIV/AIDS patients, and transplant recipients, respectively. Based on 50 case-control studies (54 datasets), the highest ORs were associated with cancer [2.81 (95% CI: 1.24-6.38, P = 0.013)] and hemodialysis patients [2.78 (95% CI: 1.19-6.48, P = 0.018)]. The most frequent subtype being found in immunocompromised patients was ST3 [41.7% (95% CI: 31.4-52.7%)], followed by ST1 [31.7% (95% CI: 23.2-41.8%)] and ST2 [23.1% (95% CI: 14.8-34.1%)]. Also, the weighted frequency of Blastocystis in various subgroups (publication year, WHO regions, geographical distribution, continents, and country income) was analyzed separately. In total, the results of the present meta-analysis highlighted that one's immunodeficiency status is probably associated with an increased Blastocystis infection, underpinning strict preventive measures to be taken.
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Affiliation(s)
- Ali Asghari
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zeinab Sadeghipour
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Abbasali
- Department of Medical Parasitology and Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hasan Ebrahimzadeh-Parikhani
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Hashemzaei
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Alimardani
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamreza Hatam
- Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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12
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Lew J, Sheeder J, Lazorwitz A. Etonogestrel contraceptive implant uptake and safety among solid organ transplant recipients. Contraception 2021; 104:556-560. [PMID: 34147509 PMCID: PMC8502202 DOI: 10.1016/j.contraception.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine the safety of etonogestrel contraceptive implant use among reproductive-age women who are solid organ transplant recipients. STUDY DESIGN We conducted a retrospective cohort study with matching of reproductive-age women (14-45 years) who were solid organ transplant recipients and received care at a tertiary medical center in Denver, Colorado between 2011 and 2019. We identified cases who used an etonogestrel contraceptive implant post-transplant and then matched controls (no hormonal contraceptive use) in a 1:1 ratio according to age, transplant type, and institution. We compared pregnancy patterns, post-transplant infections, immunosuppressant therapy adjustments, and graft complications between cases and controls. We also evaluated implant-related side effect profiles and continuation rates among cases only. RESULTS We identified 24 cases and 24 matched controls. When compared to age and transplant organ-matched controls, contraceptive implant users were not at increased risk for adverse transplant-related outcomes. Graft rejection was the most common transplant-related complication in both groups (n = 11, 45.8% cases; n = 10, 41.7% controls). Additionally, outcomes concerning pregnancies, infections and immunosuppressant therapy changes showed no statistically significant difference between either group. CONCLUSIONS This study provides the first data that the etonogestrel contraceptive implant is likely a safe contraceptive option for reproductive-age women who are solid organ transplant recipients. Given the solid organ transplant recommendations to avoid pregnancy during the first 1 to 2 years post-transplant, healthcare providers should continue to counsel solid organ transplant recipients at risk of pregnancy on the etonogestrel contraceptive implant as an effective and safe method of pregnancy prevention. IMPLICATIONS Reproductive age women who are solid organ transplant recipients face additional health risks with unintended pregnancies. The etonogestrel contraceptive implant remains a safe and effective method of contraception for this specific population, with no increase in graft-related complications among contraceptive implant users.
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Affiliation(s)
- Jessica Lew
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning, Aurora, CO, United States
| | - Jeanelle Sheeder
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning, Aurora, CO, United States
| | - Aaron Lazorwitz
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning, Aurora, CO, United States.
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Timar J, Bleil M, Daly T, Koomar S, Hasz R, Nathan H. Successful strategies to increase organ donation: the Gift of Life Donor Program Philadelphia model. Indian J Thorac Cardiovasc Surg 2021; 37:380-394. [PMID: 34629767 PMCID: PMC8464643 DOI: 10.1007/s12055-021-01219-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 10/20/2022] Open
Abstract
Organ donation connects the ending of one life with the renewal of another. Acute care hospitals care for the organ donor and transplant organizations complete life-saving surgeries. Between them is a vital component: a less-known medical team dedicated to ensuring that organ donation and transplantation are possible. Organ procurement organizations (OPOs) support grieving families during a painful time of loss, providing a rare and precious opportunity in donation. The OPO is simultaneously poised to ensure that organs successfully begin their journey to renewing life and restoring hope for recipients and their loved ones. Every OPO faces a myriad of challenges in meeting its responsibilities. A recognized leader in the field, Gift of Life Donor Program (GLDP) in Philadelphia, Pennsylvania has been committed to meeting these challenges for nearly fifty years. The successes of this OPO reflect the legacies of organ donors, recipients, and their cherished loved ones.
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Affiliation(s)
- Jennifer Timar
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Maria Bleil
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Theresa Daly
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Susan Koomar
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Richard Hasz
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Howard Nathan
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
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14
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Schramm R, Costard-Jäckle A, Rivinius R, Fischer B, Müller B, Boeken U, Haneya A, Provaznik Z, Knabbe C, Gummert J. Poor humoral and T-cell response to two-dose SARS-CoV-2 messenger RNA vaccine BNT162b2 in cardiothoracic transplant recipients. Clin Res Cardiol 2021; 110:1142-1149. [PMID: 34241676 PMCID: PMC8267767 DOI: 10.1007/s00392-021-01880-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022]
Abstract
AIMS Immunocompromised patients have been excluded from studies of SARS-CoV-2 messenger RNA vaccines. The immune response to vaccines against other infectious agents has been shown to be blunted in such patients. We aimed to analyse the humoral and cellular response to prime-boost vaccination with the BNT162b2 vaccine (Pfizer-BioNTech) in cardiothoracic transplant recipients. METHODS AND RESULTS A total of 50 transplant patients [1-3 years post heart (42), lung (7), or heart-lung (1) transplant, mean age 55 ± 10 years] and a control group of 50 healthy staff members were included. Blood samples were analysed 21 days after the prime and the boosting dose, respectively, to quantify anti-SARS-CoV-2 spike protein (S) immunoglobulin titres (tested by Abbott, Euroimmun and RocheElecsys Immunoassays, each) and the functional inhibitory capacity of neutralizing antibodies (Genscript). To test for a specific T-cell response, heparinized whole blood was stimulated with SARS-CoV-2 specific peptides, covering domains of the viral spike, nucleocapsid and membrane protein, and the interferon-γ release was measured (QuantiFERON Monitor ELISA, Qiagen). The vast majority of transplant patients (90%) showed neither a detectable humoral nor a T-cell response three weeks after the completed two-dose BNT162b2 vaccination; these results are in sharp contrast to the robust immunogenicity seen in the control group: 98% exhibited seroconversion after the prime dose already, with a further significant increase of IgG titres after the booster dose (average > tenfold increase), a more than 90% inhibition capability of neutralizing antibodies as well as evidence of a T-cell responsiveness. CONCLUSIONS The findings of poor immune responses to a two-dose BNT162b2 vaccination in cardiothoracic transplant patients have a significant impact for organ transplant recipients specifically and possibly for immunocompromised patients in general. It urges for a review of future vaccine strategies in these patients.
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Affiliation(s)
- René Schramm
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinik, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Angelika Costard-Jäckle
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinik, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
| | - Rasmus Rivinius
- Klinik für Kardiologie, Angiologie Und Pneumologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Bastian Fischer
- Institut für Transfusions- Und Labormedizin, Herz Und Diabeteszentrum NRW, Universitätsklinik, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Benjamin Müller
- Institut für Transfusions- Und Labormedizin, Herz Und Diabeteszentrum NRW, Universitätsklinik, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Udo Boeken
- Klinik für Herzchirurgie, Universitätsklinikum Düsseldorf, Heinrich Heine Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Assad Haneya
- Klinik für Herznahe- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Zdenek Provaznik
- Klinik für Herz-, Thorax- Und Herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Cornelius Knabbe
- Institut für Transfusions- Und Labormedizin, Herz Und Diabeteszentrum NRW, Universitätsklinik, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Jan Gummert
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinik, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
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15
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Courtwright AM, Erler KS, Bandini JI, Zwirner M, Cremens MC, McCoy TH, Robinson EM, Rubin E. Ethics Consultation for Adult Solid Organ Transplantation Candidates and Recipients: A Single Centre Experience. J Bioeth Inq 2021; 18:291-303. [PMID: 33638124 PMCID: PMC7908944 DOI: 10.1007/s11673-021-10092-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent , p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families.
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Affiliation(s)
- Andrew M Courtwright
- Department of Pulmonary and Critical Care, Hospital of the University of Pennsylvania, Gates 940, Philadelphia, PA, 19102, USA.
- Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA.
| | - Kim S Erler
- Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | | | - Mary Zwirner
- Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA
- Social Service, Massachusetts General Hospital, Boston, MA, USA
| | - M Cornelia Cremens
- Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas H McCoy
- Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ellen M Robinson
- Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA
- Patient Care Services, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Rubin
- Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
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16
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Solomon-Cohen E, Reiss-Huss S, Hodak E, Davidovici B. Low-Dose Acitretin for Secondary Prevention of Keratinocyte Carcinomas in Solid-Organ Transplant Recipients. Dermatology 2021; 238:161-166. [PMID: 33902035 DOI: 10.1159/000515496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Keratinocyte carcinomas, particularly squamous cell carcinoma (SCC), occur more frequently and aggressively in solid-organ transplant recipients (SOTRs) than in the general population. Systemic retinoids are effective in secondary prevention of keratinocyte carcinomas in this population, but their use is limited by adverse effects including a rebound effect in cases of treatment discontinuation. OBJECTIVE Our aim was to determine whether low-dose acitretin is efficient in the secondary prevention of keratinocyte carcinomas in SOTRs. METHODS This retrospective case-crossover study was conducted at a specialized dermatology clinic for SOTRs in a large transplantation center in 2010-2017. Patients with at least 1 previous keratinocyte carcinoma who were treated with acitretin 10 mg/day for 2 years were included. The main outcome was the difference in the number of new keratinocyte carcinomas diagnosed during treatment compared to during the 2-year pretreatment period. RESULTS The cohort included 34 SOTRs. A significant reduction in the mean number of new keratinocyte carcinomas during treatment relative to the pretreatment period was observed (1.7 vs. 3.6, -53% p = 0.002). Similar results were noted on analysis by tumor type, for both SCC and basal cell carcinoma. CONCLUSION This study of SOTRs demonstrated positive results for low-dose acitretin as a chemoprevention of keratinocyte carcinomas in this population.
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Affiliation(s)
- Efrat Solomon-Cohen
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiran Reiss-Huss
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmilia Hodak
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Batya Davidovici
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Kim DG, Seo WJ, Cho M, Kim YM, Huh KH, Cheong JH, Hyung WJ, Kim MS, Kim HI. Perioperative, short-, and long-term outcomes of gastric cancer surgery: Propensity score-matched analysis of patients with or without prior solid organ transplantation. Eur J Surg Oncol 2021; 47:3105-3112. [PMID: 33906787 DOI: 10.1016/j.ejso.2021.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/28/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Details of perioperative outcomes and survival after gastric cancer surgery in prior transplant recipients have received minimal research attention. METHODS We performed an observational cohort study using the database of 20,147 gastric cancer patients who underwent gastrectomy at a single gastric cancer center in Korea. Forty-one solid organ recipients [kidney (n = 35), liver (n = 5), or heart (n = 1)] were matched with 205 controls using propensity score matching. RESULTS Operation time, blood loss, and postoperative pain were similar between groups. Short-term complication rates were similar between transplantation and control groups (22.0% vs. 20.1%, P = 0.777). Transplantation group patients with stage 1 gastric cancer experienced no recurrence, while those with stage 2/3 cancer had significantly higher recurrence risk compared to the controls (P = 0.049). For patients with stage 1 cancer, the transplantation group had a significantly higher rate of non-gastric cancer-related deaths compared to the controls (19.2% vs. 1.4%, P = 0.001). For those with stage 2/3 cancer, significantly lower proportion of the transplantation group received adjuvant chemotherapy compared to the control group (26.7% vs. 80.3%, P < 0.001). The transplantation group had a higher (albeit not statistically significant) rate of gastric cancer-related deaths compared to the controls (40.0% vs. 18.0%, P = 0.087). CONCLUSION Transplant recipients and non-transplant recipients exhibited similar perioperative and short-term outcomes after gastric cancer surgery. From long-term outcome analyses, we suggest active surveillance for non-gastric cancer-related deaths in patients with early gastric cancer, as well as strict oncologic care in patients with advanced cancer, as effective strategies for transplant recipients.
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Affiliation(s)
- Deok Gie Kim
- Transplantation Center, Department of Transplantation Surgery, Wonju Severance Christian Hospital, Wonju, South Korea; Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Won Jun Seo
- Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea; Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea; Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoo-Min Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea; Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea; Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyu Ha Huh
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea; The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae-Ho Cheong
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea; Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea; Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea; Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea; Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea; The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea; Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea; Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.
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18
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Yu J, Diaz JD, Goldstein SC, Patel RD, Varela JC, Reyenga C, Smith M, Smith T, Balls J, Ahmad S, Mori S. Impact of Next-Generation Sequencing Cell-free Pathogen DNA Test on Antimicrobial Management in Adults with Hematological Malignancies and Transplant Recipients with Suspected Infections. Transplant Cell Ther 2021; 27:500.e1-500.e6. [PMID: 33849818 DOI: 10.1016/j.jtct.2021.02.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/30/2020] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
Infections in adult patients with hematological malignancies (HM) and stem cell transplant (SCT) recipients are a significant cause of morbidity and mortality. A timely diagnosis of infections can have a major impact on outcomes. Tools that help rule out infectious causes of fever can decrease antibiotic use, toxicities, hospitalization costs, and potentially decrease antibiotic resistance in the long term. We retrospectively evaluated the ability of cell-free DNA next-generation sequencing (NGS) testing in the timely identification of pathogenic microorganisms and its impact on the antimicrobial management of immunocompromised patients with hematologic malignancies. In the period between 2018 to 2020, 95 samples were reviewed, of which 31 adult patients (32 tests) had hematologic malignancies or were recipients of SCT. The NGS tests were performed in the following patients: (a) patients with prolonged fever and negative conventional tests, (b) persistent fever despite positive conventional test and appropriate antimicrobials, and (c) fever-free patients with imaging suspicious for infection. The median time from fever to NGS sampling was 5 days (range, 1-28). The median time to NGS results was 2 days (range, 1-6). The NGS resulted in an escalation of antibiotics in 28% of cases (9/32) and de-escalation of antibiotics in 31% of cases (10/32). Overall, NGS testing changed management in nearly 59% (19/32) of patients. The sensitivity and specificity of NGS to detect clinically significant infection was 80% and 58%, respectively. The test identified uncommon and difficult to diagnose organisms such as Nocardia, Legionella, Toxoplasma and Pneumocystis jirovecii resulting in rapid antimicrobial interventions. In conclusion, in patients with HM or SCT recipients, microbial cell-free DNA sequencing allowed rapid and actionable treatment. This strategy can target appropriate antibiotic use, avoid overtreatment, and potentially decrease the hospital length-of-stay.
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Affiliation(s)
- James Yu
- Department of Internal Medicine, AdventHealth Cancer Institute, Orlando, Florida
| | - Juan D Diaz
- Section of Infectious Disease, AdventHealth Cancer Institute, Orlando, Florida
| | - Steven C Goldstein
- Blood and Marrow Transplant Center, AdventHealth Cancer Institute, Orlando, Florida
| | - Rushang D Patel
- Blood and Marrow Transplant Center, AdventHealth Cancer Institute, Orlando, Florida
| | - Juan C Varela
- Blood and Marrow Transplant Center, AdventHealth Cancer Institute, Orlando, Florida
| | - Caralyn Reyenga
- Blood and Marrow Transplant Center, AdventHealth Cancer Institute, Orlando, Florida
| | - Megan Smith
- Blood and Marrow Transplant Center, AdventHealth Cancer Institute, Orlando, Florida
| | - Tori Smith
- Blood and Marrow Transplant Center, AdventHealth Cancer Institute, Orlando, Florida
| | - Jason Balls
- Blood and Marrow Transplant Center, AdventHealth Cancer Institute, Orlando, Florida
| | - Sarfraz Ahmad
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, Florida
| | - Shahram Mori
- Blood and Marrow Transplant Center, AdventHealth Cancer Institute, Orlando, Florida.
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Finello M, Suasnabar DF, García MDJ, Díaz MV, Richetta L, Toranzo A, Hernández D, Cometto MA, Vázquez SM, Caeiro JP, Sierra J, Saad EJ. [Clinical and microbiological characteristics of bloodstream infections in adult neutropenic patients]. Rev Argent Microbiol 2021; 53:183-193. [PMID: 33388181 DOI: 10.1016/j.ram.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 09/07/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
Bloodstream infections (BI) are relevant in neutropenic patients because they are associated with an increased number of complications and death. The objective was determinate the epidemiologic and microbiologic features of the BI in neutropenic patients with solid neoplasm (SN) and hematologic neoplasm (HN). Retrospective study in two third level hospitals between 2009 and 2016. They were included all the patients older than 18 years-old with active oncologic disease and neutropenia, who had BI. Patients with dermatologic cancer other than melanoma where excluded. A total of 143 BI in neutropenic were observed, of which 80.4% occurred in HN. Around 97.9% of the patients had a high-risk neutropenia without differences between both groups. The most frequent site of BI was primary bacteremia (46.9%) and catheter-associated infection (21%), without significant differences between the two groups. The gram negatives bacilli (GNB) predominated over the gram positive cocci (GPC) and they represented 74.1% of the isolated bacteria, being Escherichia coli the most frequent (32.8%). Among the gram positive cocci, Staphylococcus aureus (28.1%) was the most frequent isolated, followed by coagulase-negative Staphylococci (CNS). There were no differences in microbiological isolates between both groups. With regard to the antimicrobial susceptibility 67.5% of the CNS, 17.6% of the E. coli and 27.6% of the Klebsiella pneumoniae were multiresistant with no differences between both groups. Only 11.1% of S. aureus isolates were methicillin resistant. In conclusion BI of the neutropenic patients where most frequents within patients with HN, GNB were the main microbiological isolates. High mortality was observed in neutropenic patients with BI.
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Affiliation(s)
- Malena Finello
- Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | | | - Mercedes de Jesús García
- Servicio de Hematología y Oncología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - María Victoria Díaz
- Servicio de Hematología y Oncología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Luis Richetta
- Servicio de Anestesiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Agustín Toranzo
- Servicio de Diagnóstico por Imágenes, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Daniela Hernández
- Laboratorio de Microbiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - María Aldana Cometto
- Laboratorio de Microbiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Sofía Mariela Vázquez
- Laboratorio de Microbiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Juan Pablo Caeiro
- Servicio de Enfermedades Infecciosas, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Jeremías Sierra
- Servicio de Hematología y Oncología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Emanuel José Saad
- Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina.
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Allen SM, Liang CS, Chesnokova AE, Childress KJ, Pascoe KF, Dietrich JE. Patterns of Genital Examination and Vulvovaginal Graft-Versus-Host Disease in a Pediatric Post-Hematopoietic Stem Cell Transplant Population. J Pediatr Adolesc Gynecol 2020; 33:658-666. [PMID: 32781233 DOI: 10.1016/j.jpag.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/29/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To determine vulvovaginal graft-versus-host disease (vvGVHD) incidence among pediatric patients who have received hematopoietic stem cell transplantation (HSCT) and who already have graft-versus-host disease (GVHD) involving any organ system and characterize patterns of genital examination and referral to pediatric and adolescent gynecology (PAG) in the post-HSCT population. DESIGN Retrospective chart review. SETTING Large tertiary children's hospital in Texas. PARTICIPANTS Eighty-six post-HSCT female patients 21 years old and younger with GVHD involving any organ system. INTERVENTIONS None. MAIN OUTCOME MEASURES vvGVHD among post-HSCT children, referrals to PAG, genital examinations documented by any clinician. RESULTS Eighty-six patients met inclusion criteria. Most HSCTs were bone marrow transplants, typically for leukemia. Median ages of indication diagnosis and HSCT were 5.1 and 7.5 years, respectively. Median time from HSCT to first GVHD diagnosis (eg, skin, intestine) was 96 days. Nearly all patients had at least 1 genital exam documented in the first 2 years post-HSCT, with a median of 17 exams. Twenty-eight patients were seen by PAG post-HSCT, with 7 of these patients seen within the first 2 years post-HSCT. Four symptomatic patients were diagnosed with vvGVHD. Median time from HSCT to vvGVHD was 398 days. CONCLUSION The small number of vvGVHD cases in our study population is likely because of lack of symptom reporting from patients and families and difficulty with vvGVHD diagnosis. Further training for non-PAG physicians, including pediatricians and oncologists, in identifying and managing vvGVHD might prevent delayed diagnosis and severe sequelae. Earlier referral to PAG or a gynecologist versed in post-HSCT survivorship is also recommended.
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Affiliation(s)
- Stephanie M Allen
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota.
| | - Cynthia S Liang
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Arina E Chesnokova
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Krista J Childress
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Kristin F Pascoe
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Texas
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Chee-How EL, Acquisto NM, Zhang YV. Appropriateness of tacrolimus therapeutic drug monitoring timing in the emergency department. Am J Emerg Med 2020; 45:233-236. [PMID: 33046300 DOI: 10.1016/j.ajem.2020.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Evaluate the appropriateness of the timing of serum samples collected in the emergency department (ED) for tacrolimus (TAC) measurement. METHODS Single-center, retrospective review of TAC samples collected in the ED from September 1 to October 31, 2017. The primary evaluation was incidence of inappropriate sample collection for TAC measurement, defined as samples not collected 12 h (±2 h; 10-14 h) after the last dose, or within 2 h of the next dose if last known dose time was not documented. Incidence of repeat TAC measurements obtained within 24 h of ED presentation (if initial sample collection inappropriate), inappropriate TAC regimen adjustments, and healthcare costs of inappropriate TAC measurements was evaluated. Data collection included patient demographics, ED visit information, TAC measurement and timing related to last or next dose, changes to TAC regimen, and ED disposition. Descriptive data are reported. RESULTS Sixty-two patients were included. Forty-one (66%) initial TAC measurements were collected inappropriately in the ED. No patients had a regimen adjustment as a result of inappropriate concentration collection, but 32 patients (78%) did require a repeat measurement within 24 h of ED presentation due to initial inappropriate collection. Costs associated with incorrectly collected TAC measurements were $2,647.78 for the two-month time period and this is extrapolated to an estimated $15,886.68 annual expense for patients. CONCLUSIONS Inappropriate sample collection for TAC measurements was common in the ED, resulting in frequent repeat laboratory draws and increased healthcare costs.
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Affiliation(s)
- Emma L Chee-How
- Emergency Medicine Pharmacy Resident, Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Ave., Box 638, Rochester, NY 14642, United States of America
| | - Nicole M Acquisto
- Emergency Medicine Clinical Pharmacy Specialist, Department of Pharmacy and Associate Professor, Department of Emergency Medicine, 601 Elmwood Ave., Box 638, Rochester, NY 14642, United States of America.
| | - Y Victoria Zhang
- Vice Chair for Clinical Enterprise Strategy, Department of Pathology and Laboratory Medicine, Medical Director of Ambulatory Lab Services, Department of Pathology and Laboratory Medicine, Director of Regional Toxicology and Mass Spectrometry Laboratory, Department of Pathology and Laboratory Medicine, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Box 608, Rochester, NY 14642, United States of America.
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Alfishawy M, Elbendary A, Mohamed M, Nassar M. COVID-19 Mortality in Transplant Recipients. Int J Organ Transplant Med 2020; 11:145-162. [PMID: 33335696 PMCID: PMC7726838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Organ transplant recipients are vulnerable to multiple infectious agents and in a world with a circulating SARS-CoV-2 virus, it would be expected that patients who are immunosuppressed would have higher mortality. OBJECTIVE To determine the COVID-19 mortality in transplant recipients. METHODS We conducted a search in PubMed and Google scholar databases using the keywords for COVID-19 and transplantation. All related studies between January 1, 2020 and May 7, 2020 were reviewed. All relevant published articles related to COVID-19 in transplant recipients were included. RESULTS 46 articles were included; they studied a total of 320 transplant patients-220 kidney transplant recipients, 42 liver, 19 heart, 22 lung, 8 HSCT, and 9 dual organ transplant recipients. The overall mortality rate was 20% and was variable among different organs and different countries. 65 transplant recipients died of complications attributable to COVID-19; 33 were males (15% of males in this cohort), 8 females (8% of females in this cohort), and 24 whose sex was not determined. They had a median age of 66 (range: 32-87) years. The median transplantation duration was 8 years (range: 30 days to 20 years). The most frequent comorbidity reported was hypertensions followed by diabetes mellitus, obesity, malignancy, ischemic heart disease, and chronic obstructive pulmonary disease. The most frequent cause of death reported was acute respiratory distress syndrome. CONCLUSION Transplant recipients in our cohort had a high mortality rate. However, outcomes were not the same in different countries based on outbreak settings. Mortality was noted in elder patients with comorbidities.
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Affiliation(s)
- M. Alfishawy
- Infectious Diseases Consultants and Academic Researchers of Egypt (IDCARE), Cairo, Egypt
- Aswan Heart Centre, Aswan, Egypt
| | - A. Elbendary
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M. Mohamed
- Nephrology Division, University of Tennessee Health Science Center, Memphis, TN, USA
| | - M. Nassar
- Internal Medicine Department, Beni Suef University, Beni Suef, Egypt
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Mamishi S, Pourakbari B, Moradzadeh M, van Leeuwen WB, Mahmoudi S. Prevalence of active tuberculosis infection in transplant recipients: A systematic review and meta-analysis. Microb Pathog 2019; 139:103894. [PMID: 31805320 DOI: 10.1016/j.micpath.2019.103894] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Tuberculosis (TB) is considered as a serious complication of organ transplant; therefore, the detection and appropriate treatment of active TB infection is highly recommended for the reduction of mortality in the future. The aim of this review was to conduct a systematic review and meta-analysis assessing the prevalence of active TB infection in transplant recipients (TRs). MATERIAL AND METHODS Electronic databases, including MEDLINE (via PubMed), SCOPUS and Web of Science were searched up to December 24, 2017. The prevalence of active TB was estimated using the random effects meta-analysis. Heterogeneity was evaluated by subgroup analysis. Data were analyzed by STATA version 14. RESULTS The pooled prevalence of post-transplant active TB was estimated 3% [95% CI: 2-3]. The pooled prevalence of active TB in different transplant forms was as follows: renal,3% [95% CI: 2-4]; stem cell transplant (SCT), 1% [95% CI: 0-3]; lung, 4% [95% CI: 2-6]; heart, 3% [95% CI: 2-4]; liver, 1% [95% CI: 1], and hematopoietic stem cell transplant (HSCT), 2% [95% CI: 1-3]. The prevalence of different clinical presentations of TB was as follows: pulmonary TB (59%; 95% CI: 54-65), extra pulmonary TB (27%; 95% CI: 21-33), disseminated TB (15%; 95% CI: 12-19) and miliary TB (8%; 95% CI: 4-13). The pooled prevalence of different diagnostic tests was as follows: chest X-ray, 57% [95% CI, 46-67]; culture, 56% [95% CI, 45-68]; smear, 49% [95% CI, 40-58]; PCR, 43% [95% CI, 40-58]; histology, 26% [95% CI, 20-32], and tuberculin skin test, 19% [95% CI, 10-28]. CONCLUSION A high suspicion level for TB, the early diagnosis and the prompt initiation of therapy could increase the survival rates among SOT patients. Overall, renal and lung TRs appear to have a higher predisposition for acquiring TB than other type of recipients. Monitoring of the high-risk recipients, prompt diagnosis, and appropriate treatment are required to manage TB infection among TRs especially in endemic areas.
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Affiliation(s)
- Setareh Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran; Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Pourakbari
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Mina Moradzadeh
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Willem B van Leeuwen
- Department of Innovative Molecular Diagnostics, University of Applied Sciences Leiden, Leiden, the Netherlands
| | - Shima Mahmoudi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran.
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DiBrito SR, Bowring MG, Holscher CM, Haugen CE, Rasmussen SV, Duncan MD, Efron DT, Stevens K, Segev DL, Garonzik-Wang J, Haut ER. Acute Care Surgery for Transplant Recipients: A National Survey of Surgeon Perspectives and Practices. J Surg Res 2019; 243:114-122. [PMID: 31170553 PMCID: PMC6773475 DOI: 10.1016/j.jss.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/13/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Transplant recipients are living longer than ever before, and occasionally require acute care surgery for nontransplant-related issues. We hypothesized that while both acute care surgeons (ACS) and transplant surgeons would feel comfortable operating on this unique patient population, both would believe transplant centers provide superior care. METHODS To characterize surgeon perspectives, we conducted a national survey of ACS and transplant surgeons. Surgeon- and center-specific demographics were collected; surgeon preferences were compared using χ2, Fisher's exact, and Kruskal-Wallis tests. RESULTS We obtained 230 responses from ACS and 204 from transplant surgeons. ACS and transplant surgeons believed care is better at transplant centers (78% and 100%), and transplant recipients requiring acute care surgery should be transferred to a transplant center (80.2% and 87.2%). ACS felt comfortable operating (97.5%) and performing laparoscopy (94.0%) on transplant recipients. ACS cited transplant medication use as the most important underlying cause of increased surgical complications for transplant recipients. Transplant surgeons felt it was their responsibility to perform acute care surgery on transplant recipients (67.3%), but less so if patient underwent transplant at a different institution (26.5%). Transplant surgeons cited poor transplanted organ resiliency as the most important underlying cause of increased surgical complications for transplant recipients. CONCLUSIONS ACS and transplant surgeons feel comfortable performing laparoscopic and open acute care surgery on transplant recipients, and recommend treating transplant recipients at transplant centers, despite the lack of supportive evidence. Elucidating common goals allows surgeons to provide optimal care for this unique patient population.
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Affiliation(s)
- Sandra R DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Mary Grace Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine E Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah V Rasmussen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark D Duncan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David T Efron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kent Stevens
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Elliott R Haut
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Leddington Wright S, Bloxham A, Hames T, Price M. Therapeutic perceptions in management of transplant athletes at transplant games. Phys Ther Sport 2019; 39:114-9. [PMID: 31344534 DOI: 10.1016/j.ptsp.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate manual therapist's knowledge and beliefs of working with Transplantee Athletes (TxA) at Transplant Games. DESIGN On-line questionnaire. PARTICIPANTS Thirty present and previous members of Transplant Sport 'therapy team' (age; 35 ± 14 years, 24 female). MAIN OUTCOME MEASURES Questions concerned demographics and general information on the background of the therapists. Closed questions with rating statements concerning beliefs when treating TxA and open questions asking for advice the participants would give to colleagues and further information they would like to have available to them. RESULTS TxA were thought to be a vulnerable group of athletes requiring special precautions and considerations. Two areas of information evolved: "general advice for TxA management" and "specific advice for therapists". General advice was to understand TxAs and be vigilant with hygiene. Specific therapy advice was to avoid grade V manipulations and care with taping and massage, because of complications resulting from side effects of long-term medication. CONCLUSION There appears to be a lack of research-based evidence to guide practitioners in their management of TxAs. Generic, good advice is now available from experienced practitioners however there is a paucity of research evidence to support this. Thus, there is a potential danger of being overcautious in approaches to treatment which ultimately may impact on athletic performance. .
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Abstract
PURPOSE OF REVIEW Due to their immunocompromised status, solid organ transplant (SOT) recipients are at risk for Nocardia infections. These infections often necessitate early invasive diagnostics alongside prolonged, often combination antimicrobial therapy. This review summarizes the importance of this pathogen in skin and soft tissue infections (SSTIs) in SOT recipients inclusive of recently reported cases in the literature and an update on the epidemiology, diagnostics, and management. RECENT FINDINGS Six studies with 13 isolated SSTIs due to Nocardia have been published in the last 5 years in SOT recipients. The most common underlying type of transplant was kidney and time from transplantation to infection varied from 6 months to 16 years. Misdiagnosis was frequent. Available identified species included N. brasiliensis (2), N. farcinica (2), N. flavorosea (1), N. abscessus (1), N. anaemiae (1), N. asteroides (1), N. nova (1), and N. vinacea (1). Treatment choice and duration varied widely, and trimethoprim-sulfamethoxazole was utilized most often with no documented infection relapse. Nocardia SSTIs can occur both in isolation and as a component of a disseminated infection. Overall, isolated Nocardia SSTIs are uncommon in SOT recipients and are often initially misdiagnosed. They present multiple challenges to the clinician including evaluation for potential co-pathogens and/or non-infectious processes and ruling out the presence of disseminated infection. While trimethoprim-sulfamethoxazole remains the agent of choice for management of most isolated SSTIs, therapy must be tailored to the individual patient based on species-specific susceptibility patterns and formal susceptibility testing, site(s) of infection, and patient tolerability.
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Affiliation(s)
- Marion Hemmersbach-Miller
- Infectious Diseases Division, Duke University Medical Center, Durham, NC, USA.
- Duke Clinical Research Institute, Durham, NC, USA.
| | - Jelena Catania
- Infectious Disease Section, Orlando Veterans Affairs Medical Center, Orlando, FL, USA
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Jennifer L Saullo
- Infectious Diseases Division, Duke University Medical Center, Durham, NC, USA
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Mombelli M, Rettby N, Perreau M, Pascual M, Pantaleo G, Manuel O. Immunogenicity and safety of double versus standard dose of the seasonal influenza vaccine in solid-organ transplant recipients: A randomized controlled trial. Vaccine. 2018;36:6163-6169. [PMID: 30181045 DOI: 10.1016/j.vaccine.2018.08.057] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/16/2018] [Accepted: 08/22/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of vaccines with higher doses of antigen is an attractive strategy to improve the immunogenicity of influenza vaccination in transplant recipients. However, the effect of vaccination with a double-dose (DD) containing 30 µg of antigen in this population remains unknown. METHODS We performed a randomized controlled trial to compare the immunogenicity and safety of DD (30 µg) vs. standard dose (SD, 15 µg) of a trivalent inactivated influenza vaccine in kidney and liver transplant recipients. Immunogenicity was assessed by hemagglutination-inhibition assay. Vaccine response was defined as seroconversion to at least one viral strain 2 weeks after vaccination and seroprotection as a titer ≥40. RESULTS Sixty-three kidney and 16 liver transplant recipients were enrolled. Forty patients received the DD and 39 the SD vaccine. Overall, 40% of patients in the DD compared to 26% in the SD group (P = 0.174) responded to vaccine. In the DD arm, more patients were seroprotected to all viral strains after vaccination (88% vs 69%, P = 0.048). Post vaccination geometric mean titers of antibodies were 131.9 vs. 89.7 (P = 0.187) for H1N1, 185.4 vs. 138.7 (P = 0.182) for H3N2, and 96.6 vs. 68.8 (P = 0.081) for influenza B with the DD vs. SD. In both groups, most of the adverse events were mild and no vaccine-related severe adverse events were observed. CONCLUSION Double-dose influenza vaccine is safe and may increase antibody response in transplant recipients. In this population, DD vaccination could be an alternative when high-dose vaccine is not available. NCT02746783.
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Mokhtari G, Teimoori M. Effects of pre-transplant azithromycin administration on kidney graft function: study protocol for a double-blind randomized clinical trial. Trials 2018; 19:345. [PMID: 29950182 DOI: 10.1186/s13063-018-2744-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/14/2018] [Indexed: 12/02/2022] Open
Abstract
Background Kidney transplantation is the best strategy for the management of end-stage renal disease; however, the outcomes need to improve further. Macrolides show antimicrobial and anti-inflammatory properties in chronic diseases and intraoperatively, and can accumulate in tissues for extended periods. Therefore, theoretically, when administered to a donor and because of accumulation in the donor kidney, macrolides can cause graft immunomodulation and improve kidney transplantation outcomes. Methods This study is a single-center, randomized clinical trial. A total of 60 kidney donors will be randomly allocated to the azithromycin or placebo group and treated with a single dose (1 g) of azithromycin or placebo, respectively, 1 day before surgery. Recruitment commenced in September 2016 and is expected to be completed by March 2018. The primary outcome is kidney graft function. The secondary outcomes include rejection rate, urinary tract infections in graft recipients, pain and systemic inflammatory response syndrome in live donors, and complications in both donors and recipients. Outcomes will be evaluated at baseline and every day in the first week after transplantation, as well as at 1 and 3 months post transplantation. Adverse reactions will be documented. If the efficacy of azithromycin in reducing adverse outcomes is confirmed, it would serve as an easy to use, economic intervention able to lower post-transplantation risks. Discussion Short and mid-term analyses of blood and urine samples as well as immunological assays will facilitate a more in-depth analysis of the effects of azithromycin on transplantation outcomes. Trial registration Iranian Clinical Trial Registry, IRCT201606141853N11, registered on September 5, 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2744-y) contains supplementary material, which is available to authorized users.
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Dehghani SM, Shahramian I, Afshari M, Bahmanyar M, Ataollahi M, Sargazi A. Acute Hepatic Allograft Rejection in Pediatric Recipients: Effective Factors. Int J Organ Transplant Med 2018; 9. [PMID: 29531646 PMCID: PMC5839629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Acute cellular rejection (ACR), a reversible process, can affect the graft survival. OBJECTIVE To evaluate the relation between ACR and clinical factors in recipients of allograft liver transplantation. METHODS 47 recipients of liver were consecutively enrolled in a retrospective study. Their information were retrieved from their medical records and analyzed. RESULTS Of the 47 recipients, 38 (81%) experienced acute rejection during 24 months of the transplantation. None of the studied factors for occurring transplant rejection, i.e., blood groups, sex, age, familial history of disease, receiving drugs and blood products, type of donor, Child score, and Child class, was not found to be significant. CONCLUSION During a limited follow-up period, we did not find any association between ACR and suspected risk factors.
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Affiliation(s)
- S. M. Dehghani
- Professor of Pediatric Gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - I. Shahramian
- Associate Professor of Pediatric Gastroenterology, Zabol University of Medical Sciences, Zabol, Iran,Correspondence: I. Shahramian, MD, Associate Professor of Pediatric Gastroenterology, Zabol University of Medical Sciences, Zabol, Iran E-mail:
| | - M. Afshari
- Department of Community Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - M. Bahmanyar
- Assistant Professor of Pediatric Gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Ataollahi
- Assistant Professor of Pediatric Gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A. Sargazi
- Student Research Committee, Zabol University of Medical Sciences, Zabol, Iran
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Abbas S, Raybould JE, Sastry S, de la Cruz O. Respiratory viruses in transplant recipients: more than just a cold. Clinical syndromes and infection prevention principles. Int J Infect Dis 2017; 62:86-93. [PMID: 28739424 DOI: 10.1016/j.ijid.2017.07.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The aim of this review is to provide updated information on the clinical spectrum, treatment options, and infection prevention strategies for respiratory viral infections (RVIs) in both solid organ (SOT) and hematopoietic stem cell transplant (HSCT) patients. METHODS The MEDLINE and PubMed databases were searched for literature regarding the aforementioned aspects of RVIs, with focus on respiratory syncytial virus, adenovirus, influenza virus, parainfluenza virus, human metapneumovirus, and rhinovirus. RESULTS Compared to immunocompetent hosts, SOT and HSCT patients are much more likely to experience a prolonged duration of illness, prolonged shedding, and progression of upper respiratory tract disease to pneumonia when infected with respiratory viruses. Adenovirus and respiratory syncytial virus tend to have the highest mortality and risk for disseminated disease, but all the RVIs are associated with higher morbidity and mortality in these patients than in the general population. These viruses are spread via direct contact and aerosolized droplets, and nosocomial spread has been reported. CONCLUSIONS RVIs are associated with high morbidity and mortality among SOT and HSCT recipients. Management options are currently limited or lack strong clinical evidence. As community and nosocomial spread has been reported for all reviewed RVIs, strict adherence to infection control measures is key to preventing outbreaks.
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Annema C, Drent G, Roodbol PF, Metselaar HJ, Van Hoek B, Porte RJ, Schroevers MJ, Ranchor AV. A prospective cohort study on posttraumatic stress disorder in liver transplantation recipients before and after transplantation: Prevalence, symptom occurrence, and intrusive memories. J Psychosom Res 2017; 95:88-93. [PMID: 28185646 DOI: 10.1016/j.jpsychores.2017.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed at increasing the understanding of posttraumatic stress disorder (PTSD) in liver transplant patients by describing the course of PTSD, symptom occurrence, psychological co-morbidity, and the nature of re-experiencing symptoms. METHODS A prospective cohort study was performed among 95 liver transplant recipients from before transplantation up until one year post-transplantation. Respondents filled out a questionnaire regarding psychological functioning (PTSD, anxiety, and depression) before, and at 3, 6, and 12months post-transplantation. Both quantitative and qualitative methods were used to analyze the data. RESULTS Before transplantation, respectively 10.5% and 6.3% of the respondents were identified as possible cases of full or partial PTSD. In all cases, co-morbid conditions of anxiety and/or depression were present. After transplantation, no new onset of full PTSD was found. New onset of possible partial PTSD was found in six respondents. Arousal symptoms were the most frequently reported symptoms, but may not be distinctive for PTSD in transplant patients because of the overlap with disease- and treatment-related symptoms. Re-experiencing symptoms before transplantation were mostly related to waiting for a donor organ and the upcoming surgery; after transplantation this was related to aspects of the hospital stay. CONCLUSIONS In our group of liver transplant patients, PTSD symptomatology was more present before transplantation than after transplantation. Being diagnosed with a life-threatening disease seemed to be the main stressor. However, when a diagnosis of PTSD is suspected, assessment by a clinician is warranted because of the overlap with mood and anxiety disorders, and disease- and treatment-related symptoms.
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Affiliation(s)
- Coby Annema
- University of Groningen, University Medical Center Groningen, School of Nursing & Health, Groningen, The Netherlands.
| | - Gerda Drent
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, The Netherlands
| | - Petrie F Roodbol
- University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands
| | - Herold J Metselaar
- Erasmus Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands
| | - Bart Van Hoek
- Leiden University Medical Center, Department of Gastroenterology and Hepatology, Leiden, The Netherlands
| | - Robert J Porte
- University of Groningen, University Medical Center Groningen, Department of Surgery, Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Groningen, The Netherlands
| | - Maya J Schroevers
- University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands
| | - Adelita V Ranchor
- University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands
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Fernandes AR, Laranjinha IJ, Birne R, Matias P, Jorge C, Adragão T, Bruges M, Weigert A, Machado D. HCV-infected Renal Transplant Recipients: Our Experience before the Availability of New Antiviral Drugs. Int J Organ Transplant Med 2017; 8:104-9. [PMID: 28828170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Natural history of HCV-infected renal transplant recipients is about to change with the invention of new drugs available for the treatment of HCV. OBJECTIVE To analyze the evolution of renal transplant recipients infected with HCV in 30 years of activity of a Renal Transplantation Unit. METHODS We studied 1334 patients who underwent renal transplantation between 1985 and 2015. RESULTS 189 (14.2%) of these 1334 were found HCV seropositive. 60 were HCV RNA-positive for >6 months. 5 died with a functioning graft; 19 lost their graft and resumed dialysis. Most of the rejections occurred within the first year of the transplantation and none resulted in immediate loss of the graft. In post-transplantation period, 14 patients developed clinical hepatic disease, 10 manifested new-onset diabetes after transplantation, and 4 had de novo neoplasia, none of them had hepatocellular carcinoma. The outcomes of the different variables analyzed were similar between patients with HCV-infection and those with HCV and HBV co-infection. The median survival time was 13.4 (95% CI: 10.7-16.1) years; the median survival time of patients without HCV infection was 14.6 (95% CI: 13.8-15.4) years (p=0.23). CONCLUSION In the era before the availability of new anti-HCV drugs, our experience with HCV-infected renal transplant recipients revealed similar post-transplantation complications, graft and patient survival as those not infected with HCV.
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Basiri A, Zare S, Simforoosh N, Tabibi A, Shakibi MH. Comparison of Renal Growth, Proteinuria and Graft Survival between Recipients of Pediatric and Adult Cadaveric Kidney Transplants. Int J Organ Transplant Med 2017; 8:97-103. [PMID: 28828169 PMCID: PMC5549006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The shortage of cadaveric kidney donors has prompted transplant teams to expanding the donor selection criteria. The usage of pediatric cadaveric kidneys is one of those expanded criteria. But the main concern is the probability of hyperfiltration syndrome due to small renal mass of pediatric donors. OBJECTIVE To compare the graft and patient survivals, post-transplantation complications, rate and severity of proteinuria secondary to hyperfiltration injury and the kidney growth of recipients who underwent transplantation from adult (group 1) and pediatric deceased donors (group 2). METHODS In this historical cohort study, each group contains 36 patients. Outcome measures included patient and graft survivals, quality of graft function as assessed by serum creatinine (SCr) and estimated GFR (eGFR), surgical complications, proteinuria that was detected by routine urinalysis and then confirmed by a 24-h urine protein >150 mg, blood pressure, and kidney length and volume measured by early and follow-up ultrasonography. RESULTS The mean donor age in groups 1 and 2 was 36 and 6.5 years, respectively. 9 (25%) kidneys taken from pediatric donors (group 2) were offered en-bloc. The mean follow-up was 28 month. The two groups were not significantly different in terms of the incidence of DGF, rate of acute rejection, 1-year graft survival, SCr and eGFR levels, rates of surgical complications requiring surgical interventions, development of proteinuria, and rate of post-transplantation rise in blood pressure. The mean±SD kidney length within 24 hours of transplantation was significantly higher in group 1 compared to group 2 recipients (112±14 vs. 75±12 mm; p=0.001), but the rate of increase in kidney length in group 2 was significantly higher than that in group 1 recipients (43±4 vs. 10±2 mm; p=0.002) during the follow-up period. 80% of the increase in the kidney size was observed during the first 12 months of surgery; another 20% happened between 12 and 18 months. CONCLUSION We found that obligatory and compensatory growth of pediatric kidney donors can overcome the concern of hyperfiltration syndrome and that the outcome is the same as adult donors.
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Affiliation(s)
- A. Basiri
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Shahid Labbafinejad Medical Center, Tehran, Iran
| | - S. Zare
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran,Correspondence: Samad Zare, Fellowship of Kidney Transplantation, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Tel: +98-353-627-1197, Fax: +98-353-627-1198, E-mail:
| | - N. Simforoosh
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Shahid Labbafinejad Medical Center, Tehran, Iran
| | - A. Tabibi
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Shahid Labbafinejad Medical Center, Tehran, Iran
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Monfared A, Azimi SZ, Kazemnezhad E. The association between atorvastatin administration and plasma total homocysteine levels in renal transplant recipients. J Nephropathol 2016; 5:98-104. [PMID: 27540537 PMCID: PMC4961823 DOI: 10.15171/jnp.2016.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/19/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Statins improve prognosis in patients with coronary heart diseases by decreasing the incidence of vascular events. Excess prevalence of hyperhomocysteinemia, an independent risk factor of cardiovascular diseases, has been observed in stable renal transplant recipients (RTRs). OBJECTIVES The objective of our study was to evaluate the association between atorvastatin administration and plasma total homocysteine (tHcy) levels in RTRs. PATIENTS AND METHODS We performed a retrospective cross-sectional study in 148 cyclosporine A (CsA) treated stable RTRs. We compared tHcy level and other demographic and clinical variables in RTRs with and without atorvastatin. RESULTS 58.1% of the 148 RTRs were treated with atorvastatin (20-40 mg/day). Mean tHcy levels were lower in patients treated with atorvastatin compared to nonusers (14.80 ± 5.13 µmol/l versus 16.95 ± 7.87 µmol/l, P = 0.04). The comparison of 85 patients treated with atorvastatin and 61 non-users revealed that those subjects with atorvastatin were older, with higher estimated creatinine clearance and elevated body mass index (BMI). They were more likely to have higher systolic blood pressure and CsA trough level (C0). The association between lower tHcy levels and atorvastatin use was confirmed in the multivariate regression model (P = 0.004). However tHcy levels were independently and negatively associated with serum folate (P = 0.0001) and vitamin B12 levels (P = 0.001) and positively with serum BUN (P = 0.001) and diastolic blood pressure (P = 0.024) as well. CONCLUSIONS These data support the association between lower tHcy levels and atorvastatin administration in RTRs. Further clinical trials are recommended to clarify homocysteine lowering effect of atorvastatin.
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Affiliation(s)
- Ali Monfared
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Iran
| | | | - Ehsan Kazemnezhad
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Iran
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Masoumi SJ, Mazloom Z, Rezaianzadeh A, Nikeghbalian S, Malek-Hosseini SA, Salahi H. Prevalence of Metabolic Syndrome in Liver Transplant Recipients in Iran. Int J Organ Transplant Med 2016; 7:85-90. [PMID: 28435640 PMCID: PMC5396055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetSx) is common among liver transplant recipients. It contributes to morbidity and mortality. OBJECTIVE To determine the prevalence of MetSx in patients undergoing liver transplantation (LTx) in Iran. METHODS 202 liver transplant recipients of both sexes completed this study. Relevant information including age, sex, the underlying disease, systolic and diastolic blood pressure, waist circumference, fasting serum levels of blood sugar (FBS), triglyceride (TG), and HDL-cholesterol were measured. The prevalence of MetSx was evaluated at 1, 3, 6, 9, and 12 months after LTx. RESULTS The prevalence of MetSx was 36.6% after 1 month that decreased to 28.2% after 12 months of follow-up. The lowest prevalence of MetSx (27.7%) was observed 9 months after LTx. Our data showed a decrease in TG and an increase in HDL-C level and no significant changes in blood pressure, waist circumference and FBS during the study period. CONCLUSION The prevalence of MetSx after LTx is high when compared to the normal population. It seems that a change in diet after transplantation may affect the prevalence of MetSx.
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Affiliation(s)
- S. J. Masoumi
- School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran,Nutrition and Food Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Z. Mazloom
- School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran,Nutrition and Food Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Zohreh Mazloom, PhD, School of Nutrition and Food Sciences, Shiraz, University of Medical Sciences, Shiraz, Iran, Tel/Fax: +98-71-3725-7288, E-mail:
| | - A. Rezaianzadeh
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S. Nikeghbalian
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran,Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S. A. Malek-Hosseini
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran,Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H. Salahi
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran,Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Gao PJ, Gao J, Li Z, Hu ZP, Zhu JY. De novo malignancy after liver transplantation: a single-center experience of 14 cases. Ann Surg Treat Res 2015; 88:222-8. [PMID: 25844357 PMCID: PMC4384282 DOI: 10.4174/astr.2015.88.4.222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/16/2014] [Accepted: 08/25/2014] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The aim of this study is to evaluate the incidence of de novo malignancy after liver transplantation (LT) and compare with those among the general Chinese population. METHODS A total of 466 patients who had a minimum follow-up time of 6 months were enrolled in the study. All data of medical records and follow up were retrospectively reviewed. RESULTS The incidence rate of de novo malignancy was 3.0% (14 in 466 patients). The median elapsed time from transplant to the diagnosis of de novo malignancy was 42 months (range, 6 to 106 months). The cumulative risk for development of de novo malignancy was 1.6%, 2.7%, and 8.2% at 3, 5 and 10 years after LT, respectively. The patients were all male. The types of de novo tumors included digestive system tumor (8 in 14), lung cancer (2 in 14), urologic neoplasm (2 in 14), and hematologic malignant tumor (2 in 14). Over a mean follow-up of 24 months after diagnosis of de novo malignancy, 7 patients (50.0%) died; the overall 5-year patient survival rate was 54.5%. The relative risk of malignancy following LT was 9.5 folds higher than the general Chinese population. CONCLUSION The relative risk of malignancy following LT was much higher than the general Chinese population. Digestive system tumor is the most common type of de novo malignancy after LT in China.
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Affiliation(s)
- Peng Ji Gao
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China
| | - Jie Gao
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China
| | - Zhao Li
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China
| | - Zhi Ping Hu
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China
| | - Ji Ye Zhu
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China
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Scotto G, Aucella F, Grandaliano G, Martinelli D, Querques M, Gesuete A, Infante B, Carri PD, Massa S, Salatino G, Bulla F, Fazio V. Hepatitis E in hemodialysis and kidney transplant patients in south-east Italy. World J Gastroenterol 2015; 21:3266-3273. [PMID: 25805933 PMCID: PMC4363756 DOI: 10.3748/wjg.v21.i11.3266] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/04/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the serovirological prevalence and clinical features of hepatitis E virus (HEV) infection in end-stage renal failure patients and in the healthy population.
METHODS: HEV infection is a viral disease that can cause sporadic and epidemic hepatitis. Previous studies unexpectedly showed a high prevalence of HEV antibodies in immunosuppressed subjects, including hemodialysis (HD) patients and patients who had undergone kidney transplant. A cohort/case-control study was carried out from January 2012 to August 2013 in two hospitals in southern Italy (Foggia and S. Giovanni Rotondo, Apulia). The seroprevalence of HEV was determined in 801 subjects; 231 HD patients, 120 renal transplant recipients, and 450 health individuals. All HD patients and the recipients of renal transplants were attending the Departments of Nephrology and Dialysis at two hospitals located in Southern Italy, and were included progressively in this study. Serum samples were tested for HEV antibodies (IgG/IgM); in the case of positivity they were confirmed by a Western blot assay and were also tested for HEV-RNA, and the HEV genotypes were determined.
RESULTS: A total of 30/801 (3.7%) patients were positive for anti-HEV Ig (IgG and/or IgM) and by Western blot. The healthy population presented with a prevalence of 2.7%, HD patients had a prevalence of 6.0%, and transplant recipients had a prevalence of 3.3%. The overall combined HEV-positive prevalence in the two groups with chronic renal failure was 5.1%. The rates of exposure to HEV (positivity of HEV-IgG/M in the early samples) were lower in the healthy controls, but the difference among the three groups was not statistically significant (P > 0.05). Positivity for anti-HEV/IgM was detected in 4/30 (13.33%) anti-HEV Ig positive individuals, in 2/14 HD patients, in 1/4 transplant individuals, and in 1/12 of the healthy population. The relative risk of being HEV-IgM-positive was significantly higher among transplant recipients compared to the other two groups (OR = 65.4, 95%CI: 7.2-592.7, P < 0.001), but the subjects with HEV-IgM positivity were numerically too few to calculate a significant difference. No patient presented with chronic hepatitis from HEV infection alone.
CONCLUSION: This study indicated a higher, but not significant, circulation of HEV in hemodialysis patients vs the healthy population. Chronic hepatitis due to the HEV virus was not observed.
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Kim BS, Yoo ES, Kim TH, Kwon TG. Renal Function Recovery in Donors and Recipients after Live Donor Nephrectomy: Hand-Assisted Laparoscopic vs. Open Procedures. Korean J Urol 2010; 51:245-9. [PMID: 20428426 PMCID: PMC2858855 DOI: 10.4111/kju.2010.51.4.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 04/01/2010] [Indexed: 11/18/2022] Open
Abstract
Purpose Laparoscopic donor nephrectomy is associated with less postoperative pain and faster recovery times in living kidney donors. However, pneumoperitoneum, which is required in laparoscopic donor nephrectomy, can result in adverse effects on renal function in donors and recipients. We compared renal function in donors and recipients after hand-assisted laparoscopic donor nephrectomy (HALDN) and open donor nephrectomy (ODN). Materials and Methods Between January 1997 and January 2008, 241 live donor nephrectomies were performed by either HALDN (n=118) or ODN (n=123). Preoperative patient characteristics were not significantly different between the donors and recipients. We monitored the changes in serum creatinine levels of the donors and recipients preoperatively and on postoperative days 1, 5, 28, 84, and 365. Results The mean operative times of HALDN and ODN were 171 and 163 minutes (p=0.284), and the mean warm ischemic times were 292 and 236 seconds (p=0.207), respectively. The mean serum creatinine level in the recipients on postoperative day 1 was significantly higher after HALDN than after ODN (3.48 vs. 2.62 mg/dl, p=0.003). However, from postoperative day 5 to 1 year, there was no significant difference between the two groups. The mean serum creatinine level in the donors was not significantly different between the HALDN and ODN groups throughout the study period. Conclusions Renal function recovery in the donors was similar with both HALDN and ODN. Graft renal function recovery after HALDN was comparable with that after ODN, except immediately after surgery (postoperative day 1).
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Affiliation(s)
- Bum Soo Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
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