151
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Chelmoński A, Jabłecki J, Szajerka T. Insidious Course of Cytomegalovirus Infection in Hand Transplant Recipient: Case Report, Diagnostics, and Treatment. Transplant Proc 2011; 43:2827-30. [DOI: 10.1016/j.transproceed.2011.06.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 05/15/2011] [Accepted: 06/03/2011] [Indexed: 11/16/2022]
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152
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Chen TC, Lin PC, Chi CY, Ho CM, Chou CH, Ho MW, Wang JH, Jeng LB. Infection in liver transplant recipients—Analysis of 68 cases at teaching hospital in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 44:303-9. [DOI: 10.1016/j.jmii.2011.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 07/04/2010] [Accepted: 08/13/2010] [Indexed: 11/29/2022]
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153
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Piersimoni C. Nontuberculous mycobacteria infection in solid organ transplant recipients. Eur J Clin Microbiol Infect Dis 2011; 31:397-403. [DOI: 10.1007/s10096-011-1329-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 06/20/2011] [Indexed: 11/29/2022]
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154
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Frequency of musculoskeletal complications among the patients receiving solid organ transplantation in a tertiary health-care center. Rheumatol Int 2011; 32:2363-6. [PMID: 21644040 DOI: 10.1007/s00296-011-1970-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 05/22/2011] [Indexed: 10/18/2022]
Abstract
Solid organ transplantation is an important lifesaving procedure mainly performed in patients with end-stage organ failure such as liver cirrhosis, congestive heart failure, and end-stage renal disease. While these complications are among the most preventable adverse effects of solid organ transplantation, these are generally neglected by physicians. Accordingly, this study was performed to evaluate the frequency of musculoskeletal complications among the patients receiving solid organ transplantation in a tertiary health-care center in a developing country. This cohort study was performed from 2000 to 2009, among fifty patients receiving organ transplantation (liver, heart, and lung) attending to a training hospital in Tehran, Iran. The main variables were musculoskeletal complaints and findings that were measured according to patients' self-report and clinical examination. The mean age of the patients was 40.2 ± 10.9 years ranging from 5 to 58 years. Twenty out of 50 patients (40%) had musculoskeletal complaints that the most common complaint was the arthralgia. Also, the mechanical arthritis was the most common clinical finding in clinical examination (24%). Low serum level of vitamin D (74.4%) and high serum alkaline phosphatase level (27.9%) were the most common biochemical abnormalities in understudy population. Finally, it may be concluded that nearly forty percent of patients receiving solid organ transplantation may develop musculoskeletal findings and/or complaints. These complications may be found and treated with regular examinations to reduce the burden of disease.
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155
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Milan A, Sampaio A, Guardia A, Pavan C, Andrade P, Bonon S, Costa S, Ataíde E, Boin I, Stucchi R. Monitoring and Detection of Cytomegalovirus in Liver Transplant Recipients. Transplant Proc 2011; 43:1360-1. [DOI: 10.1016/j.transproceed.2011.02.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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156
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Ahmed EB, Daniels M, Alegre ML, Chong AS. Bacterial infections, alloimmunity, and transplantation tolerance. Transplant Rev (Orlando) 2011; 25:27-35. [PMID: 21126661 DOI: 10.1016/j.trre.2010.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 10/01/2010] [Indexed: 12/27/2022]
Abstract
Transplantation of solid organs across histocompatibility barriers in the absence of immunosuppression is invariably followed by acute allograft rejection. Although several immunosuppressive regimens have been developed to prevent allograft rejection, these global immunosuppressive agents effectively inhibit all T cells, leaving the host vulnerable to infections. Thus, a major goal in transplantation immunology is to induce donor-specific tolerance that results in the extended suppression of allograft-specific immune responses, while leaving the remainder of the immune system competent to fight infections and malignancies. Initial successes in identifying approaches that successfully induce transplantation tolerance in experimental models have led to a newer research focus of identifying potential barriers to the induction of such tolerance as well as events that may reverse established allograft tolerance. Both clinical and experimental studies have identified bacterial infections as a possible trigger of allograft rejection. Recently, experimental models of transplantation tolerance have identified that bacterial signals can promote acute allograft rejection either by preventing the induction of transplantation tolerance or by reversing tolerance after it has been stably established. This review summarizes experimental and clinical literature supporting the hypothesis that bacterial infections and innate immunity can qualitatively and quantitatively alter adaptive alloreactivity through effects on innate immune responses.
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Affiliation(s)
- Emily B Ahmed
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA
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157
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Togashi J, Sugawara Y, Hashimoto M, Tamura S, Kaneko J, Aoki T, Hasegawa K, Kokudo N. Oral valganciclovir versus intravenous ganciclovir as preemptive treatment for cytomegalovirus infection after living donor liver transplantation: A randomized trial. Biosci Trends 2011; 5:217-22. [DOI: 10.5582/bst.2011.v5.5.217] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Junichi Togashi
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo
| | - Yasuhiko Sugawara
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo
| | - Masao Hashimoto
- Division of Viral Immunology, Centers for AIDS Research, Kumamoto University
| | - Sumihito Tamura
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo
| | - Junichi Kaneko
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo
| | - Taku Aoki
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo
| | - Kiyoshi Hasegawa
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo
| | - Norihiro Kokudo
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo
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158
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Honar N, Imanieh MH, Haghighat M, Dehghani SM, Zahmatkeshan M, Geramizadeh B, Badiee P, Nikeghbalian S, Kazemi K, Bahador A, Salahi H, Malek-Hosseini SA. Evaluation of Candida infection after six months of transplantation in pediatric liver recipients in iran. Int J Organ Transplant Med 2011; 2:105-7. [PMID: 25013602 PMCID: PMC4089262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Liver transplantation (LT) is the standard treatment of end-stage liver diseases (ESLD). Invasive fungal infection is one of the important causes of morbidity and mortality after transplantation. OBJECTIVE To determine the incidence of late-onset (after 6 months of LT) Candida infection in recipients. METHODS A retrospective study was conducted to evaluate 50 pediatric patients after LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We followed the patients until 6 months post-LT for episodes of Candida infection proven by culture. RESULTS One recipient (2%) developed late-onset esophageal candidiasis with improvement after intravenous amphotricin therapy but finally expired with a diagnosis of post-transplant lymphoproliferative disorder (PTLD). CONCLUSIONS The incidence of late-onset Candida infection is not significant in pediatric liver recipient, but it still remains a significant problem. Control of Candida colonization would reduce the risk of invasive fungal infections and possibly more fatal complications.
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Affiliation(s)
- N. Honar
- Gastroenterohepatology Research Center,
| | - M. H. Imanieh
- Gastroenterohepatology Research Center,,Shiraz Transplant Research Center
| | | | - S. M. Dehghani
- Gastroenterohepatology Research Center,,Shiraz Transplant Research Center,Correspondence: Seyed Mohsen Dehghani, MD, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
E-mail:
| | | | | | - P. Badiee
- Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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159
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Guimarães-Souza NK, Dalboni MA, Câmara NC, Medina-Pestana JO, Paheco-Silva A, Cendoroglo M. Infectious complications after deceased kidney donor transplantation. Transplant Proc 2010; 42:1137-41. [PMID: 20534244 DOI: 10.1016/j.transproceed.2010.03.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite improvements in immunosuppressive therapy, infections remain a complication of renal transplantation that is associated with increased morbidity and graft rejection. The aim of this study was to evaluate the relationship between initial renal function after deceased donor transplantation and viral infections. METHODS We included patients 18 years and older who received a deceased donor transplantation between January 1995 and December 2004. They were divided into 2 groups: cases from 1994 to 1999, versus from 2000 to 2004. Initial renal function was classified as immediate (IGF), slow (SGF), or delayed (DGF). Infections were classified according to Centers for Disease Control and prevention standards. RESULTS Among 534 patients, SGF and DGF patients who underwent immunosuppression between 2000 and 2004 show a higher infection rate than IGF patients (P = .005). SGF patients showed a higher incidence of tissue-invasive cytomegalovirus disease (P < .001). Second episodes of viral infections were more common among all patients in this period. However, DGF patients were more susceptible to second episodes of viral infection. In the first group, OKT3 use (P = .013) and donor age (P = .012) were the major risk factors associated with viral infections whereas in the second group, thymoglobulin use (P = .002), acute rejection episode (P = .003), and anemia (P = .044) were the risk factors for viral infection. CONCLUSION Initial renal function after deceased donor transplantation was correlated with viral infection. DGF patients had a higher risk for second infection episodes. SGF patients had a higher risk for tissue-invasive cytomegalovirus infection.
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160
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Guan Z, Chai X, Yu S, Hu H, Jiang Y, Meng Q, Wu Q. Synthesis, Molecular Docking, and Biological Evaluation of Novel Triazole Derivatives as Antifungal Agents. Chem Biol Drug Des 2010; 76:496-504. [DOI: 10.1111/j.1747-0285.2010.01038.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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161
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Delgado J, Manito N, Almenar L, Crespo-Leiro M, Roig E, Segovia J, Vázquez de Prada J, Lage E, Palomo J, Campreciós M, Arizón J, Rodríguez-Lambert J, Blasco T, de la Fuente L, Pascual D, Rábago G. Risk factors associated with cytomegalovirus infection in heart transplant patients: a prospective, epidemiological study. Transpl Infect Dis 2010; 13:136-44. [DOI: 10.1111/j.1399-3062.2010.00573.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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162
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Ticha O, Stouracova M, Kuman M, Studenik P, Freiberger T, Litzman J. Monitoring of CD38high expression in peripheral blood CD8+ lymphocytes in patients after kidney transplantation as a marker of cytomegalovirus infection. Transpl Immunol 2010; 24:50-6. [DOI: 10.1016/j.trim.2010.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/30/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
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163
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Min SI, Park YJ, Ra W, Kim SY, Min SK, Oh MD, Kim YS, Ahn C, Kim SJ, Ha J. Infectious Complications in Renal Transplant Recipients: Changing Epidemiology under Modern Immunosuppression. KOREAN JOURNAL OF TRANSPLANTATION 2010. [DOI: 10.4285/jkstn.2010.24.3.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sang Il Min
- Departments of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yang Jin Park
- Departments of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Whando Ra
- Departments of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Yup Kim
- Departments of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Departments of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Research Institute, Seoul National University Medical Research Center, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Research Institute, Seoul National University Medical Research Center, Seoul, Korea
| | - Sang Joon Kim
- Departments of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Research Institute, Seoul National University Medical Research Center, Seoul, Korea
| | - Jongwon Ha
- Departments of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Research Institute, Seoul National University Medical Research Center, Seoul, Korea
- Seoul National University Hospital, Seoul, Korea
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164
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Merçon M, Regua-Mangia AH, Teixeira LM, Irino K, Tuboi SH, Goncalves RT, Santoro-Lopes G. Urinary tract infections in renal transplant recipients: virulence traits of uropathogenic Escherichia coli. Transplant Proc 2010; 42:483-5. [PMID: 20304171 DOI: 10.1016/j.transproceed.2010.01.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Urinary tract infection (UTI) is the most common infectious complication after renal transplantation. Most infections are caused by uropathogenic Escherichia coli (UPEC). There are limited data on the prevalence of virulence traits among UPEC isolated from renal transplant recipients. This study compared the phenotypic and genotypic profiles of UPEC strains isolated from recipients with those from control patients. METHODS E coli isolates that caused UTI in recipients versus nonimmunosuppressed control patients were characterized according to phylogenetic group and the presence of urovirulence genes pap1/pap2; sfa1/sfa2; afa1/afa2; aer1/aer2; and cnf1/cnf2. RESULTS Thirty-six UPEC isolates from recipients and another 27 from control individuals were included in the study. The proportion of episodes of pyelonephritis in recipients (50%) versus control subjects (41%) was similar (P = .46). However, secondary bacteremia was observed only among recipients (n = 8; P < .001). There was no significant difference in the distribution of phylogenetic groups or the prevalence of analyzed virulence traits between UPEC isolated from the 2 groups. Nevertheless, strains associated with secondary bacteremia in recipients showed a higher prevalence of mannose-resistant hemagglutination (P = .013). CONCLUSION The phenotypic and genotypic characteristics of UPEC isolated from recipients were similar to those from control patients at a tertiary care center. Secondary bacteremia in recipients was associated with a higher prevalence of mannose-resistant hemagglutination.
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Affiliation(s)
- M Merçon
- Departamento de Medicina Preventiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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165
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Kosa KM, Cates SC, Adams-King J, O'Brien B. Improving Foodborne Illness Prevention Among Transplant Recipients. Health Promot Pract 2010; 12:235-43. [DOI: 10.1177/1524839909359157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The U.S. Department of Agriculture developed a food safety brochure to educate transplant recipients and their caregivers about the risk of contracting foodborne illnesses and safe food-handling prevention practices. Qualitative research was conducted with transplant recipients and caregivers to collect information on participants’ food safety concerns, knowledge, and practices; changes in food safety knowledge and practices after receiving the food safety brochure; preferred communication channels and dissemination strategies for delivering the brochure; and evaluation of the brochure. Many participants received food safety information from a health care provider, but the content and format varied by institution. Most participants are not following recommended practices to cook and chill food safely, and many participants consume high-risk foods associated with foodborne illnesses. After reading the brochure, many participants made or plan to make at least one food safety recommendation. The research findings were used to refine the brochure before nationwide distribution.
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Affiliation(s)
| | | | - Janice Adams-King
- U.S. Public Health Service, and the Food and Drug Administration, Center for Drug Evaluation and Research, Division of Nonprescription Clinical Evaluation in White Oak, Maryland
| | - Barbara O'Brien
- U.S. Department of Agriculture, Food Safety and Inspection Service, Food Safety Education Staff in Beltsville, Maryland
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166
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Asberg A, Jardine AG, Bignamini AA, Rollag H, Pescovitz MD, Gahlemann CC, Humar A, Hartmann A. Effects of the intensity of immunosuppressive therapy on outcome of treatment for CMV disease in organ transplant recipients. Am J Transplant 2010; 10:1881-8. [PMID: 20486914 DOI: 10.1111/j.1600-6143.2010.03114.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
An effective host immune response, critical for successful control of Cytomegalovirus (CMV) disease in solid organ transplant recipients, is affected by intensity and type of immunosuppressive therapy. We used information prospectively captured in the VICTOR-trial to investigate the impact of immunosuppressive therapy on short- and long-term outcomes of CMV treatment in organ transplant recipients. Dual, as compared to triple, immunosuppressive therapy ([odds ratios] OR of 2.55; 95% CI: 1.51-4.60; p = 0.002), lower blood concentrations of calcineurin inhibitors (OR of 5.53; CI: 1.04-29.35; p = 0.045), and longer time since transplantation (OR of 1.70; CI: 1.01-2.87; p = 0.047) all showed better early (Day 21) CMV DNAemia eradication. We observed no effect of the intensity of the immunosuppressive therapy on overall rates of viral eradication or recurrence. The type of calcineurin inhibitor (tacrolimus/cyclosporine) or use of mycophenolate did not affect treatment efficacy, although both tacrolimus and mycophenolate treated patients showed a lower rate of virological recurrence OR 0.51 (95% CI: 0.26-0.98; p = 0.044) and OR 0.45 (95% CI: 0.22-0.93; p = 0.031), respectively. Lower total intensity of immunosuppressive therapy was associated with more effective early, but not overall, CMV DNAemia eradication by valganciclovir/ganciclovir therapy. Both mycophenolate and tacrolimus (rather than cyclosporine) therapy seem to be associated with reduced risk of recurrence.
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Affiliation(s)
- A Asberg
- Department of Pharmaceutical Biosciences, University of Oslo, Oslo, Norway.
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167
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Kim YJ, Kim SI, Hong KW, Chang MO, Kim JI, Yoo YK, Moon IS, Kim DG, Lee MD, Kang MW. Two Cases of Pneumocystis Pneumonia after Liver Transplantation Presenting with Different Clinical Manifestations. KOREAN JOURNAL OF TRANSPLANTATION 2010. [DOI: 10.4285/jkstn.2010.24.2.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Youn Jeong Kim
- Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sang Il Kim
- Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Wook Hong
- Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Mine-Ok Chang
- Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ji Il Kim
- Department of Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yung Kyung Yoo
- Department of Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - In Sung Moon
- Department of Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Dong Goo Kim
- Department of Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Myung Duk Lee
- Department of Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Moon Won Kang
- Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
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168
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Wittek M, Doerr HW, Allwinn R. Varizellen und Herpes zoster. ACTA ACUST UNITED AC 2010; 105:399-403. [DOI: 10.1007/s00063-010-1071-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 02/24/2010] [Indexed: 11/30/2022]
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169
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Fan MH, Hadjiliadis D. Incidence and management of mycobacterial infection in solid organ transplant recipients. Curr Infect Dis Rep 2010; 11:216-22. [PMID: 19366564 DOI: 10.1007/s11908-009-0032-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although advances in surgical technique, immunosuppressive regimens, and medical management have led to improved survival and quality of life after solid organ transplantation, infection continues to represent a major cause of morbidity and mortality in transplant recipients. Immunosuppressive therapy after transplantation compromises cell-mediated immunity in particular, leaving the patient at risk for opportunistic as well as routine community-acquired infections. Mycobacterial infection is a rare but important complication of solid organ transplantation, presenting significant risk to the patient and challenges in terms of treatment. The available literature consists predominantly of case reports and institutional experiences. This article examines both Mycobacterium tuberculosis and nontuberculous mycobacterial infection in the transplant setting.
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Affiliation(s)
- Ming-Hui Fan
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania Medical Center, 835 West Gates Building, 3600 Spruce Street, Philadelphia, PA 19104, USA.
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170
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Ulusoy Ş, Özkan G, Bektaş D, Kaynar K, Cansız M, Kazaz N. Ramsay Hunt Syndrome in Renal Transplantation Recipient: A Case Report. Transplant Proc 2010; 42:1986-8. [DOI: 10.1016/j.transproceed.2010.02.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 02/26/2010] [Indexed: 10/19/2022]
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171
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Peres RMB, Costa CRC, Andrade PD, Bonon SHA, Albuquerque DM, de Oliveira C, Vigorito AC, Aranha FJP, de Souza CA, Costa SCB. Surveillance of active human cytomegalovirus infection in hematopoietic stem cell transplantation (HLA sibling identical donor): search for optimal cutoff value by real-time PCR. BMC Infect Dis 2010; 10:147. [PMID: 20515464 PMCID: PMC2890007 DOI: 10.1186/1471-2334-10-147] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 06/01/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human cytomegalovirus (CMV) infection still causes significant morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Therefore, it is extremely important to diagnosis and monitor active CMV infection in HSCT patients, defining the CMV DNA levels of virus replication that warrant intervention with antiviral agents in order to accurately prevent CMV disease and further related complications. METHODS During the first 150 days after allogeneic HSTC, thirty patients were monitored weekly for active CMV infection by pp65 antigenemia, nested-PCR and real-time PCR assays. Receiver operating characteristic (ROC) plot analysis was performed to determine a threshold value of the CMV DNA load by real-time PCR. RESULTS Using ROC curves, the optimal cutoff value by real-time PCR was 418.4 copies/104 PBL (sensitivity, 71.4%; specificity, 89.7%). Twenty seven (90%) of the 30 analyzed patients had active CMV infection and two (6.7%) developed CMV disease. Eleven (40.7%) of these 27 patients had acute GVHD, 18 (66.7%) had opportunistic infection, 5 (18.5%) had chronic rejection and 11 (40.7%) died - one died of CMV disease associated with GVHD and bacterial infection. CONCLUSIONS The low incidence of CMV disease in HSCT recipients in our study attests to the efficacy of CMV surveillance based on clinical routine assay. The quantification of CMV DNA load using real-time PCR appears to be applicable to the clinical practice and an optimal cutoff value for guiding timely preemptive therapy should be clinically validated in future studies.
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Affiliation(s)
- Renata M B Peres
- Department of Clinical Medicine, Faculty of Medical Sciences, University of Campinas, P.O. Box 6111, Zipe Code 13083-970, Campinas, SP, Brazil
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172
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Wittek M, Doerr HW, Allwinn R. Varizellen und Herpes zoster. ACTA ACUST UNITED AC 2010; 105:334-8. [DOI: 10.1007/s00063-010-1061-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
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173
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Deep sequencing reveals highly complex dynamics of human cytomegalovirus genotypes in transplant patients over time. J Virol 2010; 84:7195-203. [PMID: 20463084 DOI: 10.1128/jvi.00475-10] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In lung transplant patients undergoing immunosuppression, more than one human cytomegalovirus (HCMV) genotype may emerge during follow-up, and this could be critical for the outcome of HCMV infection. Up to now, many cases of infection with multiple HCMV genotypes were probably overlooked due to the limitations of the current genotyping approaches. We have now analyzed mixed-genotype infections in 17 clinical samples from 9 lung transplant patients using the highly sensitive ultradeep-pyrosequencing (UDPS) technology. UDPS genotyping was performed at three variable HCMV genes, coding for glycoprotein N (gN), glycoprotein O (gO), and UL139. Simultaneous analysis of a mean of 10,430 sequence reads per amplicon allowed the relative amounts of distinct genotypes in the samples to be determined down to 0.1% to 1% abundance. Complex mixtures of up to six different HCMV genotypes per sample were observed. In all samples, no more than two major genotypes accounted for at least 88% of the HCMV DNA load, and these were often accompanied by up to four low-abundance genotypes at frequencies of 0.1% to 8.6%. No evidence for the emergence of new genotypes or sequence changes over time was observed. However, analysis of different samples withdrawn from the same patients at different time points revealed that the relative levels of replication of the individual HCMV genotypes changed within a mixed-genotype population upon reemergence of the virus. Our data show for the first time that, similar to what has been hypothesized for the murine model, HCMV reactivation in humans seems to occur stochastically.
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174
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[Requirements for hygiene in the medical care of immunocompromised patients. Recommendations from the Committee for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (RKI)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:357-88. [PMID: 20300719 PMCID: PMC7095954 DOI: 10.1007/s00103-010-1028-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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175
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Kim JE, Oh SH, Kim KM, Choi BH, Kim DY, Cho HR, Lee YJ, Rhee KW, Park SJ, Lee YJ, Lee SG. Infections after living donor liver transplantation in children. J Korean Med Sci 2010; 25:527-31. [PMID: 20357992 PMCID: PMC2844587 DOI: 10.3346/jkms.2010.25.4.527] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 07/27/2009] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to evaluate the infectious complications after living donor liver transplantation (LDLT) in children. We enrolled 95 children (38 boys and 57 girls) who underwent LDLT from 1994 to 2004. The median age was 22 months (range, 6 months to 15 yr). We retrospectively investigated the proven episodes of bacterial, viral, and fungal infection. There occurred 150 infections in 67 (70%) of 95 patients (1.49 infections/patient); 74 in 43 patients were bacterial, 2 in 2 were fungal, and 74 in 42 were viral. The most common sites of bacterial infection were the bloodstream (33%) and abdomen (25%). Most of the bacterial infections occurred within the first month after LDLT. Bacterial and fungal infections did not result in any deaths. The most common causes of viral infection were Epstein-Barr virus in 37 patients and cytomegalovirus in 18. Seven of the 14 deaths after LDLT were associated with viral infection. Our study suggests that infection is one of the important causes of morbidity and mortality after LDLT. Especially careful monitoring and management of viral infections is crucial for improving the outcome of LDLT in children.
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Affiliation(s)
- Jeong Eun Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
- Department of Pediatrics, Jung-Gu Community Health Center, Seoul, Korea
| | - Seak Hee Oh
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Mo Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Bo Hwa Choi
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
- Department of Pediatrics, Yosuseongsim General Hospital, Yosu, Korea
| | - Dae Yeon Kim
- Department of Pediatric Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Rae Cho
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeoun Joo Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Kang Won Rhee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Jong Park
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Joo Lee
- Division of Hepato-Biliary and Pancreas Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Gyu Lee
- Division of Hepato-Biliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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176
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Affiliation(s)
- D Lopez de Castilla
- Department of Epidemiology and Environmental Health Sciences, Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York, New York 10032, USA
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177
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Early and Delayed Onset Cytomegalovirus Infection of Liver Transplant Recipients in Endemic Areas. Transplant Proc 2010; 42:884-9. [DOI: 10.1016/j.transproceed.2010.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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178
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Abstract
Pneumocystis jirovecii is the opportunistic fungal organism that causes Pneumocystis pneumonia (PCP) in humans. Similar to other opportunistic pathogens, Pneumocystis causes disease in individuals who are immunocompromised, particularly those infected with HIV. PCP remains the most common opportunistic infection in patients with AIDS. Incidence has decreased greatly with the advent of HAART. However, an increase in the non-HIV immunocompromised population, noncompliance with current treatments, emergence of drug-resistant strains and rise in HIV(+) cases in developing countries makes Pneumocystis a pathogen of continued interest and a public health threat. A great deal of research interest has addressed therapeutic interventions to boost waning immunity in the host to prevent or treat PCP. This article focuses on research conducted during the previous 5 years regarding the host immune response to Pneumocystis, including innate, cell-mediated and humoral immunity, and associated immunotherapies tested against PCP.
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Affiliation(s)
- Michelle N Kelly
- Section of Pulmonary/Critical Care Medicine, LSU Health Sciences Center, Medical Education Building 3205, 1901 Perdido Street, New Orleans, LA 70112, USA.
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179
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Inoue KI, Takano H, Oda T, Yanagisawa R, Tamura H, Adachi Y, Ishibashi KI, Ohno N. Soluble cell wall beta-glucan of Candida induces/enhances apoptosis and oxidative stress in murine lung. Immunopharmacol Immunotoxicol 2010; 31:140-5. [PMID: 19951074 DOI: 10.1080/08923970802534678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The bioactivity of cell wall component(s) of fungi has not been fully investigated, especially in vivo. We have successfully extracted a soluble cell wall beta-glucan from C. albicans (CSBG), and shown that pulmonary exposure to CSBG induces lung inflammation in mice. CSBG-induced lung inflammation was concomitant with the nuclear translocation of signal transducer and activator of transcription (STAT)6 and enhanced lung expression of various cytokines and chemokines. However, the effects of CSBG on the murine respiratory system and their mechanisms have not been fully investigated. In this study, we further explored the effects of pulmonary exposure to CSBG on lung pathophysiology in terms of the induction of apoptosis and enhancement of oxidative stress. ICR mice were intratracheally instilled with vehicle, CSBG, or structurally degraded products of CSBG by formic acid (DEG-CSBG), and 24 h later, the lungs were isolated and evaluated for apoptosis by the TUNEL assay and oxidative stress by immunohistochemistry of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a proper marker of the oxidative DNA damage. In another experiment, the mice were sacrificed and lungs were isolated 4 h after the instillation with vehicle or CSBG for evaluation of transcriptional level of heme oxygenase (HO)-1, a stress responsive protein. Pulmonary exposure to CSBG significantly induced apoptosis and enhanced the formation of 8-OHdG in the lung parenchyma as compared to vehicle or DEG-CSBG exposure. CSBG significantly induced HO-1 in the lung. Taken together, CSBG induces/enhances apoptosis and oxidative stress in the lung in association with lung inflammation/injury.
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Affiliation(s)
- Ken-ichiro Inoue
- Environmental Health Sciences Division, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan.
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180
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Li Y, Yan H, Xue WJ, Tian PX, Ding XM, Pan XM, Feng XS, Tian XH, Xiang HL, Hou J. Allograft rejection-related gene expression in the endothelial cells of renal transplantation recipients after cytomegalovirus infection. J Zhejiang Univ Sci B 2010; 10:820-8. [PMID: 19882756 DOI: 10.1631/jzus.b0920115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To explore the effects of cytomegalovirus (CMV) infection on rejection-related gene expression in the endothelial cells of renal transplantation recipients. METHODS Endothelial cells (ECs) were cultured and stimulated by a variety of factors: A, normal control group; B, inactivated human cytomegalovirus (HCMV) infection group; C, HCMV infection group; D, HCMV supernatant infection group; and E, ganciclovir HCMV group. Expression of intercellular adhesion molecule-1 (ICAM-1) and major histocompability complex (MHC) class I and class II antigens was detected by flow cytometry (FCM) and immunohistochemistry. RESULTS We found characteristic CMV-infected ECs in this study. There were no significant differences among groups A, B and D (P>0.05). Although the expression levels of ICAM-1 were not significantly different between groups C and E (P>0.05), the ICAM-1 expression in these two groups was significantly higher than that in group A (P<0.05). ICAM-1 expression was detected in groups C and E, while there was no expression in groups A, B and D. Furthermore, there was no significant difference of ICAM-1 mRNA expression between groups C and E (P>0.05). Human leucocyte antigen (HLA)-ABC expression was detected in all the groups, while HLA-DR expression was only detected in groups C and E. There were no significant differences of HLA-ABC and HLA-DR expression among groups A, B and D (P>0.05). However, the HLA-ABC and HLA-DR expression levels in groups C and D were higher than those of the remaining groups previously reported (P<0.05). Meanwhile, the HLA-ABC and HLA-DR expression levels in group E were lower than those of group C (P<0.05). CONCLUSION CMV could up-regulate the expression levels of ICAM-1 and MHC antigens, which was closely related to allograft rejection.
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Affiliation(s)
- Yang Li
- Department of Renal Transplantation, Center of Nephropathy, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710061, China.
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181
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Chesi C, Günther M, Huzly D, Neuhaus R, Reinke P, Engelmann H, Mockenhaupt F, Bienzle U. Immunization of liver and renal transplant recipients: a seroepidemiological and sociodemographic survey. Transpl Infect Dis 2009; 11:507-12. [DOI: 10.1111/j.1399-3062.2009.00436.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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182
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Abe Y, Urakami H, Ostanin D, Zibari G, Hayashida T, Kitagawa Y, Grisham MB. Induction of Foxp3-expressing regulatory T-cells by donor blood transfusion is required for tolerance to rat liver allografts. PLoS One 2009; 4:e7840. [PMID: 19956764 PMCID: PMC2776304 DOI: 10.1371/journal.pone.0007840] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 10/22/2009] [Indexed: 01/08/2023] Open
Abstract
Background Donor-specific blood transfusion (DST) prior to solid organ transplantation has been shown to induce long-term allograft survival in the absence of immunosuppressive therapy. Although the mechanisms underlying DST-induced allograft tolerance are not well defined, there is evidence to suggest DST induces one or more populations of antigen-specific regulatory cells that suppress allograft rejection. However, neither the identity nor the regulatory properties of these tolerogenic lymphocytes have been reported. Therefore, the objective of this study was to define the kinetics, phenotype and suppressive function of the regulatory cells induced by DST alone or in combination with liver allograft transplantation (LTx). Methodology/Principal Findings Tolerance to Dark Agouti (DA; RT1a) rat liver allografts was induced by injection (iv) of 1 ml of heparinized DA blood to naïve Lewis (LEW; RT1l) rats once per week for 4 weeks prior to LTx. We found that preoperative DST alone generates CD4+ T-cells that when transferred into naïve LEW recipients are capable of suppressing DA liver allograft rejection and promoting long-term survival of the graft and recipient. However, these DST-generated T-cells did not express the regulatory T-cell (Treg) transcription factor Foxp3 nor did they suppress alloantigen (DA)-induced activation of LEW T-cells in vitro suggesting that these lymphocytes are not fully functional regulatory Tregs. We did observe that DST+LTx (but not DST alone) induced the time-dependent formation of CD4+Foxp3+ Tregs that potently suppressed alloantigen-induced activation of naïve LEW T-cells in vitro and liver allograft rejection in vivo. Finally, we present data demonstrating that virtually all of the Foxp3-expressing Tregs reside within the CD4+CD45RC− population whereas in which approximately 50% of these Tregs express CD25. Conclusions/Significance We conclude that preoperative DST, in the absence of liver allograft transplantation, induces the formation of CD4+ T-cells that are not themselves Tregs but give rise directly or indirectly to fully functional CD4+CD45RC−Foxp3+Tregs when transferred into MHC mismatched recipients prior to LTx. These Tregs possess potent suppressive activity and are capable of suppressing acute liver allograft rejection. Understanding the mechanisms by which preoperative DST induces the generation of tolerogenic Tregs in the presence of alloantigens may lead to the development of novel antigen-specific immunological therapies for the treatment of solid organ rejection.
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Affiliation(s)
- Yuta Abe
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Hidejiro Urakami
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Dmitry Ostanin
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Gazi Zibari
- Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Tetsu Hayashida
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Matthew B. Grisham
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- * E-mail:
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183
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Abstract
BACKGROUND The incidence and prevalence of serious mycoses continues to be a public health problem. These infections are an important cause of morbidity and mortality, especially in immunocompromised patients. The present patent deals with isolation and characterization of a 'pure' mixture of two novel isoxazolidinone-containing natural products from two new fungal strains. They have the partial structure of secalonic acid and show very good antifungal activity in mammals and plants and also synergism with other active ingredients. OBJECTIVE To analyze the activity of the isoxazolidinone-containing compounds in the present patent. METHODS To review the discovery and development of antifungal compounds in general and secalonic acid related compounds in particular. CONCLUSION The research of Parish and collaborators at Merck and Co. has isolated novel antifungal compounds with a new mode of action. These molecules may be considered potential antifungal leads for further clinical study.
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Affiliation(s)
- Pore Vandana Sudhir
- National Chemical Laboratory, Division of Organic Chemistry, Dr Homi Bhabha Road, Pashan, Pune 411 008, India.
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184
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Oak NR, Triulzi DJ. Granulocyte transfusion therapy in abdominal organ transplant recipients. J Clin Apher 2009; 24:186-9. [PMID: 19753654 DOI: 10.1002/jca.20209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with neutropenia are at increased risk for infections. Granulocyte transfusions (GT) have had mixed success in treatment of neutropenic infections in adult patients with hematologic malignancy. This study examined the outcomes of GT therapy in neutropenic solid organ transplant recipients, a novel population for this therapy. METHODS We performed a retrospective examination of the transfusion and medical records of all 14 solid organ-transplant recipients without hematologic malignancy who experienced neutropenia and received GT therapy from 2004 to 2006. RESULTS Twelve patients received GT therapy for an active infection and two patients for infection prophylaxis. The mean absolute neutrophil count (ANC) one day increment per GT in these patients was 526/microl (median 215/microl). The mean ANC one day increment per dose of 10(10) granulocytes was 246/microl (median 86/microl). Of the 12 infected patients, four patients (33%) showed a clinical response to GT with improvement or resolution of the infection, 7 (58%) patients had no clinical response and one additional patient had a clinical response to a course of GT but died during a second GT course. Neither patient receiving GT for prophylaxis developed an infection. CONCLUSIONS We observed temporal increases in ANC to levels above 1,000/microl in 15/18 (83.3%) courses of GT. We observed a clinical response to infection in 5/12 (42%) patients, the remaining infected patients had no clinical response. Our results suggest that GT therapy in neutropenic solid organ transplant recipients can boost peripheral blood neutrophil counts. Additional studies are needed to document an independent clinical benefit for GT in this patient population.
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Affiliation(s)
- Nikhil R Oak
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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185
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Taherimahmoudi M, Ahmadi H, Baradaran N, Montaser-Kouhsari L, Salem S, Mehrsai A, Kalantar E, Jahani Y, Pourmand G. Cytomegalovirus Infection and Disease Following Renal Transplantation: Preliminary Report of Incidence and Potential Risk Factors. Transplant Proc 2009; 41:2841-4. [DOI: 10.1016/j.transproceed.2009.07.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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186
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Perdiz L, Furtado G, Linhares M, Gonzalez A, Pestana J, Medeiros E. Incidence and risk factors for surgical site infection after simultaneous pancreas–kidney transplantation. J Hosp Infect 2009; 72:326-31. [DOI: 10.1016/j.jhin.2009.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 04/27/2009] [Indexed: 10/20/2022]
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187
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Holty JEC, Gould MK, Meinke L, Keeffe EB, Ruoss SJ. Tuberculosis in liver transplant recipients: a systematic review and meta-analysis of individual patient data. Liver Transpl 2009; 15:894-906. [PMID: 19642133 DOI: 10.1002/lt.21709] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mycobacterium tuberculosis (MTB) causes substantial morbidity and mortality in liver transplant recipients. We examined the efficacy of isoniazid latent Mycobacterium tuberculosis infection (LTBI) treatment in liver transplant recipients and reviewed systematically all cases of active MTB infection in this population. We found 7 studies that evaluated LTBI treatment and 139 cases of active MTB infection in liver transplant recipients. Isoniazid LTBI treatment was associated with reduced MTB reactivation in transplant patients with latent MTB risk factors (0.0% versus 8.2%, P = 0.02), and isoniazid-related hepatotoxicity occurred in 6% of treated patients, with no reported deaths. The prevalence of active MTB infection in transplant recipients was 1.3%. Nearly half of all recipients with active MTB infection had an identifiable pretransplant MTB risk factor. Among recipients who developed active MTB infection, extrapulmonary involvement was common (67%), including multiorgan disease (27%). The short-term mortality rate was 31%. Surviving patients were more likely to have received 3 or more drugs for MTB induction therapy (P = 0.003) and to have been diagnosed within 1 month of symptom onset (P = 0.01) and were less likely to have multiorgan disease (P = 0.01) or to have experienced episodes of acute transplant rejection (P = 0.02). Compared with the general population, liver transplant recipients have an 18-fold increase in the prevalence of active MTB infection and a 4-fold increase in the case-fatality rate. For high-risk transplant candidates, isoniazid appears safe and is probably effective at reducing MTB reactivation. All liver transplant candidates should receive a tuberculin skin test, and isoniazid LTBI treatment should be given to patients with a positive skin test result or MTB pretransplant risk factors, barring a specific contraindication. Liver Transpl 15:894-906, 2009. (c) 2009 AASLD.
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Affiliation(s)
- Jon-Erik C Holty
- Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.
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188
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The risk, prevention, and outcome of cytomegalovirus after pediatric lung transplantation. Transplantation 2009; 87:1541-8. [PMID: 19461492 DOI: 10.1097/tp.0b013e3181a492e8] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A retrospective review of pediatric lung transplant recipients at 14 centers in North America and Europe was conducted to characterize the epidemiology and the risk factors for cytomegalovirus (CMV) and to explore the impact of preventative antiviral therapy. METHODS Data were recorded for 1 year posttransplant. Associations between CMV and continuous and categorical risk factors were assessed using Wilcoxon rank sum and chi-square tests, respectively. Associations between time to CMV and risk factors or survival were assessed by multivariable Cox proportional hazards models. RESULTS Within 12 months posttransplant, 172 of 577 subjects (29.8%) developed 218 CMV episodes (90 asymptomatic infection, 25 syndrome, and 103 disease). Forty-one subjects developed more than one episode of CMV. Donor or recipient CMV seropositivity was associated with increased risk of CMV episodes. Except for decreased prophylaxis in CMV D-/R- subjects, duration of prophylaxis did not vary by D/R serostatus. For CMV D+ subjects, not being on prophylaxis at the time of CMV episode increased the risk of CMV (D+/R+ hazard ratio 3.5, 95% confidence interval 1.4-8.4; D+/R- 1.9, 1.02-3.7). CMV was associated with increased mortality within the first posttransplant year among those with donor or recipient CMV seropositivity (hazard ratio 2.0: 95% confidence interval 1.1-3.6; P=0.024). CONCLUSIONS CMV remains a serious complication after pediatric lung transplant, and the impact of prophylaxis is complex.
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189
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Abstract
Nocardia species is an uncommon pathogen that affects both immunosuppressed and immunocompetent patients. The clinical and microbiologic spectrum of nocardiosis has changed recently due to the widespread use of cotrimoxazole prophylaxis, the emergence of new types of immunosuppressed patients, and the improved identification of isolates using molecular techniques. Nocardia asteroides was traditionally considered the predominant organism, and prophylaxis with cotrimoxazole was considered almost universally protective. We conducted the current study to determine the incidence of nocardiosis and its microbiologic and clinical characteristics in a general hospital over the last 12 years. We reviewed the clinical records of all patients in whom Nocardia species was isolated from clinical specimens between 1995 and 2006. Nocardia isolates were identified by standard procedures and by 5' end 16S rRNA gene polymerase chain reaction (PCR) and sequencing. Susceptibility to cotrimoxazole, minocycline, imipenem, linezolid, and amikacin was determined by the broth microdilution method following the guidelines of the Clinical and Laboratory Standards Institute.The incidence of Nocardia infections did not increase significantly during the study period (0.39/100,000 inhabitants in 1995-1998 and 0.55/100,000 inhabitants in 2003-2006). Nocardia was recovered from 43 patients. Six were considered to be colonized. The colonizing species were N. farcinica, N. nova, and N. asteroides. All colonized patients had severe underlying pulmonary conditions and were treated with antimicrobials (6 patients) or corticosteroids (4 patients). Invasive nocardiosis was diagnosed in 37 patients (86.5% were men, and their mean age was 55.8 +/- 17.3 yr). The most common underlying condition in our institution was human immunodeficiency virus (HIV) infection (10 patients; 27%), followed by chronic obstructive pulmonary disease (8 patients; 21.6%), autoimmune diseases (8 patients; 21.6%), solid organ transplantation (7 patients; 18.9%), and cancer (4 patients; 10.8%). The most important risk factor for nocardiosis was corticosteroid administration (23 patients; 62.2%). Nocardiosis affected the lungs in 26 cases (70.3%), the skin in 3 cases (8.1%), and the central nervous system in 2 cases (5.4%). It was disseminated in 5 cases (13.5%) and caused otomastoiditis in 1 (2.7%). The species identified were N. cyriacigeorgica (32.4%), N. farcinica (24.3%), N. otitidiscaviarum (10.8%), N. veterana (8.1%), N. nova (5.4%), N. abscessus (5.4%), N. asiatica (2.7%), N. beijingensis (2.7%), N. brasiliensis (2.7%), N. carnea (2.7%), and Nocardia species (2.7%).Linezolid and amikacin were uniformly active against all the isolates, whereas 29.7% of isolates showed intermediate susceptibility to minocycline (minimum inhibitory concentration = 2 mg/L), 10.8% were resistant to cotrimoxazole, and 5.4% were resistant to imipenem. Nocardiosis occurred while the patients were on cotrimoxazole prophylaxis in 8 cases (21.6%). The strains isolated from these patients were susceptible to cotrimoxazole in 5 cases (62.5%) and resistant in 3 (37.5%). Overall, 13 patients died (35.1%); related mortality was 21.6% (8 patients). We conclude that HIV infection has become the most common underlying condition for invasive nocardiosis in our institution, followed by chronic lung disease. Previous use of corticosteroids was the main risk factor and was present in more than half the patients. New species of Nocardia have been identified, and administration of cotrimoxazole prophylaxis should no longer be considered highly reliable protection against nocardiosis. Larger studies of nocardiosis are required to better identify risk factors associated with mortality, and alternative and more effective methods of prevention must be developed.
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Affiliation(s)
- Maricela Valerio Minero
- From the Department of Clinical Microbiology and Infectious Diseases (MVM, MM, EC, PMR, EB, PM), Hospital General Universitario "Gregorio Marañón," Universidad Complutense, Madrid; and CIBER de Enfermedades Respiratorias (CIBERES) (MM, EC, EB, PM), Spain
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190
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Hamandi B, Holbrook AM, Humar A, Brunton J, Papadimitropoulos EA, Wong GG, Thabane L. Delay of adequate empiric antibiotic therapy is associated with increased mortality among solid-organ transplant patients. Am J Transplant 2009; 9:1657-65. [PMID: 19459798 DOI: 10.1111/j.1600-6143.2009.02664.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Empiric antibiotic therapy is often prescribed prior to the availability of bacterial culture results. In some cases, the organism isolated may not be susceptible to initial empiric therapy (inadequate empiric therapy or IET). In solid-organ transplant recipients, the overall incidence and clinical importance of IET is unknown. We performed a retrospective cohort study of patients admitted from 2002 to 2004. Multiple logistic regression analyses were conducted to determine associations between potential determinants and mortality. IET was administered in 169/312 (54%) patients, with a hospital mortality rate that was significantly greater than those receiving adequate therapy (24.9% vs. 7.0%; relative risk [RR] 3.55; 95% confidence interval [CI], 1.85-6.83; p < 0.001). Regression analysis demonstrated that an increasing duration of IET (adjusted odds ratio [OR] at 24 h: 1.33; 95% CI: 1.15-1.53; p < 0.001), ICU-associated infections (adjusted OR: 6.27; 95% CI: 2.79-14.09; p < 0.001), prior antibiotic use (adjusted OR: 3.56; 95% CI: 1.51-8.41; p = 0.004) and increasing APACHE-II scores (adjusted OR: 1.26; 95% CI: 1.16-1.34; p < 0.001) were independently correlated with hospital mortality. IET is common and appears to be associated with an increased hospital mortality rate in the solid-organ transplant population.
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Affiliation(s)
- B Hamandi
- Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada. mailto:
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191
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Xue W, Liu H, Yan H, Tian P, Ding X, Pan X, Feng X, Xiang H, Hou J, He X. Methodology for monitoring cytomegalovirus infection after renal transplantation. Clin Chem Lab Med 2009; 47:177-81. [PMID: 19191723 DOI: 10.1515/cclm.2009.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the diagnostic value of different detection methods for cytomegalovirus (CMV) infection after renal transplantation and also to establish a system to monitor therapy for CMV infection. METHODS We retrospectively studied 1516 renal transplant recipients from June 1994 to December 2006. All patients were screened for CMV-DNA. A total of 1402 patients had received CMV-IgG/IgM detection since June 1996 and 660 had received CMV antigen detection since June 2000. RESULTS A total of 664 (43.8%) recipients developed CMV infection. The sensitivity, specificity and Youden index of the three methods, respectively, were 18.84%, 100% and 0.1884 for ELISA, 91.86%, 82.98% and 0.7484 for PCR, and 88.06%, 96.95% and 0.8501 for the CMV-pp65 antigenemia test. The sensitivity and specificity of the two combined detection methods (CMV-DNA and CMV-pp65) for post-operation CMV infection were 93.49% and 99.06%; the two detection methods had significant dependability (p<0.05) in diagnosis of CMV infection and in evaluation of therapeutic effect of antiviral drugs. CONCLUSIONS Only ELISA can be used as a screening index in order to distinguish whether the donors or recipients are infected with CMV or not. CMV-pp65 antigenemia can help guide clinical therapy for CMV infection. CMV-pp65 and CMV-PCR combined together provide a more effective method to monitor CMV infection and predict its outcome.
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Affiliation(s)
- Wujun Xue
- Department of Renal Transplantation, the First Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, China.
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192
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Bally S, Caillard S, Moulin B. [Recommendations before travelling for renal transplant patients]. Nephrol Ther 2009; 5:265-79. [PMID: 19406696 DOI: 10.1016/j.nephro.2009.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 02/02/2009] [Accepted: 02/03/2009] [Indexed: 10/20/2022]
Abstract
Travel is now a reasonable objective of CKD patients after renal transplantation. However, immunosuppressive treatment makes them particularly susceptible to infections and may interfere with vaccinations and other drugs. Travel in countries with low health level should be strongly discouraged in the first six months after transplantation or following an acute event. Otherwise, specific consultations should be arranged to prepare the patient as soon as possible. Vaccinations should be started early before departure. Specific immunisations include vaccines against hepatitis A, typhoid, meningococcus and rabies in some cases. Living vaccines are formally contra-indicated. Particular attention should be paid for protection against insects because this is the only effective measure against diseases. In the case of malaria, it should be complemented by adapted chemoprophylaxis that should be started 15 days before the departure date. Advice on hygiene measures should be clarified because this can prevent numerous infections, especially of the digestive tract. Advice on the management of diarrhoea is essential, especially in terms of preventing dehydration. Finally, advice about transport and physical risks, especially those related to sun exposure, should also be addressed.
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Affiliation(s)
- Stéphane Bally
- Service de néphrologie-dialyse-transplantation rénale, Nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
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193
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Asberg A, Humar A, Jardine AG, Rollag H, Pescovitz MD, Mouas H, Bignamini A, Töz H, Dittmer I, Montejo M, Hartmann A. Long-term outcomes of CMV disease treatment with valganciclovir versus IV ganciclovir in solid organ transplant recipients. Am J Transplant 2009; 9:1205-13. [PMID: 19422345 DOI: 10.1111/j.1600-6143.2009.02617.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Though an important cause of morbidity and mortality in solid organ transplantation (SOT), the long-term outcomes of cytomegalovirus (CMV) disease treatment have not been well studied. In a randomized trial, 321 SOT recipients with CMV disease were followed 1 year after treatment with either twice daily intravenous ganciclovir or oral valganciclovir (for 21 days) followed by once daily valganciclovir until day 49 in all patients. Clinical and viral eradication of CMV disease was similar between groups. Clinical recurrence beyond day 49 was found in 15.1% and virological recurrence in 30.0%, no difference between groups (p > 0.77). In a multivariable logistic regression analysis, the only independent predictor for recurrence was failure to eradicate DNAemia by day 21 (clinical: OR 3.9 [1.3-11.3], p = 0.012; virological: OR 5.6 [2.5-12.6], p < 0.0001). Eight patients developed ganciclovir resistance, with no difference between groups (p = 0.62). Twenty patients (valganciclovir: 11, ganciclovir: 9, p = 0.82) died, 12 due to infections, two involving CMV disease. There were no differences in long-term outcomes between treatment arms, further supporting the use of oral valganciclovir for treatment of CMV disease. Persistent DNAemia at day 21, CMV IgG serostatus and development of resistance may be relevant factors for further individualization of treatment.
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Affiliation(s)
- A Asberg
- Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway.
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194
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Moretti ML, Resende MR, Lazéra MDS, Colombo AL, Shikanai-Yasuda MA. [Guidelines in cryptococcosis--2008]. Rev Soc Bras Med Trop 2009; 41:524-44. [PMID: 19009203 DOI: 10.1590/s0037-86822008000500022] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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195
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[Descriptive study of infectious complications in 109 consecutive liver transplant recipients]. Enferm Infecc Microbiol Clin 2009; 27:199-205. [PMID: 19361893 DOI: 10.1016/j.eimc.2008.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 09/22/2008] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Infectious disease is a common, serious complication in liver transplant recipients. The etiology of these infections undergoes changes related with technical advances, prophylaxis, and local epidemiology. METHODS Prospective study in patients who underwent liver transplantation from July 2003 to December 2005 at the Hospital Universitario Virgen del Rocío. An observational description of infections occurring during the first 2 years following transplantation was carried out. RESULTS The incidence of infection was 1.32 episodes per patient over follow-up (443 +/- 248 days). The most frequent infections were surgical site (16%), cytomegalovirus (CMV) (14%), and urinary tract (11%). Etiologies included bacterial (64%), viral (31%), and fungal (5%) causes. The most common pathogens were CMV (21%), Escherichia coli (20%), among which, 40% were extended-spectrum beta-lactamase ESBL-producers, and Enterococcus spp. (11%). More than half the infectious episodes (58%) occurred in the first 4 months after transplantation. The 30-day mortality rate was 18%. In the group with infection, patient and graft survivals were 75% and 73% at the end of follow-up, and in the group without infection, survival was 80% in both cases (P=NS). CONCLUSIONS The most common infectious syndromes following liver transplantation were surgical site infection, CMV infection, and urinary tract infection. Bacteria were the most commonly isolated microorganisms, and there was a high rate of ESBL-producing E. coli.
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196
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van Hal SJ, Marriott DJE, Chen SCA, Nguyen Q, Sorrell TC, Ellis DH, Slavin MA. Candidemia following solid organ transplantation in the era of antifungal prophylaxis: the Australian experience. Transpl Infect Dis 2009; 11:122-7. [PMID: 19220822 PMCID: PMC7190180 DOI: 10.1111/j.1399-3062.2009.00371.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Solid organ transplant (SOT) recipients have high rates of invasive fungal infections, with Candida species the most commonly isolated fungi. The aim of this study was to identify differences between incidence rates, risk factors, clinical presentations, and outcomes of candidemia in SOT recipients and non-SOT patients. Data from the multicenter prospective Australian Candidaemia Study were examined. From August 2001 to July 2004, 24 episodes (2.2%; 24/1068) of candidemia were identified in SOT recipients. During this period, the numbers of transplanted organs included liver (n=455), kidney (n=1605), single lung (n=57), bilateral lung (n=183), heart and lung (n=18), heart (n=157), and pancreas (n=62). The overall annual estimated incidence of candidemia in SOT recipients was higher (3 per 1000 transplant admissions) than in non-SOT patients (incidence 0.21 per 1000 admissions; P<0.001). The incidence and timing of candidemia post transplant was influenced by the transplanted organ type, with the majority of episodes (n=14, 54%) occurring >6 months after renal transplantation. Risk factors for candidemia in the month preceding diagnosis were similar to non-SOT recipients except for corticosteroid therapy (P<0.001). Antifungal prophylaxis did not select for more resistant or non-albicans Candida species in the SOT group. The 30-day all-cause mortality was similar to non-SOT patients with candidemia and remains high at 21%. All deaths in SOT recipients occurred early (within 5 days of diagnosis), underlining a need for better diagnostic tests, targeted prevention, and early treatment strategies.
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Affiliation(s)
- S J van Hal
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, Australia.
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197
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Late-onset CMV disease following CMV prophylaxis. Ir J Med Sci 2009; 178:333-6. [DOI: 10.1007/s11845-009-0327-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 03/09/2009] [Indexed: 11/27/2022]
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198
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Antoniewicz L, Relijc D, Poitschek C, Presterl E, Geusau A. Mucosal Candida infection and colonisation as well as associated risk factors in solid organ transplant recipients. Eur J Clin Microbiol Infect Dis 2009; 28:945-57. [PMID: 19340468 DOI: 10.1007/s10096-009-0730-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Accepted: 03/14/2009] [Indexed: 10/20/2022]
Abstract
More detailed information on Candida colonisation and infection of the mucous membranes in organ transplant recipients (OTR) is of particular interest. Therefore, this issue was prospectively evaluated in 400 different OTR in different posttransplantation periods as well as in 405 healthy age- and sex-matched controls. In addition, possible risk factors and the clinical condition in the OTR were evaluated. Independent of the transplanted organ there is a statistically significant decrease in the number of positive culture results, of symptomatic candidiasis and an increase of isolated non-albicans Candida species corresponding to length of the posttransplantation period. No significant differences could be observed in the OTR in association with different immunosuppressive regimen; however, higher dosages of corticosteroids and tacrolimus correlated with symptomatic candidiasis. As Candida spp. may also cause systemic infection and dissemination, additional knowledge about cofactors and associated strains may have an impact on therapeutic decisions.
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Affiliation(s)
- L Antoniewicz
- Department of Dermatology Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
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199
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Aher NG, Pore VS, Mishra NN, Kumar A, Shukla PK, Sharma A, Bhat MK. Synthesis and antifungal activity of 1,2,3-triazole containing fluconazole analogues. Bioorg Med Chem Lett 2009; 19:759-63. [PMID: 19110424 DOI: 10.1016/j.bmcl.2008.12.026] [Citation(s) in RCA: 225] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 11/10/2008] [Accepted: 12/05/2008] [Indexed: 11/19/2022]
Affiliation(s)
- Nilkanth G Aher
- Organic Chemistry Division, National Chemical Laboratory, Pune 411 008, India
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200
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García-Prado ME, Cordero E, Cabello V, Pereira P, Torrubia FJ, Ruíz M, Cisneros JM. Complicaciones infecciosas en 159 receptores de trasplante renal consecutivos. Enferm Infecc Microbiol Clin 2009; 27:22-7. [DOI: 10.1016/j.eimc.2008.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 02/25/2008] [Indexed: 11/27/2022]
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