The neutralizing monoclonal antibody combination of tixagevimab/cilgavimab has been shown to reduce the risk of SARS‐CoV‐2 infection in unvaccinated individuals during the Alpha (B.1.1.7) and Delta ...(B.1.617.2) waves. However, data on the efficacy and safety of tixagevimab/cilgavimab in vaccinated solid organ transplant recipients during the Omicron wave is limited. To address this, we conducted a retrospective cohort study comparing 222 solid organ transplant recipients (SOTRs) who received tixagevimab/cilgavimab for pre‐exposure prophylaxis and 222 vaccine‐matched solid organ transplant recipients who did not receive tixagevimab/cilgavimab. Breakthrough SARS‐CoV‐2 infections occurred in 11 (5%) of SOTRs who received tixagevimab/cilgavimab and in 32 (14%) of SOTRs in the control group (p < .001). In the tixagevimab/cilgavimab group, SOTRs who received the 150–150 mg dose had a higher incidence of breakthrough infections compared to those who received the 300–300 mg dose (p = .025). Adverse events were uncommon, occurring in 4% of our cohort and most were mild. There was no significant change in serum creatinine or liver chemistries in kidney and liver transplant recipients, respectively. In conclusion, we found that tixagevimab/cilgavimab use is safe and associated with a lower risk of breakthrough SARS‐CoV‐2 infection in vaccinated solid organ transplant recipients during the Omicron wave.
A retrospective matched cohort study shows that tixagevimab‐cilgavimab pre‐exposure prophylaxis in vaccinated solid organ transplant recipients is associated with a lower risk of breakthrough SARS‐CoV‐2 infection during the Omicron wave.
Background
Liver transplant is a life‐saving therapy that can restore quality life for several pediatric liver diseases. However, it is not available to all children who need one. Expertise in ...medical and surgical management is heterogeneous, and allocation policies are not optimally serving children. Technical variant grafts from both living and deceased donors are underutilized.
Methods
Several national efforts in pediatric liver transplant to improve access to and outcomes from liver transplant for children have been instituted and include adjustments to allocation policies, UNOS‐sponsored collaborative improvement projects, and the emergence of national learning networks to study ongoing challenges in the field the Surgical Working group of the Starzl Network for Excellence in Pediatric Transplantation (SNEPT) discusses key issues and proposes potential solutions to eliminate the persistent wait list mortality that pediatric patients face.
Results
A discussion of the factors impacting pediatric patients’ access to liver transplant is undertaken, along with a proposal of several measures to ensure equitable access to life‐saving liver transplant.
Conclusions
Pediatric liver transplant wait list mortality can and should be eliminated. Several measures, including collaborative efforts among centers, could be leveraged to acheive this goal.
Transplantation activity is increasing, leading to a growing number of patients at risk for toxoplasmosis. We reviewed toxoplasmosis prevention practices, prevalence, and outcomes for hematopoietic ...stem cell transplant (HSCT) and solid organ transplant (SOT; heart, kidney, or liver) patients in Europe. We collected electronic data on the transplant population and prevention guidelines/regulations and clinical data on toxoplasmosis cases diagnosed during 2010-2014. Serologic pretransplant screening of allo-hematopoietic stem cell donors was performed in 80% of countries, screening of organ donors in 100%. SOT recipients were systematically screened in 6 countries. Targeted anti-Toxoplasma chemoprophylaxis was heterogeneous. A total of 87 toxoplasmosis cases were recorded (58 allo-HSCTs, 29 SOTs). The 6-month survival rate was lower among Toxoplasma-seropositive recipients and among allo-hematopoietic stem cell and liver recipients. Chemoprophylaxis improved outcomes for SOT recipients. Toxoplasmosis remains associated with high mortality rates among transplant recipients. Guidelines are urgently needed to standardize prophylactic regimens and optimize patient management.
Background
Physical activity (PA) has been shown to have benefits, including improving health‐related quality of life (HRQOL). However, there are few and conflicting studies assessing PA and its ...relationship with HRQOL in a pediatric solid‐organ transplant (SOT) population. The aim of this study was to assess whether overall HRQOL was associated with PA and to determine whether that association was independent of other baseline and contemporaneous clinical and demographic indicators.
Methods
A retrospective cross‐sectional review was performed on 55 pediatric transplant patients (13 heart, 27 kidney, and 15 liver transplant). PA was measured by PAQ‐C/PAQ‐A, and HRQOL was measured using PedsQL. Demographics, baseline, and contemporaneous data were collected.
Results
There were no significant differences in baseline and contemporaneous characteristics between heart, kidney, and liver transplant recipients. SOT recipients were 15.0 (11.0–18.0) years old at completion of surveys. Median PAQ score was 2.3 (1.6–3.2), PedsQL total score was 77 (65–91), and PedsQL physical functioning score was 88 (72–97). The PedsQL total score was not significantly associated with PAQ score. The PAQ score was significantly associated with physical functioning subscore of the PedsQL (r = 0.37, p < 0.01). Higher physical functioning score was associated with time since transplant (r = 0.29, p = 0.031).
Conclusion
Our SOT cohort has a HRQOL similar to other chronic conditions and higher than previous reported HRQOL in pediatric SOT populations. Higher levels of PA and longer time since transplant are associated with higher physical functioning scores.
Summary
Patients with recurrent miscarriage (RM) show up‐regulated cytotoxic natural killer (NK) cells that are suspected to play a causal role in abortion. In the present study, we investigated ...counter‐regulating inhibitory mechanisms and compared the results in RM patients with those of healthy controls (HC), patients with end‐stage renal disease (ESRD) and kidney transplant recipients late post‐transplant (TX). NK, NK T and T cell subsets were analysed in the peripheral blood of 31 RM, 14 female ESRD and nine female TX patients as well as 21 female HC using eight‐colour fluorescence flow cytometry. Compared with HC, RM patients showed significantly higher absolute numbers of CD56+ NK cells co‐expressing the phenotype interferon (IFN)‐γR+, IL‐4+, transforming growth factor (TGF)‐β+, IL‐4+ human leucocyte antigen D‐related (HLA‐DR)+, TGF‐β+HLA‐DR+, IL‐4+TGF‐β+, IL‐4+TGF‐β–, IFN‐γ+ and/or IL‐10–IFN‐γ+ (all P ≤ 0·01), more IL‐17+CD56bright (P = 0·028) NK cells and more CD56dimCD16+ NK cells co‐expressing IFN‐γR, IFN‐γ, IL‐4 and/or TGF‐β (all P ≤ 0·01). When the same cell subsets were analysed in ESRD or TX patients, cytokine‐producing NK cell subsets were not significantly different from those of HC. RM patients showed significantly higher absolute numbers of CD158a+, CD158b+, CD158a–CD158e+ (all P < 0·05), NKG2D+NKG2A+, NKG2D +NKG2A–, NKG2D+ and/or NKG2A+ (all P ≤ 0·01) CD56+ NK cells and higher CD158a+, CD158b+ (all P < 0·05), NKG2D+ and/or NKG2A+ (all P < 0·01) CD56dim+CD16+ NK cells than HC. In contrast, ESRD patients had normal and TX recipients had lower CD158a+ and NKG2D+NKG2A–CD56+ NK cells and lower CD158a+CD56dim+CD16+ NK cells (all P < 0·05) than HC. RM patients have abnormally high circulating NK cells expressing inhibitory cytokines and inhibitory surface receptors which might contribute to the pathogenesis of RM.
Our data show that compared to female healthy controls, recurrent miscarriage patients have abnormally high NK, NKT and T cells in the blood which express inhibitory cytokines and inhibitory surface receptors. In contrast, dialysis and transplant patients had normal or even decreased levels of these cell subsets. We interpret these results as showing that the upregulation of inhibitory mechanisms in recurrent miscarriage patients represents a counter regulation to a strongly upregulated cytotoxic immune system, possibly the cause of recurrent miscarriage.
Pregnancy care in solid organ transplant recipients Kallapur, Aneesh; Jang, Christine; Yin, Ophelia ...
International journal of gynecology and obstetrics,
June 2022, Letnik:
157, Številka:
3
Journal Article
Recenzirano
Recipients of solid organ transplants who become pregnant represent an obstetrically high‐risk population. Preconception planning and effective contraception tailored to the individual patient are ...critical in this group. Planned pregnancies improve both maternal and neonatal outcomes and provide a window of opportunity to mitigate risk and improve lifelong health. Optimal management of these pregnancies is not well defined. Common pregnancy complications after transplantation include hypertension, preterm birth, infection, and metabolic disease. Multidisciplinary preconception and prepartum management, and counseling decrease complications and benefit the maternal‐neonatal dyad.
Transplant recipients represent an obstetrically high‐risk group and require coordinated multidisciplinary care and adequate counseling to mitigate risk and improve outcomes.
OPTN/SRTR 2022 Annual Data Report: Kidney Lentine, Krista L.; Smith, Jodi M.; Lyden, Grace R. ...
American journal of transplantation,
February 2024, 2024-Feb, 2024-02-00, 20240201, Letnik:
24, Številka:
2
Journal Article
Recenzirano
The year 2022 had continued successes and challenges for the field of kidney transplantation, as the community adapted to ongoing surges of the COVID-19 pandemic and broader geographic organ ...distribution. The total number of kidney transplants in the United States reached a record count of 26,309, driven by continued growth in deceased donor kidney transplants (DDKTs). The total number of candidates listed for DDKT rose slightly in 2022 but remained below 2019 listing levels, with 12.4% of candidates having been waiting 5 years or longer. Following the height of the COVID-19 pandemic, pretransplant mortality in 2022 declined across age, race and ethnicity, sex, and blood type groups. Pretransplant mortality continued to vary substantially by donation service area. The proportion of deceased donor kidneys recovered but not used for transplant (nonuse rate) rose to a high of 26.7% overall, with greater nonuse of biopsied kidneys (39.8%), kidneys from donors aged 55 years or older (54.7%), and kidneys with a kidney donor profile index (KDPI) of 85% or greater (71.3%). Nonuse of kidneys from donors who are hepatitis C virus (HCV) antibody positive rose to 30.2% but only slightly exceeded that of HCV antibody–negative donors. Disparities in access to living donor kidney transplant (LDKT) persist, especially for non-White and publicly insured patients. Delayed graft function continues an upward trend and occurred in 26.3% of adult kidney transplants in 2022. Five-year graft survival after LDKT compared with DDKT was 90.0% versus 81.4% for recipients aged 18-34 years and 80.8% versus 67.8% for recipients aged 65 years or older, respectively. The total number of pediatric kidney transplants performed in 2022 decreased to 705, its lowest point in the past decade; 502 (71.2%) were DDKTs and 203 (28.8%) were LDKTs. Among pediatric recipients, LDKT remains low, with continued racial disparities. The rate of DDKT among pediatric candidates has decreased by almost 25% since 2011. Congenital anomalies of the kidney and urinary tract remain the leading primary kidney disease diagnosis among pediatric candidates with a reported diagnosis. Most pediatric deceased donor recipients received a kidney from a donor with a KDPI of less than 35%. The rate of delayed graft function was 5.8% in 2022 and has been stable over the past decade. Long-term graft survival continues to improve, with superior outcomes for living donor transplant recipients.
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This year’s chapter on vascularized composite allograft (VCA) encompasses reviews of data collected from 2014 (when VCA was included in the Final Rule) through 2022. The present Annual Data Report ...shows that the number of VCA recipients in the United States continues to be small and has remained consistent from the prior report. The data continue to be limited by sample size, with trends persistently demonstrating a predominance of White males in the young/middle-aged population as both donors and recipients for nonuterus VCA transplants, and White women younger than 35 years as the predominant recipients of uterus transplant. Similar to the 2021 report, there were only eight failed uterus grafts and one failed nonuterus VCA graft reported from 2014 through 2022. Standardization of definitions of success and failure as well as outcome measures for the different VCA types remain unmet needs in VCA transplantation.
Background
This study aimed to characterize features present at the time of diagnosis and describe outcomes in patients with post‐transplant lymphoproliferative disorder (PTLD) following pediatric ...solid organ transplantation.
Methods
We performed a retrospective review of solid organ transplant patients who developed pathologically confirmed PTLD at our center from 2006 to 2016.
Results
Of 594 patients included in this study, 41(6.9%) were diagnosed with PTLD. Median age at transplant was 5.6(IQR 1.7–16.1) years. Proportion of PTLD cases by organ transplanted and median time (IQR) to disease onset were: heart 11/144(7.6%) at 13.6(8.5–55.6) months, lung 7/52(13.5%) at 9.1(4.9–35) months, kidney 8/255(3.1%) at 39.5(13.9–57.1) months, liver 12/125(9.6%) at 7.7(5.5–22) months, intestine 0/4(0%), and multi‐visceral 3/14(21.4%) at 5.4(5.4–5.6) months. No significant correlation was seen between recipient EBV status at transplant and timing of development of PTLD. There were six early lesions, 15 polymorphic, 19 monomorphic, and one uncharacterizable PTLD. Following immunosuppression reduction, 30 patients received rituximab, and 14 required chemotherapy. At median 25(IQR 12–53) months follow‐up from the onset of PTLD, eight patients died secondary to transplant related complications, three are alive with active disease, and 30 have no evidence of disease.
Conclusion
PTLD is a significant complication following pediatric solid organ transplantation. EBV levels in conjunction with symptomatic presentation following transplant may assist in detection of PTLD. Most patients can achieve long‐term disease‐free survival through immunosuppression reduction, anti‐CD20 treatment, and chemotherapy in refractory cases.
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