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While some biologicals have been routinely used in solid organ and hematopoietic stem cell transplant patients for years, a number of newer compounds have been added to the armamentarium for varying indications spanning from the underlying disease to complications of transplantation. This chapter aims at describing the infectious risk of a selection of compounds. The specific chapters list a number of recommendations to consider for infection prevention, in addition to the standard...
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Small-molecule inhibitors have revolutionized the treatment of cancer and autoimmune disease. Inhibitors of the mammalian target of rapamycin (mTOR), Janus kinases (JAK), and B-cell lymphoma-2 (BCL-2) are three of the most successful therapeutics developed. They target intracellular signaling pathways involved in cell survival, proliferation, and metabolism, processes that are frequently dysregulated in autoimmunity and neoplasia. The inhibition of such pathways also affects physiological...
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These guidelines from the AST Infectious Diseases Community of Practice review the diagnosis and management of pneumonia in the post-transplant period. Clinical presentations and differential diagnosis for pneumonia in the solid organ transplant recipient are reviewed. A two-tier approach is proposed based on the net state of immunosuppression and the severity of presentation. With a lower risk of opportunistic, hospital-acquired, or exposure-specific pathogens and a non-severe presentation,...
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Background Descriptive data on Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant recipients (SOTr) in the era of routine Pneumocystis-prophylaxis are lacking. Methods All adult SOTr between 2008 and 2016 were included. PJP was diagnosed based on consensus guidelines. Early-onset PJP was defined as PJP within the first-year-post-transplant. Results 41/2842 SOTr (1.4%) developed PJP (incidence rate: 0.01/1000 person-days) at a mean of 493-days post-transplant: 21 (51.2%) early...
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Background There are limited contemporary data on the epidemiology and outcomes of bacteremia in solid organ transplant recipients (SOTr). Methods Using the Swiss Transplant Cohort Study registry from 2008 to 2019, we performed a retrospective nested multicenter cohort study to describe the epidemiology of bacteremia in SOTr during the first year post-transplant. Results Of 4383 patients, 415 (9.5%) with 557 cases of bacteremia due to 627 pathogens were identified. One-year incidence was...
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Food-safety measures are recommended to solid organ transplant (SOT) recipients. However, the burden of foodborne infections in SOT recipients has not been established. We describe the epidemiology and outcomes of bacterial foodborne infections in a nationwide cohort including 4405 SOT recipients in Switzerland between 2008 and 2018. Participants were prospectively followed for a median of 4.2 years with systematic collection of data on infections, and patient and graft-related outcomes. We...
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Solid organ transplant (SOT) recipients are exposed to respiratory viral infection (RVI) during seasonal epidemics; however, the associated burden of disease has not been fully characterized. We describe the epidemiology and outcomes of RVI in a cohort enrolling 3294 consecutive patients undergoing SOT from May 2008 to December 2015 in Switzerland. Patient and allograft outcomes, and RVI diagnosed during routine clinical practice were prospectively collected. Median follow-up was 3.4 years...
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The use of assays detecting cytomegalovirus (CMV)-specific T-cell-mediated immunity may individualize the duration of antiviral prophylaxis in transplant recipients.In this open-label randomized trial, adult kidney and liver transplant recipients from six centers in Switzerland were enrolled if they were CMV-seronegative with seropositive donors or CMV-seropositive receiving anti-thymocyte globulins. Patients were randomized to a duration of antiviral prophylaxis based on immune-monitoring...
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Invasive aspergillosis (IA) is a rare but fatal disease among liver transplant recipients (LiTRs). We performed a multi-center 1:2 case-control study comparing LiTRs diagnosed with proven/probable IA and controls with no invasive fungal infection. We included 62 IA cases and 124 matched controls. Disseminated infection occurred only in eight cases (13%). 12-week all-cause mortality of IA was 37%. In multivariate analyses, systemic antibiotics usage (adjusted odds ratio [aOR], 4.74; p=0.03)...
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Solid organ transplant recipients (SOTRs) frequently receive adjunctive glucocorticoid therapy (AGT) for Pneumocystis jirovecii pneumonia (PJP). This multicenter cohort of SOTRs with PJP admitted to 20 transplant centers in Canada, the United States, Europe, and Australia, was examined for whether AGT was associated with a lower rate of all-cause intensive care unit (ICU) admission, 90-day death, or a composite outcome (ICU admission or death). Of 172 SOTRs with PJP (median [IQR] age: 60...
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Risk factors for nontuberculous mycobacteria (NTM) infections after solid organ transplant (SOT) are not well characterized. Here we aimed to describe these factors.Retrospective, multinational, 1:2 matched case-control study that included SOT recipients ≥12 years old diagnosed with NTM infection from January 1, 2008, to December 31, 2018. Controls were matched on transplanted organ, NTM treatment center, and post-transplant survival greater than or equal to the time to NTM diagnosis....
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Abstract Background Infectious diseases (ID) are highly relevant after solid organ transplantation in terms of morbidity and mortality, being among the most common causes of death. Patients undergoing kidney re-transplantation (re-K-Tx) have been already receiving immunosuppressive therapy over a prolonged period potentially facilitating subsequent infections. Comparing ID events after re-K-Tx and first kidney transplantation (f-K-Tx) can delineate...
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GUIDELINES
TEXTBOOKS
ORGANISMS
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BACTERIA
(2)
- MDR GNR (1)
- Non-tuberculous Mycobacteria (1)
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FUNGI
(2)
- Pneumocystis (2)
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VIRUSES
(3)
- CMV (1)
- HSV (1)
- Influenza (1)
- Respiratory Viruses (1)
- RSV (1)
DRUGS AND THERAPIES
- Stewardship (1)
SYNDROMES AND CONDITIONS
- Pneumonia (1)
SOLID ORGANS AND MCSS
- Donor (1)
- Immunosuppression (1)
- Kidney (1)
- Liver (1)
HEME-ONC AND CELLULAR THERAPIES
- Biologics (1)
- BMT-specific ID (1)