1
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Simonenko M, Hansen D, Niebauer J, Volterrani M, Adamopoulos S, Amarelli C, Ambrosetti M, Anker SD, Bayes-Genis A, Gal TB, Bowen TS, Cacciatore F, Caminiti G, Cavaretta E, Chioncel O, Coats AJS, Cohen-Solal A, D'Ascenzi F, de Pablo Zarzosa C, Gevaert AB, Gustafsson F, Kemps H, Hill L, Jaarsma T, Jankowska E, Joyce E, Krankel N, Lainscak M, Lund LH, Moura B, Nytrøen K, Osto E, Piepoli M, Potena L, Rakisheva A, Rosano G, Savarese G, Seferovic PM, Thompson DR, Thum T, Van Craenenbroeck EM. Prevention and rehabilitation after heart transplantation: A clinical consensus statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a section of ESOT. Eur J Prev Cardiol 2024:zwae179. [PMID: 38894688 DOI: 10.1093/eurjpc/zwae179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 01/20/2024] [Accepted: 02/21/2024] [Indexed: 06/21/2024]
Abstract
Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus.
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Affiliation(s)
- Maria Simonenko
- Cardiopulmonary Exercise Test Research Department, Heart Transplantation Outpatient Department, V.A. Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Dominique Hansen
- REVAL and BIOMED Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | | | - Stamatis Adamopoulos
- Heart Failure and Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Cristiano Amarelli
- Department of Cardiac Surgery and Transplants, Monaldi Hospital, Azienda dei Colli, Naples, Italy
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta d'Adda (CR), Italy
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Scott Bowen
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Francesco Cacciatore
- Department of Translational Medicine, University of Naples 'Federico II', Naples, Italy
| | | | - Elena Cavaretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | | | - Alain Cohen-Solal
- Cardiology Department, University of Paris, INSERM UMRS-942, Hopital Lariboisiere, AP-HP, Paris, France
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | - Andreas B Gevaert
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Eindhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Emer Joyce
- Department of Cardiology, Mater University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Nicolle Krankel
- Universitätsmedizin Berlin Campus Benjamin Franklin Klinik für Kardiologie Charite, Berlin, Germany
| | | | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Brenda Moura
- Armed Forces Hospital, Porto, Portugal
- Centre for Health Technologies and Services Research, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Kari Nytrøen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Elena Osto
- Division of Physiology and Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria
- Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Massimo Piepoli
- Dipartimento Scienze Biomediche per la Salute, Universita' Degli Studi di Milan, Milan, Italy
- Cardiologia Universitaria, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Amina Rakisheva
- Department of Cardiology, Scientific Institution of Cardiology and Internal Diseases, Almaty, Kazakhstan
- Department of Cardiology, Kapshagai City Hospital, Almaty, Kazakhstan
| | - Giuseppe Rosano
- St. George's Hospital NHS Trust University of London, London, UK
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petar M Seferovic
- Faculty of Medicine and Heart Failure Center, University of Belgrade, Belgrade University Medical Center, Belgrade, Serbia
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School and Fraunhofer Institute for Toxicology and Experimental Research, Hannover, Germany
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
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2
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Lacy MG, Filippov E, Nematollahi S. Controlling infections in hospitalized pretransplant candidates. Curr Opin Organ Transplant 2024; 29:56-63. [PMID: 37991047 DOI: 10.1097/mot.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
PURPOSE OF REVIEW Infections in hospitalized patients awaiting solid organ transplantation can pose complicated diagnostic and therapeutic challenges. Goals of management include stabilizing the patient, treating or controlling infections, and decreasing the risk of reactivation of infection after transplant. RECENT FINDINGS Groups such as The Organ Procurement and Transplantation Network, American Society of Transplantation Infectious Diseases Community of Practice and the European Society of Clinical Microbiology and Infectious Diseases have updated their guidelines on screening and treatment of infection in transplant candidates. There are also recent developments in therapeutic options for tuberculosis, COVID-19, Clostridioides difficile colitis, bloodstream infections, and other common infections. SUMMARY Ideally, antimicrobial therapy should be complete prior to transplantation. In situations in which completion of therapy prior to transplant is not feasible, therapy may need to be prolonged or modified. In most situations, infections can be managed similarly to the general population, although some infections, particularly fungal and mycobacterial, require a different management approach. We review disease- and organ-specific management.
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Affiliation(s)
- Marian G Lacy
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Evgenii Filippov
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Saman Nematollahi
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
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3
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Nai N, Bobba A, Oberoi M, Sohail AH, Kumar K, Mozaffar AM, Vummanenni S, Gangu K, Khan MS, Sheikh AB. Outcomes of COVID-19 Disease in Comparison with Influenza in Renal Transplant Recipients: Results from a Large Nationwide Research Network in the United States. Transplant Proc 2024; 56:87-92. [PMID: 38199856 DOI: 10.1016/j.transproceed.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/21/2023] [Accepted: 11/26/2023] [Indexed: 01/12/2024]
Abstract
COVID-19 infection has worse outcomes in immunocompromised individuals. This includes those with diabetes mellitus, cancer, chronic autoimmune diseases requiring immunomodulatory therapy, and solid-organ transplant recipients on chronic immunosuppression. Using the National Inpatient Sample Database, this study retrospectively compared 14,915 renal transplant recipients who were hospitalized with either COVID-19 or Influenza virus infection in the US at any point between 1st January 2020 and 31st December 2020. We found that compared to renal transplant recipients with influenza infection, recipients with COVID-19 infection were more likely to require mechanical ventilation and vasopressor support and develop acute kidney injury requiring hemodialysis. COVID-19 patients also had significantly longer length of hospital stay. Renal transplant recipients with COVID-19 had significantly higher in-hospital mortality compared to recipients with influenza infection (14.09% vs 2.61%, adjusted odds ratio [aOR] 9.73 [95% CI (5.74-16.52)], P < .001). Our study clearly demonstrates the severe outcomes of high mortality and morbidity in renal transplant recipients with COVID-19. Further research should be undertaken to focus on the key areas noted to reduce morbidity and mortality in this population.
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Affiliation(s)
- Nhi Nai
- Department of Medicine, University of New Mexico; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexio
| | - Aniesh Bobba
- Department of Medicine, John H. Stronger Hospital, Chicago, Illinois
| | - Meher Oberoi
- Department of Surgery, NYU Langone Long Island School of Medicine, New York, New York
| | | | - Kantesh Kumar
- Aga Khan University Medical College, AKU, Karachi, Pakistan
| | - Abbas M Mozaffar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | | | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Muhammad Salman Khan
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Babel N, Hugo C, Westhoff TH. Vaccination in patients with kidney failure: lessons from COVID-19. Nat Rev Nephrol 2022; 18:708-723. [PMID: 35999285 PMCID: PMC9397175 DOI: 10.1038/s41581-022-00617-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 02/06/2023]
Abstract
Infection is the second leading cause of death in patients with chronic kidney disease (CKD). Adequate humoral (antibody) and cellular (T cell-driven) immunity are required to minimize pathogen entry and promote pathogen clearance to enable infection control. Vaccination can generate cellular and humoral immunity against specific pathogens and is used to prevent many life-threatening infectious diseases. However, vaccination efficacy is diminished in patients with CKD. Premature ageing of the immune system and chronic systemic low-grade inflammation are the main causes of immune alteration in these patients. In the case of SARS-CoV-2 infection, COVID-19 can have considerable detrimental effects in patients with CKD, especially in those with kidney failure. COVID-19 prevention through successful vaccination is therefore paramount in this vulnerable population. Although patients receiving dialysis have seroconversion rates comparable to those of patients with normal kidney function, most kidney transplant recipients could not generate humoral immunity after two doses of the COVID-19 vaccine. Importantly, some patients who were not able to produce antibodies still had a detectable vaccine-specific T cell response, which might be sufficient to prevent severe COVID-19. Correlates of protection against SARS-CoV-2 have not been established for patients with kidney failure, but they are urgently needed to enable personalized vaccination regimens.
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Affiliation(s)
- Nina Babel
- Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
- Center for Translational Medicine and Immune Diagnostics Laboratory, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Center for Advanced Therapies (BeCAT) and Berlin Institute of Health, Berlin, Germany.
| | - Christian Hugo
- Medizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timm H Westhoff
- Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
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5
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Ponticelli C, Campise M. COVID-19 Vaccination in Kidney Transplant Candidates and Recipients. Vaccines (Basel) 2022; 10:vaccines10111808. [PMID: 36366317 PMCID: PMC9692413 DOI: 10.3390/vaccines10111808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 12/03/2022] Open
Abstract
Kidney transplant candidates and kidney transplant recipients (KTRs) are at particular risk of severe complications of COVID-19 disease. In Western countries, mortality in affected hospitalized KTRs ranges between 19% and 50%. COVID-19 vaccination remains the most important measure to prevent the severity of infection in candidates and recipients of kidney transplant. However, the uraemic condition may affect the vaccine-induced immunity in patients with advanced chronic kidney disease (CKD) and in KTRs. Retention of uraemic toxins, dysbiosis, dysmetabolism, and dialysis can diminish the normal response to vaccination, leading to dysfunction of inflammatory and immune cells. In KTRs the efficacy of vaccines may be reduced by the immunosuppressive medications, and more than half of kidney transplant recipients are unable to build an immune response even after four administrations of anti-COVID-19 vaccines. The lack of antibody response leaves these patients at high risk for SARS-CoV-2 infection and severe COVID-19 disease. The aim of the present review is to focus on the main reasons for the impaired immunological response among candidates and kidney transplant recipients and to highlight some of the present options available to solve the problem.
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Affiliation(s)
| | - Mariarosaria Campise
- Department of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence:
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Vinson AJ, Anzalone AJ, Sun J, Dai R, Agarwal G, Lee SB, French E, Olex A, Ison MG, Mannon RB. The risk and consequences of breakthrough SARS-CoV-2 infection in solid organ transplant recipients relative to non-immunosuppressed controls. Am J Transplant 2022; 22:2418-2432. [PMID: 35674237 PMCID: PMC9348256 DOI: 10.1111/ajt.17117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/05/2022] [Accepted: 06/05/2022] [Indexed: 01/25/2023]
Abstract
Clinical outcomes in solid organ transplant (SOT) recipients with breakthrough COVID (BTCo) after two doses of mRNA vaccination compared to the non-immunocompromised/immunosuppressed (ISC) general population, are not well described. In a cohort of adult patients testing positive for COVID-19 between December 10, 2020 and April 4, 2022, we compared the cumulative incidence of BTCo in a non-ISC population to SOT recipients (overall and by organ type) using the National COVID Cohort Collaborative (N3C) including data from 36 sites across the United States. We assessed the risk of complications post-BTCo in vaccinated SOT recipients versus SOT with unconfirmed vaccination status (UVS) using multivariable Cox proportional hazards and logistic regression. BTCo occurred in 4776 vaccinated SOT recipients over a median of 149 days (IQR 99-233), with the highest cumulative incidence in heart recipients. The relative risk of BTCo was greatest in SOT recipients (relative to non-ISC) during the pre-Delta period (HR 2.35, 95% CI 1.80-3.08). The greatest relative benefit with vaccination for both non-ISC and SOT cohorts was in BTCo mortality (HR 0.37, 95% CI 0.36-0.39 for non-ISC; HR 0.67, 95% 0.57-0.78 for SOT relative to UVS). While the relative benefit of vaccine was less in SOT than non-ISC, SOT patients still exhibited significant benefit with vaccination.
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Affiliation(s)
- Amanda J. Vinson
- Division of Nephrology, Department of Medicine Dalhousie University Halifax, Nova Scotia Canada
| | - Alfred J. Anzalone
- Department of Neurological Sciences University of Nebraska Medical Center Omaha, Nebraska USA
| | - Jing Sun
- Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore, Maryland USA
| | - Ran Dai
- Department of Biostatistics University of Nebraska Medical Center Omaha, Nebraska USA
| | - Gaurav Agarwal
- Division of Nephrology, Department of Medicine University of Alabama at Birmingham Birmingham, Alabama USA
| | - Stephen B. Lee
- Division of Infectious Diseases (Regina) University of Saskatchewan Saskatoon, Saskatchewan Canada
| | - Evan French
- Virginia Commonwealth University Richmond, Virginia USA
| | - Amy Olex
- Virginia Commonwealth University Richmond, Virginia USA
| | - Michael G. Ison
- Division of Infectious Diseases and Organ Transplantation Northwestern University Feinberg School of Medicine Chicago, Illinois USA
| | - Roslyn B. Mannon
- Division of Nephology, Department of Medicine University of Nebraska Medical Center Omaha, Nebraska USA
| | - N3C consortium
- Division of Nephrology, Department of Medicine Dalhousie University Halifax, Nova Scotia Canada
- Department of Neurological Sciences University of Nebraska Medical Center Omaha, Nebraska USA
- Department of Epidemiology Johns Hopkins University Bloomberg School of Public Health Baltimore, Maryland USA
- Department of Biostatistics University of Nebraska Medical Center Omaha, Nebraska USA
- Division of Nephrology, Department of Medicine University of Alabama at Birmingham Birmingham, Alabama USA
- Division of Infectious Diseases (Regina) University of Saskatchewan Saskatoon, Saskatchewan Canada
- Virginia Commonwealth University Richmond, Virginia USA
- Division of Infectious Diseases and Organ Transplantation Northwestern University Feinberg School of Medicine Chicago, Illinois USA
- Division of Nephology, Department of Medicine University of Nebraska Medical Center Omaha, Nebraska USA
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7
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Lee EH, Li JY. Immunization-Associated Corneal Transplantation Rejection: A Review. Cornea 2022; 41:660-663. [PMID: 34629440 DOI: 10.1097/ico.0000000000002898] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this review was to examine and characterize the available literature regarding immunization-associated corneal graft rejection. METHODS A Literature search was conducted using PubMed keywords relevant to corneal transplantation, graft rejection, and immunization to find relevant publications through July 2021. Nine studies were included in this review. Data including patient demographics, type of transplant, chronology of disease, type of immunization, treatment, and outcomes were evaluated. RESULTS Twenty-three cases of corneal graft rejection associated temporally with immunizations have been described in the literature. Most of these patients were female, and most commonly had received the influenza vaccine before the rejection episode. Most episodes resulted in graft preservation with intensive corticosteroid therapy. CONCLUSIONS Immunization-associated corneal graft rejection is a rare but likely underreported phenomenon. Patients and surgeons should be aware of this possible risk, although the evidence is inconclusive. Conclusions are limited because of the small sample size and the retrospective nature of all existing literature on this subject. Surgeons should be encouraged to document and report these episodes.
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Affiliation(s)
- Edward H Lee
- Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento CA
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8
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Zlamy M, Zöggeler T, Bachmann M, Schirmer M, Lechner C, Michel M, Schimkowitsch A, Karall D, Scholl-Bürgi S. Immunological Memory and Affinity Maturation After Vaccination in Patients With Propionic Acidemia. Front Immunol 2022; 13:774503. [PMID: 35401508 PMCID: PMC8993222 DOI: 10.3389/fimmu.2022.774503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/22/2022] [Indexed: 11/29/2022] Open
Abstract
Earlier studies have recommended routine childhood immunization in patients with propionic acidemia (PA); however, the literature presents insufficient data on the response to vaccines, notably specific IgG concentrations and avidity maturation, after measles, mumps, rubella (MMR), and diphtheria/tetanus (DiphtTe) vaccinations in this population. In patients with PA, cellular and humoral changes of the immune system (e.g. a decreased CD4+ T cell count, with a reversal of CD4/CD8 T cell ratio, a deficient gamma-globulin fraction, and in one case a decreased lymphocyte blastogenesis) have been reported. Former reports also detected pancytopenias accompanying febrile infections in PA patients. In the current study, we analyzed vaccine-specific IgG concentrations and avidity maturation after MMR and DiphtTe vaccinations in 10 patients with PA. Compared to gender and age matched controls, all 10 had protective IgG concentrations for at least one tested antigen, and in 6 out of 10 patients high relative avidity indices for measles and rubella were detected. In summary, the present study revealed a sufficient immune response and outcome, indicating an acceptable humoral memory in patients with PA after booster vaccinations.
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Affiliation(s)
- Manuela Zlamy
- Department of Child and Adolescent Health, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Zöggeler
- Department of Child and Adolescent Health, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Magdalena Bachmann
- Department of Child and Adolescent Health, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Schirmer
- University Hospital for Internal Medicine II, (Infectiology, Immunology, Pneumology and Rheumatology), Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Lechner
- Department of Child and Adolescent Health, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Miriam Michel
- Department of Child and Adolescent Health, Pediatrics III, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander Schimkowitsch
- Department of Child and Adolescent Health, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Karall
- Department of Child and Adolescent Health, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Sabine Scholl-Bürgi
- Department of Child and Adolescent Health, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
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9
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Charmetant X, Espi M, Benotmane I, Barateau V, Heibel F, Buron F, Gautier-Vargas G, Delafosse M, Perrin P, Koenig A, Cognard N, Levi C, Gallais F, Manière L, Rossolillo P, Soulier E, Pierre F, Ovize A, Morelon E, Defrance T, Fafi-Kremer S, Caillard S, Thaunat O. Infection or a third dose of mRNA vaccine elicits neutralizing antibody responses against SARS-CoV-2 in kidney transplant recipients. Sci Transl Med 2022; 14:eabl6141. [PMID: 35103481 PMCID: PMC8939774 DOI: 10.1126/scitranslmed.abl6141] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/25/2022] [Indexed: 12/12/2022]
Abstract
Transplant recipients, who receive therapeutic immunosuppression to prevent graft rejection, are characterized by high coronavirus disease 2019 (COVID-19)-related mortality and defective response to vaccines. We observed that previous infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but not the standard two-dose regimen of vaccination, provided protection against symptomatic COVID-19 in kidney transplant recipients. We therefore compared the cellular and humoral immune responses of these two groups of patients. Neutralizing anti-receptor-binding domain (RBD) immunoglobulin G (IgG) antibodies were identified as the primary correlate of protection for transplant recipients. Analysis of virus-specific B and T cell responses suggested that the generation of neutralizing anti-RBD IgG may have depended on cognate T-B cell interactions that took place in germinal center, potentially acting as a limiting checkpoint. High-dose mycophenolate mofetil, an immunosuppressive drug, was associated with fewer antigen-specific B and T follicular helper (TFH) cells after vaccination; this was not observed in patients recently infected with SARS-CoV-2. Last, we observed that, in two independent prospective cohorts, administration of a third dose of SARS-CoV-2 mRNA vaccine restored neutralizing titers of anti-RBD IgG in about 40% of individuals who had not previously responded to two doses of vaccine. Together, these findings suggest that a third dose of SARS-CoV-2 mRNA vaccine improves the RBD-specific responses of transplant patients treated with immunosuppressive drugs.
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Affiliation(s)
- Xavier Charmetant
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
| | - Maxime Espi
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
| | - Ilies Benotmane
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67000 Strasbourg, France
- Department of Virology, Strasbourg University Hospital, 67000 Strasbourg, France
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Véronique Barateau
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
| | - Francoise Heibel
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Fanny Buron
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
| | - Gabriela Gautier-Vargas
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Marion Delafosse
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
| | - Peggy Perrin
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Alice Koenig
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
- Claude Bernard University (Lyon 1), 43 boulevard du 11 Novembre 1918, 69622 Villeurbanne France
| | - Noëlle Cognard
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Charlène Levi
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
| | - Floriane Gallais
- Department of Virology, Strasbourg University Hospital, 67000 Strasbourg, France
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Louis Manière
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
| | - Paola Rossolillo
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Centre National de la Recherche Scientifique (CNRS), UMR 7104, Institut National de la Santé et de la Recherche Médicale (INSERM), U1258, Université de Strasbourg, 67400 Illkirch, France
| | - Eric Soulier
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Florian Pierre
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Anne Ovize
- Eurofins Biomnis Laboratory, 69007 Lyon, France
| | - Emmanuel Morelon
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
- Claude Bernard University (Lyon 1), 43 boulevard du 11 Novembre 1918, 69622 Villeurbanne France
| | - Thierry Defrance
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
| | - Samira Fafi-Kremer
- Department of Virology, Strasbourg University Hospital, 67000 Strasbourg, France
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Sophie Caillard
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67000 Strasbourg, France
- Department of Virology, Strasbourg University Hospital, 67000 Strasbourg, France
- Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Olivier Thaunat
- CIRI, INSERM U1111, Université Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Univ. Lyon, 21 avenue Tony Garnier, 69007 Lyon, France
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Transplantation, Nephrology and Clinical Immunology, 5, place d’Arsonval, 69003 Lyon, France
- Claude Bernard University (Lyon 1), 43 boulevard du 11 Novembre 1918, 69622 Villeurbanne France
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10
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Hady-Cohen R, Dragoumi P, Barca D, Plecko B, Lerman-Sagie T, Zafeiriou D. Safety and recommendations for vaccinations of children with inborn errors of metabolism. Eur J Paediatr Neurol 2021; 35:93-99. [PMID: 34673402 DOI: 10.1016/j.ejpn.2021.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/18/2021] [Accepted: 10/02/2021] [Indexed: 12/11/2022]
Abstract
Inborn errors of metabolism (IEM) are genetic disorders due to a defective metabolic pathway. The incidence of each disorder is variable and depends on the respective population. Some disorders such as urea cycle disorders (UCD) and organic acidurias, pose a high risk for a metabolic crisis culminating in a life-threatening event, especially during infections; thus, vaccines may play a crucial role in prevention. However, there are different triggers for decompensations including the notion that vaccines themselves can activate fever and malaise. Additionally, many of the IEM include immunodeficiency, placing the patients at an increased risk for infectious diseases and possibly a weaker response to immunizations. Since metabolic crises and vaccine regimens intersect in the first years of life, the question whether to vaccinate the child occupies parents and medical staff. Many metabolic experts hesitate to vaccinate IEM patients, disregarding the higher risk from the direct infections. In this paper we summarize the published data regarding the safety and recommendations for vaccinations in IEM patients, with reference to the risk for decompensations and to the immunogenic component.
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Affiliation(s)
- R Hady-Cohen
- Pediatric Neurology Unit and Magen Rare Disease Center, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - P Dragoumi
- 1(st) Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Medical School, Thessaloniki, Greece
| | - D Barca
- Pediatric Neurology Clinic, Alexandru Obregia Hospital Pediatric Neurology Discipline II, Clinical Neurosciences Department, "Carol Davila" University of Medicine, Bucharest, Romania
| | - B Plecko
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - T Lerman-Sagie
- Pediatric Neurology Unit and Magen Rare Disease Center, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - D Zafeiriou
- 1(st) Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Medical School, Thessaloniki, Greece.
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11
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Eberhardt CS, Balletto E, Cornberg M, Mikulska M. Coronavirus disease 2019 vaccination in transplant recipients. Curr Opin Infect Dis 2021; 34:275-287. [PMID: 34074880 DOI: 10.1097/qco.0000000000000739] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Coronavirus disease 2019 (COVID-19) vaccination is considered one of the most promising and socioeconomically sustainable strategy to help control the pandemic and several vaccines are currently being distributed in nationwide mass immunization campaigns. Very limited data are available on benefits and risks of COVID-19 vaccination in immunocompromised patients and in particular in solid organ or hematopoietic stem cell transplant recipients as they were excluded from phase III trials. This review summarizes current knowledge, international guidelines and controversies regarding COVID-19 vaccination in these vulnerable populations. RECENT FINDINGS Various COVID-19 vaccine platforms showed good efficacy in phase III trials in the immunocompetent and there are data arising on the safety and immunogenicity of these vaccines in the immunocompromised population. SUMMARY Transplant recipients could benefit significantly from COVID-19 vaccination, both through active immunization provided they elicit protective vaccine responses, and probably through cocooning by immunization of caregivers and healthcare personnel and thus reducing the risk of SARS-coronavirus-2 exposure. Although awaiting more data on the safety and efficacy of COVID-19 vaccines to inform potential adaptations of vaccine regimens, we strongly recommend prioritizing COVID-19 vaccination of solid and hematopoietic stem cell transplant recipients to decrease COVID-19-related morbidity and mortality.
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Affiliation(s)
- Christiane S Eberhardt
- Center for Vaccinology, University Hospitals of Geneva
- Division of General Pediatrics, Department of Woman, Child and Adolescent Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
| | - Elisa Balletto
- Department of Health Sciences (DISSAL), University of Genoa
- Division of Infectious Diseases, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School
- Centre for Individualised Infection Medicine (CiiM), A Joint Venture of Helmholtz Centre for Infection Research and Hannover Medical School
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Hannover, Germany
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa
- Division of Infectious Diseases, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
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12
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Miller-Handley H, Erickson JJ, Gregory EJ, Prasanphanich NS, Shao TY, Way SS. Tacrolimus exposure windows responsible for Listeria monocytogenes infection susceptibility. Transpl Infect Dis 2021; 23:e13655. [PMID: 34057792 DOI: 10.1111/tid.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
Tacrolimus is widely used to prevent graft rejection after allogeneic transplantation by suppressing T cells in a non-antigen-specific fashion. Global T-cell suppression makes transplant recipients more susceptible to infection, especially infection by opportunistic intracellular pathogens. Infection followed by secondary challenge with the opportunistic intracellular bacterial pathogen, Listeria monocytogenes, was used to probe when tacrolimus most significantly impacts antimicrobial host defense. Tacrolimus-treated mice showed no difference in innate susceptibility following primary infection, whereas susceptibility to secondary challenge was significantly increased. Modifying the timing of tacrolimus initiation with respect to primary infection compared with secondary challenge showed significantly reduced susceptibility in tacrolimus-treated mice where tacrolimus was discontinued prior to secondary challenge. Thus, tacrolimus overrides protection against secondary infection primed by primary infection (and presumably live attenuated vaccines), with the most critical window for tacrolimus-induced infection susceptibility being exposure immediately prior to secondary challenge. These results have important implications for strategies designed to boost antimicrobial T-cell-mediated immunity in transplant recipients.
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Affiliation(s)
- Hilary Miller-Handley
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John J Erickson
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Emily J Gregory
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nina Salinger Prasanphanich
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tzu-Yu Shao
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Immunology Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sing Sing Way
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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13
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Alqahtani SA, Barry M, Memish Z, Hashim A, Alfares MA, Alghamdi SA, Al-Hamoudi WK, Al-Judaibi B, Alhazzani W, Al-Tawfiq JA, Abaalkhail F. Use of COVID-19 vaccines in patients with liver disease and post-liver transplantation: Position statement of the Saudi association for the study of liver diseases and transplantation. Saudi J Gastroenterol 2021; 27:201-207. [PMID: 34100388 PMCID: PMC8448010 DOI: 10.4103/sjg.sjg_223_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Patients with chronic liver disease (CLD) and liver transplant recipients are at increased risk of morbidity and mortality from coronavirus disease 2019 (COVID-19). Although several studies demonstrated the safety and efficacy of COVID-19 vaccines in the general population, data in CLD patients and liver transplant recipients are lacking. Two COVID-19 vaccines were approved by the Saudi Food and Drug Authority and rolled out to several million recipients in Saudi Arabia. These vaccines are mRNA-based vaccine BNT162b2 from Pfizer/BioNTech and adenovirus-based AZD1222 from Oxford/AstraZeneca from three manufacturing sites (EU Nodes, Serum Institute of India, and South Korea Bio). The Saudi Association for the Study of Liver diseases and Transplantation (SASLT) has reviewed the available evidence and issued interim recommendations for COVID-19 vaccination in CLD and liver transplant recipients. Since there is no evidence contradicting the safety and immunogenicity of the currently approved COVID-19 vaccines in patients with CLD and hepatobiliary cancer and liver transplant recipients, the SASLT recommends vaccination in those patient populations. CLD and hepatobiliary cancer patients and liver transplant recipients should be prioritized depending on the risk factors for severe COVID-19. In transplant recipients, the optimal timing of vaccination remains unknown; however, immunization is recommended after the initial immunosuppression phase. Patients with CLD and liver transplant candidates or recipients should be closely monitored after COVID-19 vaccination. These patient populations should be included in future clinical trials to provide further evidence on the efficacy and safety of COVID-19 vaccines.
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Affiliation(s)
- Saleh A. Alqahtani
- Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia,Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, United States,Address for correspondence: Dr. Saleh A. Alqahtani, Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh 12713, MD. E-mail:
| | - Mazin Barry
- Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ziad Memish
- Research and Innovation Center, King Saud Medical City, Ministry of Health, Emory University, Riyadh, Saudi Arabia,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Almoutaz Hashim
- Department of Gastroenterology and Transplant Hepatology, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Mona A. Alfares
- Department of Infectious Disease, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Saad A. Alghamdi
- Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Waleed K. Al-Hamoudi
- Department of Medicine, College of Medicine, Gastroenterology and Hepatology Unit, King Saud University, Riyadh, Saudi Arabia
| | - Bandar Al-Judaibi
- Department of Medicine, Division of Gastroenterology, and Multi-Organ Transplant Program, Western University and London Health Sciences Centre, London, Ontario,Division of Transplantation, University of Rochester, Rochester, NY
| | - Waleed Alhazzani
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jaffar A. Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Faisal Abaalkhail
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,Department of Medicine, Gastroenterology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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14
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Safety of the First Dose of SARS-CoV-2 Vaccination in Solid Organ Transplant Recipients. Transplantation 2021; 105:e56-e57. [PMID: 33560728 DOI: 10.1097/tp.0000000000003654] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Korth J, Jahn M, Dorsch O, Anastasiou OE, Sorge-Hädicke B, Eisenberger U, Gäckler A, Dittmer U, Witzke O, Wilde B, Dolff S, Kribben A. Impaired Humoral Response in Renal Transplant Recipients to SARS-CoV-2 Vaccination with BNT162b2 (Pfizer-BioNTech). Viruses 2021; 13:v13050756. [PMID: 33923063 PMCID: PMC8146144 DOI: 10.3390/v13050756] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 12/15/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has a major impact on transplant recipients, with mortality rates up to 20%. Therefore, the effect of established messenger RNA (mRNA)-based SARS-CoV-2 vaccines have to be evaluated for solid organ transplant patients (SOT) since they are known to have poor responses after vaccination. We investigated the SARS-CoV-2 immune response via SARS-CoV-2 IgG detection in 23 renal transplant recipients after two doses of the mRNA-based SARS-CoV-2 vaccine BNT162b2 following the standard protocol. The antibody response was evaluated once with an anti-SARS-CoV-2 IgG CLIA 15.8 +/− 3.0 days after the second dose. As a control, SARS-CoV-2 IgG was determined in 23 healthcare workers (HCW) and compared to the patient cohort. Only 5 of 23 (22%) renal transplant recipients were tested positive for SARS-CoV-2 IgG antibodies after the second dose of vaccine. In contrast, all 23 (100%) HCWs were tested positive for antibodies after the second dose. Thus, the humoral response of renal transplant recipients after two doses of the mRNA-based vaccine BNT162b2 (Pfizer-BioNTech, Kronach, Germany) is impaired and significantly lower compared to healthy controls (22% vs. 100%; p = 0.0001). Individual vaccination strategies might be beneficial in these vulnerable patients.
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Affiliation(s)
- Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.J.); (U.E.); (A.G.); (B.W.); (A.K.)
- Correspondence: ; Tel.: +49-201-723-84622
| | - Michael Jahn
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.J.); (U.E.); (A.G.); (B.W.); (A.K.)
| | - Oliver Dorsch
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, KfH-Nierenzentrum Friesener Straße 37a, 96317 Kronach, Germany;
| | - Olympia Evdoxia Anastasiou
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Burkhard Sorge-Hädicke
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, KfH-Nierenzentrum Alfried-Krupp-Str. 43, 45131 Essen, Germany;
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.J.); (U.E.); (A.G.); (B.W.); (A.K.)
| | - Anja Gäckler
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.J.); (U.E.); (A.G.); (B.W.); (A.K.)
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (O.W.); (S.D.)
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.J.); (U.E.); (A.G.); (B.W.); (A.K.)
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (O.W.); (S.D.)
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.J.); (U.E.); (A.G.); (B.W.); (A.K.)
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16
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Eder M, Omic H, Gorges J, Badt F, Kikic Z, Saemann MD, Tong A, Bauer D, Semmler G, Reiberger T, Lagler H, Scheiner B. Influenza vaccination uptake and factors influencing vaccination decision among patients with chronic kidney or liver disease. PLoS One 2021; 16:e0249785. [PMID: 33848305 PMCID: PMC8043408 DOI: 10.1371/journal.pone.0249785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/24/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Seasonal influenza is a major global health problem causing substantial morbidity and health care costs. Yet, in many countries, the rates of influenza vaccination remain low. Chronic kidney or liver diseases (CKLD) predispose patients to severe influenza infections, but data on vaccination acceptance and status is limited in this risk population. We investigated the influenza vaccination awareness considering sociodemographic factors in CKLD patients. Patients and methods This cross-sectional, questionnaire-based study recruited CKLD patients managed at three Viennese tertiary care centers between July and October 2020. CKLD was defined as chronic kidney- (all stages) or compensated/decompensated liver disease, including kidney/liver transplant recipients. Questionnaires assessed sociodemographic and transplant- associated parameters, patients vaccination status and the individuals self-perceived risks of infection and associated complications. Results In total 516 patients (38.1% female, mean age 56.4 years) were included. 43.9% of patients declared their willingness to be vaccinated in the winter season 2020/2021, compared to 25.4% in 2019/2020 and 27.3% in 2016–2018. Vaccination uptake was associated with the self-perceived risks of infection (OR: 2.8 (95%CI: 1.8–4.5), p<0.001) and associated complications (OR: 3.8 (95%CI: 2.3–6.3), p<0.001) as well as with previously received influenza vaccination (2019/2020: OR 17.1 (95%CI: 9.5–30.7), p<0.001; season 2016–2018: OR 8.9 (95%CI: 5.5–14.5), p<0.001). Most frequent reasons for not planning vaccination were fear of a) graft injury (33.3%), b) complications after vaccination (32.4%) and c) vaccine inefficiency (15.0%). Conclusion While influenza vaccination willingness in patients with CKLD is increasing in the 2020/2021 season, vaccination rates may still remain <50%. Novel co-operations with primary health care, active vaccination surveillance and financial reimbursement may substantially improve vaccination rates in high-risk CKLD patients.
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Affiliation(s)
- Michael Eder
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Haris Omic
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jana Gorges
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Florian Badt
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Zeljko Kikic
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - David Bauer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
| | - Georg Semmler
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
| | - Heimo Lagler
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
- * E-mail:
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17
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Gonzalez Suarez ML, Parker AS, Cheungpasitporn W. Pregnancy in Kidney Transplant Recipients. Adv Chronic Kidney Dis 2020; 27:486-498. [PMID: 33328065 DOI: 10.1053/j.ackd.2020.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 11/11/2022]
Abstract
Women with end-stage kidney disease commonly have difficulty conceiving through spontaneous pregnancy, and many suffer from infertility. Kidney transplantation restores the impairment in fertility and increases the possibility of pregnancy. In addition, the number of female kidney transplant recipients of reproductive age has been increasing. Thus, preconception counseling, contraceptive management, and family planning are of great importance in the routine care of this population. Pregnancy in kidney transplant recipients is complicated by underlying maternal comorbidities, kidney allograft function, the effect of pregnancy on the transplanted kidney, and the effect of the maternal health on the fetus, in addition to immunosuppressive medications and their potential teratogenesis. Given the potential maternal and fetal risks, and possible complications during pregnancy, pretransplant and prepregnancy counseling for women of reproductive age are crucial, including delivery of information regarding contraception and timing for pregnancy, fertility and pregnancy rates, the risk of immunosuppression on the fetus, the risk of kidney allograft, and other maternal complications. In this article, we discuss aspects related to pregnancy among kidney transplant recipients and their management.
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18
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An Analysis of Adherence to Vaccination Recommendations in a Thoracic Organ Transplant Cohort. Vaccines (Basel) 2020; 8:vaccines8040622. [PMID: 33105698 PMCID: PMC7712276 DOI: 10.3390/vaccines8040622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/15/2020] [Indexed: 01/12/2023] Open
Abstract
(1) Background: Vaccination of solid organ transplant (SOT) candidates and recipients is vital to decrease infection-related morbidity and mortality. Here we describe our heart and lung transplant programs’ rates of completion of hepatitis B and pneumococcal vaccinations and identify potential opportunities for improvement. (2) Methods: This is a single-center retrospective study that included all heart and lung transplant recipients between 1 July 2013 and 31 July 2018. We assessed demographics, causes of organ failure, pretransplant hepatitis B immune status, and completion rates for hepatitis B vaccine series, pneumococcal conjugate vaccine (PCV13), and pneumococcal polysaccharide vaccine (PPSV23). (3) Results: A total of 41 patients were included in the heart transplant cohort. Twelve (29.3%) had baseline hepatitis B immunity. Only 8/29 (27.6%) completed the entire 3-dose hepatitis B vaccination series pretransplant. Pretransplant PCV13 and PPSV23 vaccination rates were 58.5% (24/41) and 48.8% (20/41), respectively; no additional patients received PCV13 or PPSV23 post-transplant. In the heart transplant cohort, a majority (82.9%) of patients were evaluated by the Transplant Infectious Diseases consultative service (TxID) pretransplant, and this had a statistically significant association with increased pneumococcal vaccination rates (p = 0.0017, PCV13 and p = 0.0103, PPSV23). In total, 55 patients were included in the lung transplant cohort. Five (9.1%) had baseline hepatitis B immunity; 33/50 (66.0%) completed the hepatitis B vaccine series in the pretransplant setting. Pretransplant PCV13 and PPSV23 vaccination rate was 40.0% (22/55) and 69.1% (38/55), respectively. There was only a 47.3% and 72.3% completion rate overall in the post-transplant setting. (4) Conclusions: There continues to be a need for a comprehensive and coordinated effort to increase vaccine adherence for all SOT candidates in the pretransplant setting.
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19
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Hepatitis A hospitalizations among kidney transplant recipients in the United States: nationwide inpatient sample 2005-2014. Eur J Gastroenterol Hepatol 2020; 32:650-655. [PMID: 32267653 DOI: 10.1097/meg.0000000000001598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND This study aimed to evaluate the hospitalization rate for Hepatitis A virus (HAV) among kidney transplant (KTx) recipients and its outcomes as well as resource utilization. METHODS The 2005-2014 National Inpatient Sample database was used to identify all hospitalized KTx recipients with an associated diagnosis of HAV. The hospital mortality, resource utilization, and associated liver conditions were compared between patients with and without HAV, adjusting for potential confounders. RESULTS Of 871 024 KTx recipients identified, 204 had HAV. The overall inpatient prevalence of HAV in KTx recipients over 10 years in the United States was 23.42 cases per 100 000 admissions. There were no statistically significant changes in the inpatient prevalence of HAV in KTx recipients during the study period (P = 0.77), ranging from 9.2 to 34.3 per 100 000 admissions. Among hospitalized KTx recipients with HAV, 27.9% were from Northeast, 29.2% were from Midwest, 23.8% were from South, and 19.1% were from West. HAV was not significantly associated with increased hospital mortality, multiorgan failure, need for abdominal ultrasound, hospital length of stay, and total hospitalization costs and charges when compared with those without HAV. However, it is significantly associated with increased ICU stay, coexisting hepatitis B and C infection, and liver failure. CONCLUSION Overall, inpatient prevalence of HAV in KTx recipients in the United States (years 2005-2014) was 23.42 cases per 100 000 admissions. Hospitalization for HAV after KTx is associated with increased ICU stay, coexisting hepatitis B and C infection, and liver failure.
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Buchan CA, Kotton CN. Travel medicine, transplant tourism, and the solid organ transplant recipient-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13529. [PMID: 30859623 DOI: 10.1111/ctr.13529] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/26/2019] [Indexed: 12/13/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review recommendations for prevention and management of travel-related infection in solid organ transplant (SOT) recipients as well as risks associated with transplant tourism. Counseling regarding travel post-transplant should be included during the pre-transplant evaluation, and all SOT recipients should be seen by a travel medicine specialist prior to traveling to destinations with higher rates of infection. Patients should be advised on vaccine-preventable illnesses as well as any need for prophylaxis (ie, malaria) based on their individual travel itineraries. Information with regards to specific recommendations for vaccines and prophylactic medications, along with drug-drug interactions, is summarized. Counseling should be provided for modifiable risks and exposures (ie, food and water safety, and insect bite prevention) as well as non-infectious travel topics. These guidelines also briefly address risks associated with transplant tourism and specific infections to consider if patients seek care for transplants done in foreign countries.
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Affiliation(s)
- C Arianne Buchan
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,The University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Camille Nelson Kotton
- Transplant Infectious Disease and Compromised Host Program, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Travelers' Advice and Immunization Center, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
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21
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Pittet LF, Verolet CM, McLin VA, Wildhaber BE, Rodriguez M, Cherpillod P, Kaiser L, Siegrist CA, Posfay-Barbe KM. Multimodal safety assessment of measles-mumps-rubella vaccination after pediatric liver transplantation. Am J Transplant 2019; 19:844-854. [PMID: 30171797 DOI: 10.1111/ajt.15101] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/31/2018] [Accepted: 08/18/2018] [Indexed: 01/25/2023]
Abstract
Live-attenuated vaccines are currently contraindicated in solid-organ transplant recipients. However, the risk of vaccine-preventable infections is lifelong, and can be particularly severe after transplantation. In this prospective interventional national cohort study, 44 pediatric liver transplant recipients with measles IgG antibodies <150 IU/L (below seroprotection threshold) received measles-mumps-rubella vaccine (MMR) at a median of 6.3 years posttransplantation (interquartile range, 4.0 to 10.9). A maximum of two additional doses were administered in nonresponders or when seroprotection was lost. Vaccine responses occurred in 98% (95% confidence interval [CI], 88-100) of patients. Seroprotection at 1-, 2-, and 3-year follow-up reached 62% (95% CI, 45-78), 86% (95% CI, 70-95), and 89% (95% CI, 67-99), respectively. All patients responded appropriately to the booster dose(s). Vaccinations were well tolerated and no serious adverse event attributable to vaccination was identified during the 8-week follow-up period (or later), using a multimodal approach including standardized telephone interviews, diarized side effect reporting, and monitoring of vaccinal virus shedding. We conclude that live attenuated MMR vaccine can be administered in liver transplant recipients fulfilling specific eligibility criteria (>1 year posttransplantation, low immunosuppression, lymphocyte count ≥0.75 G/L), inducing seroprotection in most subjects. (Clinicaltrials.gov number NCT01770119).
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Affiliation(s)
- Laure F Pittet
- Department of Pediatrics, Division of General Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Charlotte M Verolet
- Department of Pediatrics, Division of General Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Valérie A McLin
- Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition Unit, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Barbara E Wildhaber
- Department of Pediatrics, University Center of Pediatric Surgery of Western Switzerland, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Maria Rodriguez
- Department of Pediatrics, Division of General Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Pascal Cherpillod
- Laboratory of Virology, Division of Infectious Diseases, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Laboratory of Virology, Division of Infectious Diseases, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Claire-Anne Siegrist
- Department of Pediatrics, Division of General Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Centre for Vaccinology, Departments of Pathology-Immunology and Pediatrics, University of Geneva, Geneva, Switzerland
| | - Klara M Posfay-Barbe
- Department of Pediatrics, Division of General Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Moura-Neto JA, Braga Silva CA, Moura AF, Rocco Suassuna JH. Emergent Arboviruses and Renal Transplantation: A Global Challenge. Kidney Int Rep 2019; 4:647-655. [PMID: 31080919 PMCID: PMC6506706 DOI: 10.1016/j.ekir.2019.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 12/23/2022] Open
Abstract
In recent years, Zika, Chikungunya, Dengue, West Nile Fever, and Yellow Fever epidemics have generated some concerns. Besides difficulties related to vector control, there are challenges related to behavior of pathologies not yet fully understood. The transplanted population requires additional care due to immunosuppressive drugs. Furthermore, the potential risk of transmission during donation is another source of uncertainty and generates debate among nephrologists in transplant centers. Do the clinical outcomes and prognoses of these infections tend to be more aggressive in this population? Is there a risk of viral transmission via kidney donation? In this review article, we address these issues and discuss the relationship between arbovirus and renal transplantation.
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Affiliation(s)
| | | | | | - José Hermógenes Rocco Suassuna
- Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Patel SY, Carbone J, Jolles S. The Expanding Field of Secondary Antibody Deficiency: Causes, Diagnosis, and Management. Front Immunol 2019; 10:33. [PMID: 30800120 PMCID: PMC6376447 DOI: 10.3389/fimmu.2019.00033] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/08/2019] [Indexed: 12/11/2022] Open
Abstract
Antibody deficiency or hypogammaglobulinemia can have primary or secondary etiologies. Primary antibody deficiency (PAD) is the result of intrinsic genetic defects, whereas secondary antibody deficiency may arise as a consequence of underlying conditions or medication use. On a global level, malnutrition, HIV, and malaria are major causes of secondary immunodeficiency. In this review we consider secondary antibody deficiency, for which common causes include hematological malignancies, such as chronic lymphocytic leukemia or multiple myeloma, and their treatment, protein-losing states, and side effects of a number of immunosuppressive agents and procedures involved in solid organ transplantation. Secondary antibody deficiency is not only much more common than PAD, but is also being increasingly recognized with the wider and more prolonged use of a growing list of agents targeting B cells. SAD may thus present to a broad range of specialties and is associated with an increased risk of infection. Early diagnosis and intervention is key to avoiding morbidity and mortality. Optimizing treatment requires careful clinical and laboratory assessment and may involve close monitoring of risk parameters, vaccination, antibiotic strategies, and in some patients, immunoglobulin replacement therapy (IgRT). This review discusses the rapidly evolving list of underlying causes of secondary antibody deficiency, specifically focusing on therapies targeting B cells, alongside recent advances in screening, biomarkers of risk for the development of secondary antibody deficiency, diagnosis, monitoring, and management.
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Affiliation(s)
- Smita Y. Patel
- Clinical Immunology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Javier Carbone
- Clinical Immunology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom
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24
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Arora S, Kipp G, Bhanot N, Sureshkumar KK. Vaccinations in kidney transplant recipients: Clearing the muddy waters. World J Transplant 2019; 9:1-13. [PMID: 30697516 PMCID: PMC6347668 DOI: 10.5500/wjt.v9.i1.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/13/2018] [Accepted: 01/01/2019] [Indexed: 02/05/2023] Open
Abstract
Vaccine preventable diseases account for a significant proportion of morbidity and mortality in transplant recipients and cause adverse outcomes to the patient and allograft. Patients should be screened for vaccination history at the time of pre-transplant evaluation and vaccinated at least four weeks prior to transplantation. For non-immune patients, dead-vaccines can be administered starting at six months post-transplant. Live attenuated vaccines are contraindicated after transplant due to concern for infectious complications from the vaccine and every effort should be made to vaccinate prior to transplant. Since transplant recipients are on life-long immunosuppression, these patients may have lower rates of serological conversion, lower mean antibody titers and waning of protective immunity over shorter period as compared to general population. Recommendations regarding booster dose in kidney transplant recipients with sub-optimal serological response are lacking. Travel plans should be part of routine post-transplant assessment and pre-travel vaccines and counseling should be provided. More studies are needed on vaccination schedules, serological response, need for booster doses and safety of live attenuated vaccines in this special population.
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Affiliation(s)
- Swati Arora
- Divisions of Nephrology and Hypertension, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA 15212, United States
| | - Gretchen Kipp
- Department of Pharmacy, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA 15212, United States
| | - Nitin Bhanot
- Infectious Diseases, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA 15212, United States
| | - Kalathil K Sureshkumar
- Divisions of Nephrology and Hypertension, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA 15212, United States
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Abstract
The heart transplant nurse coordinator plays a key role in educating and supporting the postoperative heart transplant patient to achieve the best outcomes for a long and healthy life. The time leading up to transplantation, wait-list candidates will hear vital information regarding life after they have received their life-sustaining heart transplant. Unfortunately, at times, the information is minimally retained. The first few days to weeks following surgery are a crucial period of time for education of patients to be discharged from the hospital setting to home where they will need to care for themselves independently. Education must be clear and concise and encompass patients' health involving their allograft heart and their body as a whole. The coordinator looks to the critical care nurse at the bedside to help teach and reiterate information to the patient in this critical period of time.
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Gunawansa N, Rathore R, Sharma A, Halawa A. Vaccination practices in End Stage Renal Failure and Renal Transplantation; Review of current guidelines and recommendations. World J Transplant 2018; 8:68-74. [PMID: 29988933 PMCID: PMC6033742 DOI: 10.5500/wjt.v8.i3.68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/02/2018] [Accepted: 03/13/2018] [Indexed: 02/05/2023] Open
Abstract
Due to the increased burden of infectious complications following solid organ transplantation, vaccination against common pathogens is a hugely important area of discussion and application in clinical practice. Reduction in infectious complications will help to reduce morbidity and mortality post-transplantation. Immunisation history is invaluable in the work-up of potential recipients. Knowledge of the available vaccines and their use in transplant recipients, donors and healthcare providers is vital in the delivery of quality care to transplant recipients. This article will serve as an aide-memoire to transplant physicians and health care professionals involved in managing transplant recipients as it provides an overview of different types of vaccines, timing of vaccination, vaccines contraindicated post solid organ transplantation and travel vaccines.
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Affiliation(s)
- Nalaka Gunawansa
- National Institute of Nephrology Dialysis and Transplantation, Sri Lanka and Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool 111, United Kingdom
| | - Roshni Rathore
- Department of Renal, University Hospitals of Coventry and Warwickshire and Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool 111, United Kingdom
| | - Ajay Sharma
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool and Royal Liverpool University Hospital, Liverpool 111, United Kingdom
| | - Ahmed Halawa
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool and Royal Liverpool University Hospital, Liverpool 111, United Kingdom
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Miller-Handley H, Paulsen G, Hooper DK, Lake M, Lazear D, Danziger-Isakov L. Durability of the hepatitis B vaccination in pediatric renal transplant recipients. Clin Transplant 2018; 32:e13247. [DOI: 10.1111/ctr.13247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Hilary Miller-Handley
- Department of Internal Medicine; Pediatrics at University of Cincinnati and Cincinnati Children's Hospital; Cincinnati OH USA
- Division of Pediatric Infection Disease; Cincinnati Children's Hospital; Cincinnati OH USA
| | - Grant Paulsen
- Division of Pediatric Infection Disease; Cincinnati Children's Hospital; Cincinnati OH USA
| | - David K. Hooper
- Division of Nephrology; Cincinnati Children's Hospital; Cincinnati OH USA
| | - Michael Lake
- Division of Pharmacy; Cincinnati Children's Hospital; Cincinnati OH USA
| | - Danielle Lazear
- Division of Pharmacy; Cincinnati Children's Hospital; Cincinnati OH USA
| | - Lara Danziger-Isakov
- Division of Pediatric Infection Disease; Cincinnati Children's Hospital; Cincinnati OH USA
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Adjuvanted (AS03) A/H1N1 2009 Pandemic Influenza Vaccines and Solid Organ Transplant Rejection: Systematic Signal Evaluation and Lessons Learnt. Drug Saf 2018; 40:693-702. [PMID: 28417321 PMCID: PMC5519647 DOI: 10.1007/s40264-017-0532-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction We investigated a signal of solid organ transplant (SOT) rejection after immunisation with (AS03) A/H1N1 2009 pandemic influenza vaccines. Methods Potential immunological mechanisms were reviewed and quantitative analyses were conducted. The feasibility of pharmacoepidemiological studies was explored. Results Overall results, including data from a pharmacoepidemiological study, support the safety of adjuvanted (AS03) pandemic influenza vaccination in SOT recipients. The regulatory commitment to evaluate the signal through a stepwise investigation was closed in 2014. Conclusion Lessons learned highlight the importance of investigating plausible biological mechanisms between vaccines and potentially associated adverse outcomes, and the importance of selecting appropriate study settings and designs for safety signal investigations. Electronic supplementary material The online version of this article (doi:10.1007/s40264-017-0532-3) contains supplementary material, which is available to authorized users.
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29
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van Kessel DA, Hoffman TW, Kwakkel-van Erp JM, Oudijk EJD, Zanen P, Rijkers GT, Grutters JC. Long-term Follow-up of Humoral Immune Status in Adult Lung Transplant Recipients. Transplantation 2017; 101:2477-2483. [PMID: 28198768 DOI: 10.1097/tp.0000000000001685] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lung transplant recipients have an increased risk for infections in the posttransplant period due to immunosuppressive therapy. Protection against infections can be achieved through vaccination, but the optimal vaccination schedule in lung transplant recipients is unknown. Data on long-term immunological follow up and vaccination responses after lung transplantation are scarce. METHODS Here we present long-term immunological follow up of a cohort of 55 lung transplant recipients. This includes detailed antibody responses after 23-valent pneumococcal polysaccharide vaccination (23vPPV). RESULTS All patients were vaccinated with 23vPPV before transplantation. Median follow-up after transplantation was 6.6 years (379 patient-years). After transplantation, there is a significant decrease of all immunoglobulins, IgG subclasses and pneumococcal polysaccharide antibodies. After the first year posttransplantation, there is a gradual increase of all immunoglobulins and IgG subclasses, but values were always significantly lower than in the pretransplant period. After a median of 4.4 years posttransplantation, patients were revaccinated with 23vPPV. The pneumococcal polysaccharide antibody response was impaired in 87% of patients (ie, antibody titer above cutoff and twofold increase between pre and postvaccination values for <70% of serotypes). CONCLUSIONS We found that impairment of humoral immunity was most outspoken in the first year after lung transplantation. Immunoglobulin levels remain decreased several years after transplantation and the response to pneumococcal polysaccharide vaccine was significantly lower posttransplantation compared to the pretransplantation response. However, most patients did show a partial response to vaccination. Based on our results, revaccination with pneumococcal vaccines after transplantation should be considered 1 year after transplantation.
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Affiliation(s)
- Diana A van Kessel
- 1 Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands. 2 Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands. 3 Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands. 4 Department of Science, University College Roosevelt, Middelburg, The Netherlands
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A Comprehensive Review of Immunization Practices in Solid Organ Transplant and Hematopoietic Stem Cell Transplant Recipients. Clin Ther 2017; 39:1581-1598. [DOI: 10.1016/j.clinthera.2017.07.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 01/16/2023]
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Samuelson DR, Charles TP, de la Rua NM, Taylor CM, Blanchard EE, Luo M, Shellito JE, Welsh DA. Analysis of the intestinal microbial community and inferred functional capacities during the host response to Pneumocystis pneumonia. Exp Lung Res 2016; 42:425-439. [PMID: 27925857 PMCID: PMC5304582 DOI: 10.1080/01902148.2016.1258442] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/04/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pneumocystis pneumonia is a major cause of morbidity and mortality in patients infected with HIV/AIDS. In this study, we evaluated the intestinal microbial communities associated with the development of experimental Pneumocystis pneumonia, as there is growing evidence that the intestinal microbiota is critical for host defense against fungal pathogens. METHODS C57BL/6 mice were infected with live Pneumocystis murina (P. murina) via intratracheal inoculation and sacrificed 7 and 14 days postinfection for microbiota analysis. In addition, we evaluated the intestinal microbiota from CD4+ T cell depleted mice infected with P. murina. RESULTS We found that the diversity of the intestinal microbial community was significantly altered by respiratory infection with P. murina. Specifically, mice infected with P. murina had altered microbial populations, as judged by changes in diversity metrics and relative taxa abundances. We also found that CD4+ T cell depleted mice infected with P. murina exhibited significantly altered intestinal microbiota that was distinct from immunocompetent mice infected with P. murina, suggesting that loss of CD4+ T cells may also affects the intestinal microbiota in the setting of Pneumocystis pneumonia. Finally, we employed a predictive metagenomics approach to evaluate various microbial features. We found that Pneumocystis pneumonia significantly alters the intestinal microbiota's inferred functional potential for carbohydrate, energy, and xenobiotic metabolism, as well as signal transduction pathways. CONCLUSIONS Our study provides insight into specific-microbial clades and inferred microbial functional pathways associated with Pneumocystis pneumonia. Our data also suggest a role for the gut-lung axis in host defense in the lung.
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Affiliation(s)
- Derrick R. Samuelson
- Department of Medicine, Section of Pulmonary/Critical Care & Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA, 70112
| | - Tysheena P. Charles
- Department of Medicine, Section of Pulmonary/Critical Care & Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA, 70112
| | - Nicholas M. de la Rua
- Department of Medicine, Section of Pulmonary/Critical Care & Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA, 70112
| | - Christopher M. Taylor
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA, 70112
| | - Eugene E. Blanchard
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA, 70112
| | - Meng Luo
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA, 70112
| | - Judd E. Shellito
- Department of Medicine, Section of Pulmonary/Critical Care & Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA, 70112
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA, 70112
| | - David A. Welsh
- Department of Medicine, Section of Pulmonary/Critical Care & Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA, 70112
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA, 70112
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Abstract
Infections and malignancies are the expected complications of immunosuppressive therapy, which non-specifically impairs cellular and humoral immune responses in renal transplant recipients. Infections were usually frequent and severe during the early post-transplant period (first year). Recent diagnostic methods (molecular biology) and availability of new antivirals, antifungal and antibiotic drugs made rapid diagnosis and systematic preventive strategies much easier and this resulted in a significant reduction of infections and infectious death in this population. However, new infectious agents like BK polyomavirus, hepatitis E virus, parvovirus (as well as Chigunkunya, West Nile and others in particular areas) were recently recognized as responsible of aggressive infections in the immunocompromised host. Malignancies are also common after transplantation, due to the intensity and duration of immunosuppression. Skin cancers and lymphoproliferative disorders are the most common and are undoubtedly caused by viral infections, but incidence of non-skin cancers is also increased. After reduction of immunosuppression, treatment is similar to non-transplant patients: Results are usually poor and cancer is now the third cause of death in transplant recipients. Due to their anti-proliferative and anti-tumoral properties, incidence of de novo cancer significantly decreased in patients receiving mTor inhibitors as maintenance immunosuppression; furthermore, in patients already diagnosed with Kaposi sarcoma or recurrent skin cancers, introduction of mTor was associated with stabilisation and/or regression of malignant lesions.
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Rocca S, Santilli V, Cotugno N, Concato C, Manno EC, Nocentini G, Macchiarulo G, Cancrini C, Finocchi A, Guzzo I, Dello Strologo L, Palma P. Waning of vaccine-induced immunity to measles in kidney transplanted children. Medicine (Baltimore) 2016; 95:e4738. [PMID: 27631222 PMCID: PMC5402565 DOI: 10.1097/md.0000000000004738] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Vaccine-preventable diseases are a significant cause of morbidity and mortality in solid organ transplant recipients who undergo immunosuppression after transplantation. Data on immune responses and long-term maintenance after vaccinations in such population are still limited.We cross-sectionally evaluated the maintenance of immune response to measles vaccine in kidney transplanted children on immunosuppressive therapy. Measles-specific enzyme-linked immunosorbent assay and B-cell enzyme-linked immunosorbent spot were performed in 74 kidney transplant patients (Tps) and in 23 healthy controls (HCs) previously vaccinated and tested for humoral protection against measles. The quality of measles antibody response was measured by avidity test. B-cell phenotype, investigated via flow cytometry, was further correlated to the ability of Tps to maintain protective humoral responses to measles over time.We observed the loss of vaccine-induced immunity against measles in 19% of Tps. Nonseroprotected children showed signs of impaired B-cell distribution as well as immune senescence and lower antibody avidity. We further reported as time elapsed between vaccination and transplantation, as well as the vaccine administration during dialysis are clinical factors affecting the maintenance of the immune memory response against measles.Tps present both quantitative and qualitative alterations in the maintenance of protective immunity to measles vaccine. Prospective studies are needed to optimize the vaccination schedules in kidney transplant recipients in order to increase the immunization coverage over time in this population.
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Affiliation(s)
| | - Veronica Santilli
- Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital-Research Institute (IRCCS)
| | - Nicola Cotugno
- Department of Public Health, University of Rome Tor Vergata
- Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital-Research Institute (IRCCS)
| | - Carlo Concato
- Virology Unit, Bambino Gesù Children's Hospital-Research Institute (IRCCS)
| | - Emma Concetta Manno
- Department of Public Health, University of Rome Tor Vergata
- Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital-Research Institute (IRCCS)
| | | | - Giulia Macchiarulo
- Department of Public Health, University of Rome Tor Vergata
- Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital-Research Institute (IRCCS)
| | - Caterina Cancrini
- Department of Public Health, University of Rome Tor Vergata
- Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital-Research Institute (IRCCS)
| | - Andrea Finocchi
- Department of Public Health, University of Rome Tor Vergata
- Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital-Research Institute (IRCCS)
| | - Isabella Guzzo
- Nephrology Unit, Bambino Gesù Children's Hospital-Research Institute (IRCCS)
| | - Luca Dello Strologo
- Nephrology Unit, Bambino Gesù Children's Hospital-Research Institute (IRCCS)
| | - Paolo Palma
- Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital-Research Institute (IRCCS)
- Research Unit in Congenital and Perinatal Infections, Bambino Gesù Children's Hospital-Research Institute (IRCCS), Rome, Italy
- Correspondence: Paolo Palma, Bambino Gesù Children's Hospital-Research Institute (IRCCS), Piazza Sant’Onofrio, 4, 00146 Rome, Italy (e-mail: )
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Dedeoglu B, Meijers RWJ, Klepper M, Hesselink DA, Baan CC, Litjens NHR, Betjes MGH. Uremia-Associated Premature Aging of T Cells Does Not Predict Infectious Complications After Renal Transplantation. Am J Transplant 2016; 16:2324-33. [PMID: 26914971 DOI: 10.1111/ajt.13759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 01/26/2016] [Accepted: 02/13/2016] [Indexed: 01/25/2023]
Abstract
Patients with end-stage renal disease have prematurely aged T cell systems. We tested whether T cell aging parameters were associated with the risk of infections after renal transplantation (RTx). We studied 188 patients over 1 year. Peripheral T cells were analyzed before and at 3 and 6 mo after RTx for frequency of recent thymic emigrants, relative telomere length and differentiation status. These parameters were related to the occurrence of opportunistic and serious infections. Overall, 84 patients developed an infection. In this group, 50 developed an opportunistic infection and 53 developed a serious infection. T cell aging parameters assessed before RTx were not associated with infection risk. The memory T cells showed a decrease within the first 3 mo in both groups (p < 0.001). The CD4(+) memory T cells increased between 3 and 6 mo within the infection group (p = 0.015). The number of CD8(+) memory T cells increased in both groups (p < 0.001) but reached baseline levels only in the infection group. In the infection group, the CD8(+) CD28(null) T cell percentage increased between 3 and 6 mo (p = 0.024), tending to be higher than at baseline (p = 0.061). These differences in post-RTx dynamics resulted from infections. Parameters of uremia-associated premature aging of peripheral T cells do not predict posttransplant infections.
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Affiliation(s)
- B Dedeoglu
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - R W J Meijers
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - M Klepper
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - D A Hesselink
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - C C Baan
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - N H R Litjens
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - M G H Betjes
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
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Randomized Controlled Trial of Adjuvanted Versus Nonadjuvanted Influenza Vaccine in Kidney Transplant Recipients. Transplantation 2016; 100:662-9. [PMID: 26335915 DOI: 10.1097/tp.0000000000000861] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Influenza vaccine containing an oil-in-water emulsion adjuvant (MF-59) may lead to greater immunogenicity in organ transplant recipients. However, alloimmunization may be a concern with adjuvanted vaccines. METHODS We conducted a randomized trial comparing the safety and immunogenicity of adjuvanted versus nonadjuvanted influenza vaccine in adult kidney transplant patients. Patients were randomized 1:1 to receive 2012 to 2013 influenza vaccine with or without MF59 adjuvant. Preimmunization and postimmunization sera underwent strain-specific hemagglutination inhibition assay. HLA alloantibody was determined by Luminex single-antigen bead assay. RESULTS We randomized 68 patients and 60 (29 nonadjuvanted; 31 adjuvanted) had complete samples available at follow-up. Seroconversion to at least 1 of 3 influenza antigens was present in 71.0% versus 55.2% in adjuvanted versus nonadjuvanted vaccine respectively (P = 0.21). Geometric mean titers and seroprotection rates were similar between groups. Seroconversion rates were especially low in those on MMF of 2 g or greater daily (44.4% vs 71.4%; P = 0.047). In the subgroup of patients 18 to 64 years old, seroconversion was significantly greater with adjuvanted vaccine (odds ratio, 6.10; 95% confidence interval, 1.25-28.6). There were no increases in HLA alloantibodies in patients who received adjuvanted vaccine. CONCLUSIONS Adjuvanted vaccine was safe and had similar immunogenicity to standard vaccine in the overall transplant cohort but did show a potential immunogenicity benefit for the 18 to 64 years age group.
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Trubiano JA, Johnson D, Sohail A, Torresi J. Travel vaccination recommendations and endemic infection risks in solid organ transplantation recipients. J Travel Med 2016; 23:taw058. [PMID: 27625399 DOI: 10.1093/jtm/taw058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/25/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are often heavily immunosuppressed and consequently at risk of serious illness from vaccine preventable viral and bacterial infections or with endemic fungal and parasitic infections. We review the literature to provide guidance regarding the timing and appropriateness of vaccination and pathogen avoidance related to the immunological status of SOT recipients. METHODS A PUBMED search ([Vaccination OR vaccine] AND/OR ["specific vaccine"] AND/OR [immunology OR immune response OR cytokine OR T lymphocyte] AND transplant was performed. A review of the literature was performed in order to develop recommendations on vaccination for SOT recipients travelling to high-risk destinations. RESULTS Whilst immunological failure of vaccination in SOT is primarily the result of impaired B-cell responses, the role of T-cells in vaccine failure and success remains unknown. Vaccination should be initiated at least 4 weeks prior to SOT or more than 6 months post-SOT. Avoidance of live vaccination is generally recommended, although some live vaccines may be considered in the specific situations (e.g. yellow fever). The practicing physician requires a detailed understanding of region-specific endemic pathogen risks. CONCLUSIONS We provide a vaccination and endemic pathogen guide for physicians and travel clinics involved in the care of SOT recipients. In addition, recommendations based on timing of anticipated immunological recovery and available evidence regarding vaccine immunogenicity in SOT recipients are provided to help guide pre-travel consultations.
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Affiliation(s)
- Jason A Trubiano
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Department of Infectious Diseases, Peter MaCallum Cancer Centre, Melbourne, VIC, Australia Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Douglas Johnson
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Department of Medicine, University of Melbourne, Parkville, VIC, Australia Department of General Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Asma Sohail
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia
| | - Joseph Torresi
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia Eastern Infectious Diseases and Travel medicine, Knox Private Hospital, Boronia, VIC, Australia
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Guidelines for vaccination in kidney transplant recipients. Indian J Nephrol 2016. [PMCID: PMC4928525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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38
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Samuelson DR, de la Rua NM, Charles TP, Ruan S, Taylor CM, Blanchard EE, Luo M, Ramsay AJ, Shellito JE, Welsh DA. Oral Immunization of Mice with Live Pneumocystis murina Protects against Pneumocystis Pneumonia. THE JOURNAL OF IMMUNOLOGY 2016; 196:2655-65. [PMID: 26864029 DOI: 10.4049/jimmunol.1502004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/06/2016] [Indexed: 01/01/2023]
Abstract
Pneumocystis pneumonia is a major cause of morbidity and mortality in immunocompromised patients, particularly those infected with HIV. In this study, we evaluated the potential of oral immunization with live Pneumocystis to elicit protection against respiratory infection with Pneumocystis murina. C57BL/6 mice vaccinated with live P. murina using a prime-boost vaccination strategy were protected from a subsequent lung challenge with P. murina at 2, 7, 14, and 28 d postinfection even after CD4(+) T cell depletion. Specifically, vaccinated immunocompetent mice had significantly faster clearance than unvaccinated immunocompetent mice and unvaccinated CD4-depleted mice remained persistently infected with P. murina. Vaccination also increased numbers of CD4(+) T cells, CD8(+) T cells, CD19(+) B cells, and CD11b(+) macrophages in the lungs following respiratory infection. In addition, levels of lung, serum, and fecal P. murina-specific IgG and IgA were increased in vaccinated animals. Furthermore, administration of serum from vaccinated mice significantly reduced Pneumocystis lung burden in infected animals compared with control serum. We also found that the diversity of the intestinal microbial community was altered by oral immunization with P. murina. To our knowledge, our data demonstrate for the first time that an oral vaccination strategy prevents Pneumocystis infection.
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Affiliation(s)
- Derrick R Samuelson
- Section of Pulmonary/Critical Care and Allergy/Immunology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112
| | - Nicholas M de la Rua
- Section of Pulmonary/Critical Care and Allergy/Immunology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112
| | - Tysheena P Charles
- Section of Pulmonary/Critical Care and Allergy/Immunology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112
| | - Sanbao Ruan
- Section of Pulmonary/Critical Care and Allergy/Immunology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112
| | - Christopher M Taylor
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA 70112; and
| | - Eugene E Blanchard
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA 70112; and
| | - Meng Luo
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA 70112; and
| | - Alistair J Ramsay
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA 70112; and Louisiana Vaccine Center, Louisiana State University Health Sciences Center, New Orleans, LA 70112
| | - Judd E Shellito
- Section of Pulmonary/Critical Care and Allergy/Immunology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112; Louisiana Vaccine Center, Louisiana State University Health Sciences Center, New Orleans, LA 70112
| | - David A Welsh
- Section of Pulmonary/Critical Care and Allergy/Immunology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112;
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Streblow DN, Hwee YK, Kreklywich CN, Andoh T, Denton M, Smith P, Hart E, Broekel R, Pallett C, Rogers K, Streblow AD, Chuop M, Perry A, Slifka M, Messaoudi I, Orloff SL. Rat Cytomegalovirus Vaccine Prevents Accelerated Chronic Rejection in CMV-Naïve Recipients of Infected Donor Allograft Hearts. Am J Transplant 2015; 15:1805-16. [PMID: 25766876 PMCID: PMC5006870 DOI: 10.1111/ajt.13188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 11/26/2014] [Accepted: 12/14/2014] [Indexed: 01/25/2023]
Abstract
Cytomegalovirus accelerates transplant vascular sclerosis (TVS) and chronic rejection (CR) in solid organ transplants; however, the mechanisms involved are unclear. We determined the efficacy of a CMV vaccine in preventing CMV-accelerated rat cardiac allograft rejection in naïve recipients of CMV+ donor hearts. F344 donor rats were infected with RCMV 5 days prior to heterotopic cardiac transplantation into CMV-naïve or H2 O2 -inactivated RCMV-vaccinated Lewis recipients. Recipients of RCMV-infected donor hearts rejected at POD59, whereas vaccinated recipients exhibited a significantly prolonged time to rejection-POD97, similar to recipients of uninfected donor hearts (POD108). Although all of the donor hearts were preinfected, the vaccinated recipients had lower graft and PBMC viral loads at POD 7 compared to unvaccinated controls. Adoptive T cell and passive antibody transfers from vaccinated Lewis rats into naïve recipients demonstrate that both T-cell and B-cell arms of the adaptive immune response provide protection against CMV-accelerated rejection. Similar findings were obtained when testing three different adjuvants in passive transfer experiments. We have determined that the timing of the vaccine prior to transplantation and the specific adjuvant play critical roles in mediating anti-viral responses and promoting graft survival. CMV vaccination prior to transplantation may effectively increase graft survival.
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Affiliation(s)
- D. N. Streblow
- Department of Molecular Microbiology and ImmunologyOregon Health Sciences UniversityPortlandOR,The Vaccine and Gene Therapy InstituteOregon Health Sciences UniversityBeavertonOR
| | - Y. K. Hwee
- Department of SurgeryOregon Health Sciences UniversityPortlandOR
| | - C. N. Kreklywich
- The Vaccine and Gene Therapy InstituteOregon Health Sciences UniversityBeavertonOR,Department of SurgeryOregon Health Sciences UniversityPortlandOR
| | - T. Andoh
- Department of SurgeryOregon Health Sciences UniversityPortlandOR,Portland Veterans Affairs Medical CenterPortlandOR
| | - M. Denton
- The Vaccine and Gene Therapy InstituteOregon Health Sciences UniversityBeavertonOR
| | - P. Smith
- The Vaccine and Gene Therapy InstituteOregon Health Sciences UniversityBeavertonOR
| | - E. Hart
- The Vaccine and Gene Therapy InstituteOregon Health Sciences UniversityBeavertonOR
| | - R. Broekel
- The Vaccine and Gene Therapy InstituteOregon Health Sciences UniversityBeavertonOR
| | - C. Pallett
- The Vaccine and Gene Therapy InstituteOregon Health Sciences UniversityBeavertonOR
| | - K. Rogers
- The Vaccine and Gene Therapy InstituteOregon Health Sciences UniversityBeavertonOR
| | - A. D. Streblow
- The Vaccine and Gene Therapy InstituteOregon Health Sciences UniversityBeavertonOR
| | - M. Chuop
- The Vaccine and Gene Therapy InstituteOregon Health Sciences UniversityBeavertonOR
| | - A. Perry
- Department of Molecular Microbiology and ImmunologyOregon Health Sciences UniversityPortlandOR
| | - M. Slifka
- Department of Molecular Microbiology and ImmunologyOregon Health Sciences UniversityPortlandOR,Division of NeuroscienceOregon National Primate Research CenterBeavertonOR
| | - I. Messaoudi
- Division of Biomedical SciencesSchool of MedicineUniversity of California‐RiversideRiversideCA
| | - S. L. Orloff
- Department of Molecular Microbiology and ImmunologyOregon Health Sciences UniversityPortlandOR,Department of SurgeryOregon Health Sciences UniversityPortlandOR,Portland Veterans Affairs Medical CenterPortlandOR
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40
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Fischer ASL, Møller BK, Krag S, Jespersen B. Influenza virus vaccination and kidney graft rejection: causality or coincidence. Clin Kidney J 2015; 8:325-8. [PMID: 26034595 PMCID: PMC4440474 DOI: 10.1093/ckj/sfv027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 04/09/2015] [Indexed: 11/14/2022] Open
Abstract
Influenza can cause significant morbidity and mortality in renal transplant recipients especially with a high rate of lower respiratory disease. Annual influenza vaccination is therefore recommended to renal transplant recipients. We report the first three cases of acute kidney injury in renal transplant recipients following influenza vaccination that all led to graft loss. They all had different native diseases and were all vaccinated in the same season of 2009-10. The time span from vaccination to decline of kidney function is shorter than the time to diagnosis since the three patients only had blood tests every 3 months or when symptoms became severe. These reports do not justify a change of current recommendations regarding influenza vaccination in renal transplant recipients, but they support the continued attention and registration of vaccinations to monitor side effects.
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Affiliation(s)
| | - Bjarne Kuno Møller
- Department of Clinical Immunology , Aarhus University Hospital, Skejby , Aarhus N DK-8200 , Denmark
| | - Søren Krag
- Department of Pathology , Aarhus University Hospital , Aarhus N DK-8200 , Denmark
| | - Bente Jespersen
- Department of Nephrology , Aarhus University Hospital, Skejby , Århus N DK-8200 , Denmark
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41
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Abstract
BACKGROUND Optimal hepatitis B (HBV) vaccination strategies for lung transplantation (LT) candidates are not well established. METHODS LT candidates with negative anti-HBs and anti-HBc antibody titers at baseline who received standard-dose HBV vaccination (Recombivax-HB 10 mcg/mL or Engerix-B 20 mcg/mL) administered at months 0, 1, and 6 or an accelerated vaccination schedule on days 0, 7 to 14, and 21 to 28 between June 1988 and October 2012 were studied. Patients who were more likely to undergo LT within 6 months of evaluation received the accelerated vaccination schedule starting in August 2009. RESULTS Ninety-six HBV-seronegative patients who completed the vaccination series and had postvaccination anti-HBs titers available were identified. Median age was 60 years; 55.2% were female, and 92.7% were white. Underlying lung diseases included COPD (44.8%), idiopathic pulmonary fibrosis (22.9%), interstitial lung disease (15.6%), and cystic fibrosis (8.3%). The overall anti-HBs response rate was 54.2%. There was no significant difference in vaccine responses between accelerated and standard vaccination schedules (54.2% vs. 54.1%; P=1.0). Patients who received steroids or other immunosuppressants before transplantation had lower response rates compared with those who did not (38.9% vs. 63.3%; P=0.03). CONCLUSIONS Better vaccination strategies to improve response rate are needed in this population. The accelerated HBV vaccination schedule elicited similar anti-HBs responses as the standard schedule and could be advantageous in this population, given current organ allocation practices, and it could allow repeat vaccination series for initial nonresponders before transplantation.
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42
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Shao M, Wan Q, Xie W, Ye Q. Bloodstream infections among solid organ transplant recipients: Epidemiology, microbiology, associated risk factors for morbility and mortality. Transplant Rev (Orlando) 2014; 28:176-81. [PMID: 24630890 DOI: 10.1016/j.trre.2014.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/26/2013] [Accepted: 02/09/2014] [Indexed: 12/15/2022]
Abstract
Bloodstream infections (BSIs) remain important causes of morbidity and mortality among solid organ transplant (SOT) recipients and still threaten the success of SOT. In general, among SOT recipients, risk factors for BSIs are associated with prior ICU admission, catheterization, older recipient or donor age…etc. Pulmonary focus, nosocomial source of BSIs, lack of appropriate antibiotic therapy and other variables have significant impacts on BSIs-related mortality in SOT. Most of BSIs in SOT are caused by gram-negative bacteria. However, all aspects including microbiological spectrum, morbidity and mortality rates, risk factors of BSIs and BSIs-related death depend on the type of transplantation. The purpose of this review is to summarize the epidemiology, microbiologic features including antimicrobial resistance of organisms, and associated risk factors for morbidity and mortality of BSIs according to different type of transplantation to better understand the characteristics of BSIs and improve the outcomes after SOT.
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Abstract
Many transplant recipients are not protected against vaccine-preventable illnesses, primarily because vaccination is still an underutilized tool both before and after transplantation. This missed opportunity for protection can result in substantial morbidity, graft loss and mortality. Immunization strategies should be formulated early in the course of renal disease to maximize the likelihood of vaccine-induced immunity, particularly as booster or secondary antibody responses are less affected by immune compromise than are primary or de novo antibody responses in naive vaccine recipients. However, live vaccines should be avoided in immunocompromised hosts. Although some concern has been raised regarding increased HLA sensitization after vaccination, no clinical data to suggest harm currently exists; overall, non-live vaccines seem to be immunogenic, protective and safe. In organ transplant recipients, some vaccines are indicated based on specific risk factors and certain vaccines, such as hepatitis B, can protect against donor-derived infection. Vaccines given to close contacts of renal transplant recipients can provide an additional layer of protection against infectious diseases. In this article, optimal vaccination of adult transplant recipients, including safety, efficacy, indication and timing, is reviewed.
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44
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Debbink K, Lindesmith LC, Baric RS. The state of norovirus vaccines. Clin Infect Dis 2014; 58:1746-52. [PMID: 24585561 PMCID: PMC4036685 DOI: 10.1093/cid/ciu120] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/20/2014] [Indexed: 01/10/2023] Open
Abstract
Noroviruses represent the most important cause of acute gastroenteritis worldwide; however, currently no licensed vaccine exists. Widespread vaccination that minimizes overall norovirus disease burden would benefit the entire population, but targeted vaccination of specific populations such as healthcare workers may further mitigate the risk of severe disease and death in vulnerable populations. While a few obstacles hinder the rapid development of efficacious vaccines, human trials for virus-like particle (VLP)-based vaccines show promise in both immune response and protection studies, with availability of vaccines being targeted over the next 5-10 years. Ongoing work including identification of important norovirus capsid antigenic sites, development of improved model systems, and continued studies in humans will allow improvement of future vaccines. In the meantime, a better understanding of norovirus disease course and transmission patterns can aid healthcare workers as they take steps to protect high-risk populations such as the elderly and immunocompromised individuals from chronic and severe disease.
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Affiliation(s)
| | - Lisa C Lindesmith
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Ralph S Baric
- Department of Microbiology and Immunology Department of Epidemiology, University of North Carolina, Chapel Hill
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Fagiuoli S, Colli A, Bruno R, Craxì A, Gaeta GB, Grossi P, Mondelli MU, Puoti M, Sagnelli E, Stefani S, Toniutto P, Burra P. Management of infections pre- and post-liver transplantation: report of an AISF consensus conference. J Hepatol 2014; 60:1075-89. [PMID: 24384327 DOI: 10.1016/j.jhep.2013.12.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 02/06/2023]
Abstract
The burden of infectious diseases both before and after liver transplantation is clearly attributable to the dysfunction of defensive mechanisms of the host, both as a result of cirrhosis, as well as the use of immunosuppressive agents. The present document represents the recommendations of an expert panel commended by the Italian Association for the Study of the Liver (AISF), on the prevention and management of infectious complications excluding hepatitis B, D, C, and HIV in the setting of liver transplantation. Due to a decreased response to vaccinations in cirrhosis as well as within the first six months after transplantation, the best timing for immunization is likely before transplant and early in the course of disease. Before transplantation, a vaccination panel including inactivated as well as live attenuated vaccines is recommended, while oral polio vaccine, Calmette-Guerin's bacillus, and Smallpox are contraindicated, whereas after transplantation, live attenuated vaccines are contraindicated. Before transplant, screening protocols should be divided into different levels according to the likelihood of infection, in order to reduce costs for the National Health Service. Recommended preoperative and postoperative prophylaxis varies according to the pathologic agent to which it is directed (bacterial vs. viral vs. fungal). Timing after transplantation greatly determines the most likely agent involved in post-transplant infections, and specific high-risk categories of patients have been identified that warrant closer surveillance. Clearly, specifically targeted treatment protocols are needed upon diagnosis of infections in both the pre- as well as the post-transplant scenarios, not without considering local microbiology and resistance patterns.
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Affiliation(s)
- Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | | | - Raffaele Bruno
- Department of Infectious Diseases, IRCCS San Matteo, University of Pavia, Pavia, Italy
| | - Antonio Craxì
- Gastroenterology and Hepatology, Di.Bi.M.I.S., University of Palermo, Italy
| | - Giovanni Battista Gaeta
- Infectious Diseases, Department of Internal and Experimental Medicine, Second University of Naples, Italy
| | - Paolo Grossi
- Infectious & Tropical Diseases Unit, Department of Surgical & Morphological Sciences, Insubria University, Varese, Italy
| | - Mario U Mondelli
- Research Laboratories, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Italy
| | - Massimo Puoti
- Infectious Diseases Department, Niguarda Cà Granda Hospital, Milano, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Preventive Medicine, Second University of Naples, Italy
| | - Stefania Stefani
- Department of Bio-Medical Sciences, Section of Microbiology, University of Catania, Italy
| | - Pierluigi Toniutto
- Department of Medical Sciences, Experimental and Clinical, Medical Liver Transplant Section, Internal Medicine, University of Udine, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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Protective vaccination against papillomavirus-induced skin tumors under immunocompetent and immunosuppressive conditions: a preclinical study using a natural outbred animal model. PLoS Pathog 2014; 10:e1003924. [PMID: 24586150 PMCID: PMC3930562 DOI: 10.1371/journal.ppat.1003924] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 12/27/2013] [Indexed: 11/19/2022] Open
Abstract
Certain cutaneous human papillomaviruses (HPVs), which are ubiquitous and acquired early during childhood, can cause a variety of skin tumors and are likely involved in the development of non-melanoma skin cancer, especially in immunosuppressed patients. Hence, the burden of these clinical manifestations demands for a prophylactic approach. To evaluate whether protective efficacy of a vaccine is potentially translatable to patients, we used the rodent Mastomys coucha that is naturally infected with Mastomys natalensis papillomavirus (MnPV). This skin type papillomavirus induces not only benign skin tumours, such as papillomas and keratoacanthomas, but also squamous cell carcinomas, thereby allowing a straightforward read-out for successful vaccination in a small immunocompetent laboratory animal. Here, we examined the efficacy of a virus-like particle (VLP)-based vaccine on either previously or newly established infections. VLPs raise a strong and long-lasting neutralizing antibody response that confers protection even under systemic long-term cyclosporine A treatment. Remarkably, the vaccine completely prevents the appearance of benign as well as malignant skin tumors. Protection involves the maintenance of a low viral load in the skin by an antibody-dependent prevention of virus spread. Our results provide first evidence that VLPs elicit an effective immune response in the skin under immunocompetent and immunosuppressed conditions in an outbred animal model, irrespective of the infection status at the time of vaccination. These findings provide the basis for the clinical development of potent vaccination strategies against cutaneous HPV infections and HPV-induced tumors, especially in patients awaiting organ transplantation. Organ transplant recipients (OTR) frequently suffer from fulminant warts that are induced by cutaneous human papillomaviruses (HPV). Moreover, some skin HPV types may also be involved in the development of non-melanoma skin cancer. Mimicking the situation of immunosuppressed OTR who acquire cutaneous HPV infections already in childhood, we explored the efficacy of a vaccine in infected animals that additionally underwent immunosuppression. We demonstrate for the first time the success of a vaccine against a skin papillomavirus in a natural outbred animal system, which completely prevents both benign and malignant skin tumor formation even under immunosuppressed conditions. Hence, our study provides the basis for clinical development of a vaccine against cutaneous HPV infections, which may be particularly useful in transplant recipients.
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Caza T, Oaks Z, Perl A. Interplay of Infections, Autoimmunity, and Immunosuppression in Systemic Lupus Erythematosus. Int Rev Immunol 2014; 33:330-63. [DOI: 10.3109/08830185.2013.863305] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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48
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Hanson K, Alexander B. Strategies for the prevention of infection after solid organ transplantation. Expert Rev Anti Infect Ther 2014; 4:837-52. [PMID: 17140359 DOI: 10.1586/14787210.4.5.837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Infection is a frequent complication of organ transplantation and is associated with significant morbidity and mortality. Preventative antimicrobial strategies are a key component of the care received by transplant patients. This review summarizes the evidence supporting anti-infective prophylaxis in this setting. Specific recommendations for the prevention of bacterial, fungal, viral and parasitic infection after transplant are made, with a focus on recent developments in the field of transplant infectious diseases.
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Affiliation(s)
- Kimberly Hanson
- Duke University Medical Center, Division of Infectious Diseases and International Health, Duke Clinical Microbiology Laboratory, NC 27710, USA.
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49
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Kotton CN. Vaccination and immunization against travel-related diseases in immunocompromised hosts. Expert Rev Vaccines 2014; 7:663-72. [DOI: 10.1586/14760584.7.5.663] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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50
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Abstract
The development of vaccination is a major achievement in modern medicine. However, children treated with immunosuppression may not at all, or only in part, receive routine immunization due to uncertainty of its risks and effect. There is a substantial lack of pediatric studies concerning the efficacy and safety of vaccination in this patient group. Experience from similar adult groups and children with HIV infection can be used as a model for other disease categories. With increasing knowledge of the immunologic basis of vaccination and how immunosuppressive drugs interfere with the immune system, improved vaccines could be tailored, and adequate, individualized guidelines issued.
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Affiliation(s)
- Thomas H Casswall
- Paediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital, Karolinska University Hospital, Sweden.
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