Estimating the total coronavirus disease 2019 (COVID‐19) mortality burden of solid organ transplant recipients (SOTRs), both directly through COVID‐19 infection and indirectly through other impacts ...on the healthcare system and society, is critical for understanding the disease's impact on the SOTR population. Using SRTR data, we modeled expected mortality risk per month pre‐COVID (January 2015–February 2020) for kidney/liver/heart/lung SOTRs, and compared monthly COVID‐era deaths (March 2020–March 2021) to expected rates, overall and among subgroups. Deaths above expected rates were designated "excess deaths." Between March 2020 and March 2021, there were 3739/827/265/252 excess deaths among kidney/liver/heart/lung SOTRs, respectively, representing a 41.2%/27.4%/18.5%/15.0% increase above expected deaths. 93.0% of excess deaths occurred in patients age≥50. The observed:expected ratio was highest among Hispanic SOTRs (1.82) and lowest among White SOTRs (1.20); 56.0% of excess deaths occurred among Black or Hispanic SOTRs. 64.7% of excess deaths occurred among patients who had survived ≥5 years post‐transplant. Excess deaths peaked in January 2021; geographic distribution of excess deaths broadly mirrored COVID‐19 incidence. COVID‐19 likely caused over 5000 excess deaths among SOTRs in the US in a 13‐month period, representing 1 in 75 SOTRs and a substantial proportion of all deaths among SOTRs during this time. SOTRs will remain at elevated mortality risk until the COVID‐19 pandemic can be controlled.
This study reports substantial excess mortality among solid organ transplant recipients in the United States experience that is spatially and temporally associated with COVID‐19.
Lifelong multi-drug immunosuppression is essential in pediatric cardiac transplant with regimens varying between pediatric centers. Current data suggests pre-transplant immunologic phenotype ...differences may predispose patients to over-immunosuppression. At our tertiary care center, targeted reduction of immunosuppression has recently become common practice despite limited published data. We hypothesize that individualized reduction of immunosuppression in pediatric cardiac transplant patients based on baseline immunophenotype will lead to improved outcomes post-transplant.
From January 2020 through July 2022, 52 pediatric patients were referred to our tertiary care center for cardiac transplant evaluation, which includes Immunology evaluation. Patient demographics, cardiac history, and pre-transplant immune evaluation (T/B/NK cell quantitation, quantitative immunoglobulins, vaccine responses and T cell functional testing, as available) were collected. Genetic testing was reviewed. 28 patients who completed cardiac transplant were followed up to 12 months for information on reduced immunosuppression (decreased/bypassed induction with antithymocyte globulin and/or decreased long-term immunosuppression goals), infections, and rejection post-transplant.
Of patients referred for evaluation, 63% had congenital heart disease (CHD). Nearly 100% of CHD patients required cardiac surgery in the first year of life with thymectomy. Of all referred patients and of those with available total T cell count (CD3+ T cells), 54% were lymphopenic (CD3+ T cells < 1000/mm3), and 11% of the lymphopenic children were severely lymphopenic (CD3+ T cells < 300/mm3). Patient IgG levels outside of protein losing enteropathy (PLE) and vaccine responses were within normal limits. Available microarray results showed 5 children with abnormal chromosomal syndromes (including 22q11.2 deletion syndrome). Of those referred, 28 patients underwent cardiac transplant and review of outcomes for up to 12 months post-transplant is on-going.
Immunologic abnormalities are inconsistent in cardiac patients and may be secondary to early thymectomy, PLE or chromosomal deletion syndromes. Our data demonstrates significant differences in pre-transplant immunologic phenotypes and will add to the limited literature on decreasing immunosuppression in severely lymphopenic cardiac patients. This retrospective study provides encouragement for partnership between immunology and cardiology teams to conduct larger, prospective multicenter studies to further understand individualization of immunosuppression regimens, the role of baseline immunophenotyping to inform these decisions and the resulting improvement in transplant outcomes.
Pediatric heart failure and transplantation carry associated risks for kidney failure and potential need for kidney transplant following pediatric heart transplantation (KT/pHT). This retrospective, ...United Network of Organ Sharing study of 10,030 pediatric heart transplants (pHTs) from 1987 to 2020 aimed to determine the incidence of waitlisting for and completion of KT/pHT, risk factors for KT/pHT, and risk factors for nonreceipt of a KT/pHT. Among pHT recipients, 3.4% were waitlisted for KT/pHT (median time of 14 years after pHT). Among those waitlisted, 70% received a KT/pHT, and 18% died on the waitlist at a median time of 0.8 years from KT/pHT waitlisting (median age of 20 years). Moderate-high sensitization at KT/pHT waitlisting (calculated panel reactive antibody, ≥ 20%) was associated with a lower likelihood of KT/pHT (adjusted hazard ratio, 0.67; 95% confidence interval, 0.47-0.95). Waitlisting for heart transplantation simultaneously with kidney transplant (adjusted hazard ratio, 3.73; 95% confidence interval, 2.01-6.92) was associated with increased risk of death on the KT/pHT waitlist. While the prevalence of KT/pHT is low, there is substantial mortality among those waitlisted for KT/pHT. These findings suggest a need to consider novel risk factors for nonreceipt of KT/pHT and death on the waitlist in prioritizing criteria/guidelines for simultaneous heart-kidney transplantation.
(1) Background: We analyzed the association between atrial fibrillation or atrial flutter (AF) and in-hospital mortality (IHM) among patients who underwent solid organ transplants in Spain from 2004 ...to 2021. (2) Methods: We gathered information from all hospital admissions for lung, liver, kidney, and heart transplants. (3) Results: A total of 71,827 transplants were analyzed (4598 lung transplants; 18,127 liver transplants; 45,262 kidney transplants; and 4734 heart transplants). One third of these were for women. Overall, the prevalence of AF was 6.8% and increased from 5.3% in 2004–2009 to 8.6% in 2016–2021. The highest prevalence of AF was found for heart transplants (24.0%), followed by lung transplants (14.7%). The rates for kidney and liver transplants were 5.3% and 4.1%, respectively. The AF code increased over time for all of the transplants analyzed (p < 0.001). The patients’ IHM decreased significantly from 2004–2009 to 2016–2021 for all types of transplants. AF was associated with a higher IHM for all of the types of transplants analyzed, except for heart transplants. (4) Conclusions: The prevalence of AF among patients admitted for solid organ transplants was highest for those who underwent heart transplants. The mortality rate during the patients’ admission for lung, liver, kidney, or heart transplants decreased over time. AF was independently associated with a higher risk of dying in the hospital for those who underwent lung, liver, or kidney transplants.
Lung transplant is now an established modality for a broad spectrum of end-stage pulmonary diseases. According to the International Society for Heart and Lung Transplantation Registry, more than ...50,000 lung transplants have been performed worldwide, with nearly 11,000 recipients of lung transplants alive in the United States. With the increasing use of lung transplant, pulmonologists must be cognizant of the common as well as the unique posttransplant dermatologic complications. Immunosuppression, infections, and a variety of medications and environmental exposures can contribute to these complications. This review aims to provide representative pictures and describe the pathogenesis, epidemiologic characteristics, and clinical manifestations of dermatologic complications encountered among recipients of lung transplants.
Diabetes mellitus (DM) is a growing public health concern in South Africa (SA) and poses a substantial economic burden on healthcare globally. A century has passed since the discovery of insulin, and ...despite advances in diabetes management, exogenous insulin remains a primary treatment for type 1 DM, posing challenges of hyperglycaemia and hypoglycaemia. Pancreas transplantation should be considered a treatment for insulin-deficient DM, offering sustained euglycaemia and preventing complications associated with the disease. However, there has been a global decrease in the number of transplants performed. In SA, only a few pancreas transplants have been performed, primarily because of surgical risks and the need for immunosuppression. Islet transplantation is an alternative but faces limitations due to donor scarcity and immunosuppression requirements. This review explores recent progress in pancreas and islet transplants for DM, with the aim of providing insights into expanding treatment options for people with insulin-deficient DM.
To date, no comprehensive marker to monitor the immune status of patients is available. Given that Torque teno virus (TTV), a known human virome component, has previously been identified as a marker ...of immunocompetence, it was retrospectively investigated whether TTV viral load may also represent a marker of ability to develop antibody in response to COVID‐19‐BNT162B2 vaccine in solid organ transplant recipients (SOT). Specifically, 273 samples from 146 kidney and 26 lung transplant recipients after successive doses of vaccine were analyzed. An inverse correlation was observed within the TTV copy number and anti‐Spike IgG antibody titer with a progressive decrease in viremia the further away from the transplant date. Analyzing the data obtained after the second dose, a significant difference in TTV copy number between responsive and nonresponsive patients was observed, considering a 5 log10 TTV copies/mL threshold to discriminate between the two groups. Moreover, for 86 patients followed in their response to the second and third vaccination doses a 6 log10 TTV copies/mL threshold was used to predict responsivity to the booster dose. Although further investigation is necessary, possibly extending the analysis to other patient categories, this study suggests that TTV can be used as a good marker of vaccine response in transplant patients.
(1) Background: To analyze the association between hospital-acquired pneumonia (HAP) and in-hospital mortality (IHM) during hospital admission for solid organ transplant in Spain during 2004–2021. ...(2) Methods: We used national hospital discharge data to select all hospital admissions for kidney, liver, heart, and lung transplants. We stratified the data according to HAP status. To examine time trends, we grouped data into three consecutive 6-year periods (2004–2009; 2010–2015; and 2016–2021). We assessed in-hospital mortality (IHM) in logistic regression analyses and obtained odds ratios (ORs) with their 95% confidence intervals (CIs). (3) Results: We identified a total of 71,827 transplants (45,262, kidney; 18,127, liver; 4734, heart; and 4598, lung). Two thirds of the patients were men. Overall, the rate of HAP during admission was 2.6% and decreased from 3.0% during 2004–2009 to 2.4% during 2016–2021. The highest rate of HAP corresponded to lung transplant (9.4%), whereas we found the lowest rate for kidney transplant (1.1%). Rates of HAP for liver and heart transplants were 3.8% and 6.3%, respectively. IHM was significantly lower during 2016–2021 compared to 2004–2009 for all types of transplants (ORs (CIs) = 0.65 (0.53–0.79) for kidney; 0.73 (0.63–0.84) for liver; 0.72 (0.59–0.87) for heart; and 0.39 (0.31–0.47) for lung). HAP was associated with IHM for all types of transplants (ORs (CIs) = 4.47 (2.85–9.08) for kidney; 2.96 (2.34–3.75) for liver; 1.86 (1.34–2.57) for heart; and 2.97 (2.24–3.94) for lung). (4) Conclusions: Rates of HAP during admission for solid organ transplant differ depending on the type of transplant. Although IHM during admission for solid organ transplant has decreased over time in our country, HAP persists and is associated with a higher IHM after accounting for potential confounding variables.
