These updated guidelines of the AST IDCOP review vaccination of solid organ transplant candidates and recipients. General principles of vaccination as well as the use of specific vaccines in this ...population are discussed. Vaccination should be reviewed in the pre‐transplant setting and appropriate vaccines updated. Both inactivated and live vaccines can be given pre‐transplant. The timing of vaccination post‐transplant should be taken into account. In the post‐transplant setting, inactivated vaccines can be administered starting at 3 months post‐transplant with the exception of influenza which can be given as early as one month. Inactivated vaccines can be safely administered post‐transplant. There is accumulating data that live‐attenuated vaccines can also be given to select post‐transplant patients. Close contacts of transplant patients can receive most routine live vaccines. Specific vaccines including pneumococcal, influenza, hepatitis B, HPV, and meningococcal vaccines are discussed. Newer vaccines for seasonal influenza vaccine and herpes zoster are highlighted. Live‐attenuated vaccines such as measles, mumps, rubella, and varicella are also discussed. Emerging data on live‐attenuated vaccines post‐transplant are highlighted.
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Impact of COVID‐19 in solid organ transplant recipients Danziger‐Isakov, Lara; Blumberg, Emily A.; Manuel, Oriol ...
American journal of transplantation,
March 2021, 2021-03-00, 20210301, Volume:
21, Issue:
3
Journal Article
Peer reviewed
Open access
The coronavirus disease 2019 (COVID‐19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) exploded onto the world stage in early 2020. The impact on solid organ ...transplantation (SOT) has been profound affecting potential donors, candidates, and recipients. Importantly, decreased donations and the pressure of limited resources placed on health care by the pandemic also disrupted transplant systems. We address the impact of COVID‐19 on organ transplantation globally and review current understanding of the epidemiology, outcomes, diagnosis, and treatment of COVID‐19 in SOT recipients.
The authors address the global impact of COVID‐19 on organ transplantation and the current understanding of the epidemiology, outcomes, diagnosis, and treatment of COVID‐19 in solid organ transplant recipients.
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In response to Kaul et al.'s article (page 2885), the editorialists recommend testing lower respiratory tract samples from potential deceased lung donors for SARS‐CoV‐2 to mitigate the risk of donor ...derived disease.
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The authors provide insight on recent articles, including Herrera et al. (page 3971), addressing COVID‐19 vaccine responses in solid organ transplant recipients.
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Background
COVID‐19 vaccine is recommended for individuals ages ≥6 months; however, whether vaccination should be mandated for transplant candidates and living donors remains controversial. This ...study assessed COVID‐19 policies at US pediatric solid organ transplant centers.
Methods
A 79‐item survey was emailed between March and April 2022 to 200 UNOS Medical Directors detailing center COVID‐19 vaccine policies for transplant candidates and living donors and use of grafts from COVID‐19‐positive deceased donors.
Results
The response rate was 77% (154/200). For children aged 5–15 years, 23% (35/154 centers) have a COVID‐19 vaccine mandate, 27% (42/154) anticipate implementing a future mandate, and 47% (72/154) have not considered or do not anticipate implementing a mandate. For children ≥16 years, 32% (50/154 centers) have a COVID‐19 vaccine mandate, 25% (39/154) anticipate implementing a future mandate, and 40% (62/154) have not considered or do not anticipate implementing a mandate. The top two reasons for not implementing a COVID‐19 vaccine mandate were concerns about penalizing a child for their parent's decision and worsening inequities in transplant. Of 85 kidney and liver living donor centers, 32% (27/85) require vaccination of donors. Twenty percent (31/154) of centers accept organs from COVID‐19‐positive deceased donors.
Conclusions
There is great variation among pediatric SOT centers in both the implementation and details of COVID‐19 vaccine mandates for candidates and living donors. To guide more uniform policies, further data are needed on COVID‐19 disease, vaccine efficacy, and use of grafts from donors positive for COVID‐19 in the pediatric transplant population.
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ABSTRACTDespite recent advances, cytomegalovirus infections remain one of the most common complications affecting solid organ transplant recipients, conveying higher risks of complications, graft ...loss, morbidity, and mortality. Research in the field and development of prior consensus guidelines supported by The Transplantation Society has allowed a more standardized approach to cytomegalovirus management. An international multidisciplinary panel of experts was convened to expand and revise evidence and expert opinion-based consensus guidelines on CMV management including prevention, treatment, diagnostics, immunology, drug resistance, and pediatric issues. Highlights include advances in molecular and immunologic diagnostics, improved understanding of diagnostic thresholds, optimized methods of prevention, advances in the use of novel antiviral therapies and certain immunosuppressive agents, and more savvy approaches to treatment resistant/refractory disease. The following report summarizes the updated recommendations.
Vaccine‐preventable viral infections are associated with increased risk of morbidity and mortality in post‐transplant patients on immunosuppression regimens. Therefore, we studied rates of immunity ...against vaccine‐preventable viruses in lung transplantation (LTx) candidates and their associations with underlying lung disease and clinical characteristics. We retrospectively studied 1025 consecutive adult patients who underwent first‐time evaluation for LTx at a single center between January 2016 and October 2018. Viruses studied included varicella zoster (VZV), measles, and mumps. Young age (17–48 years old) was negatively associated with immunity for VZV (OR 4.54, p < .001), measles (OR 15.45, p < .001) and mumps (OR 3.1, p < .001), as compared to those 65+. Many LTx candidates with cystic fibrosis (CF) had undetectable virus‐specific antibody titers including: 13.5% for VZV, 19.1% for measles, and 15.7% for mumps with significant odds of undetectable titers for VZV (OR 4.54, p < .001) and measles (OR 2.32, p = .010) as compared to those without CF. Therefore, a substantial number of patients undergoing LTx evaluation had undetectable virus‐specific antibody titers. Our results emphasize the importance of screening for immunity to vaccine‐preventable infections in this population and the need for revaccination in selected patients to boost their humoral immunity prior to transplantation.
Among primary lung transplant recipients, those who are younger and those with cystic fibrosis have higher rates of undetectable virus‐specific antibodies to varicella, measles, and mumps. Meyer and Avery's editorial is on page 2633.
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Adolescent transplant recipients may encounter a range of potentially traumatic events (PTEs) pre‐ and posttransplant, yet little is known about the relationship between posttraumatic stress symptoms ...(PTSS) and medication adherence in this population. In the present study, adolescent recipients and caregivers completed psychosocial questionnaires at enrollment. Outpatient tacrolimus trough level data were collected over 1 year to calculate the Medication Level Variability Index (MLVI), a measure of medication adherence. Nonadherence (MLVI ≥2) was identified in 34.8% of patients, and most (80.7%) reported ≥1 PTE exposure. Levels of PTSS indicating likely posttraumatic stress disorder (PTSD) were endorsed by 9.2% of patients and 43.7% of caregivers. PTSS and MLVI were significantly correlated in the liver subgroup (r = .30, p = .04). Hierarchical multivariable linear regression analyses revealed overall patient PTSS were significantly associated with QoL (p < .001). PTEs are common in adolescent recipients; a minority may meet criteria for PTSD. PTSS screening to identify nonadherence risk requires further investigation and addressing PTSS may improve QoL. Caregivers appear at greater risk for PTSD and may require their own supports. The study was approved by each participating center's Institutional Review Board.
This multisite investigation of pediatric solid organ recipients found that posttraumatic stress symptoms (PTSS) are correlated with tacrolimus nonadherence in liver recipients, that caregivers compared to their children display more PTSS, and that PTSS are associated with lower recipient quality of life.
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