Immune response to CMV in solid organ transplant recipients: current concepts and future directions

2012 ◽  
Vol 8 (4) ◽  
pp. 383-393 ◽  
Author(s):  
Richard R Watkins ◽  
Tracy L Lemonovich ◽  
Raymund R Razonable
Keyword(s):  
Immune Response ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Future Directions ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

scholarly journals 156. Clinical Characteristics and Acute-phase Cytokine Response of Solid-Organ Transplant Recipients with Bloodstream Infections Differs According to Bacterial Type and Transplant Status

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S104-S104
Author(s):  
Emily Eichenberger ◽  
Felicia Ruffin ◽  
Sin-Ho Jung ◽  
Reginald Lerebours ◽  
Batu K Sharma-Kuinkel ◽  
...  
Keyword(s):  
Immune Response ◽  
Acute Phase ◽  
Clinical Characteristics ◽  
Organ Transplant ◽  
Host Immune Response ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

Abstract Background Clinical outcomes and host immune response in solid-organ transplant recipients (Tx) with Staphylococcus aureus bacteremia (SAB) and Gram-negative bacteremia (GNB) are poorly understood. The aims of this study were to describe (1) clinical characteristics and outcomes and (2) acute-phase cytokine response in Tx recipients with SAB and GNB as compared with matched non-transplant subjects (Non-Tx). Methods Thirty-two Tx recipients who were prospectively enrolled in the Blood Stream Infection Biorepository (BSIB) were matched 1:1 with Non-Tx patients on age, race, gender and bacteria using a perfect matching algorithm (Tx-SAB n = 16, Non-Tx SAB n = 16; Tx GNB n = 16, Non-Tx GNB n = 16). GNB included Escherichia coli (n = 16) and Klebsiella pneumoniae (n = 16). Multiplex cytokine testing was performed (Luminex) to evaluate acute-phase serum cytokines levels. Baseline characteristics were summarized using mean with standard deviation (SD), median with interquartile range (IQR), and ranges (min and max), or frequency with %. Differences between the Tx and Non-Tx SAB and GNB were compared using either the equal or unequal variance version of the Student’s t-test or Wilcoxon rank-sum test for continuous variables. Fisher’s exact test was used for categorical variables. Results An endovascular source was more common in Tx SAB vs. Non-Tx SAB (75.0% vs. 0.0%; P = 0.0003) and Tx-GNB (42.9% vs. 18.8%; P = 0.006). Fewer SAB cases were attributed to a skin/soft tissue/osteoarticular in Tx vs. Non-Tx (8.3% vs. 91.7%; P = 0.0001). APACHE II scores were higher in Tx SAB vs. Non-Tx SAB (14.0 [IQR: 11.0, 17.5] vs. 10.0 [IQR: 7.0, 12.5] P = 0.02), but not between Tx GNB vs. Non-Tx GNB (14 [IQR: 12.0, 15.5] vs. 13.5 [12.0, 15.0] P = 0.54). No significant difference length of stay, recurrent bacteremia or mortality were noted among or between groups. Patients with SAB had significantly higher levels of IL-10, CCL5, eotaxin vs. GNB in both Tx and Non-Tx. Conversely, IL-5, IL-13 and IL-17 levels were significantly lower in SAB compared with GNB in both Tx and Non-Tx. Within Tx alone, IL-8 and IL-15 were significantly higher in SAB as compared with GNB. Conclusion Significant differences exist in etiology and host immune response in Tx and Non-Tx with SAB and GNB. Further research is needed to understand the host immune response to BSI in these patients. Disclosures All authors: No reported disclosures.

scholarly journals SARS-CoV-2 serologic immune response in exogenously immunosuppressed patients

2020 ◽  
Author(s):  
Megan L Zilla ◽  
Christian Keetch ◽  
Gretchen Mitchell ◽  
Jeffery McBreen ◽  
Michael R Shurin ◽  
...  
Keyword(s):  
Immune Response ◽  
Antibody Response ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Organ Transplant Recipient ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Immunosuppressed Patients ◽  
Solid Organ Transplant Recipients

Abstract Background While it is presumed that immunosuppressed patients, such as solid organ transplant recipients on immunosuppression, are at greater risk from SARS-CoV-2 infection than the general population, the antibody response to infection in this patient population has not been studied. Methods In this report, we follow the anti-SARS-CoV-2 antibody levels in patients with COVID-19 who are undergoing exogenous immunosuppression. Specifically, we studied the antibody response of three solid organ transplant recipient patients, three patients who take daily inhaled fluticasone, and a patient on etanercept and daily inhaled fluticasone, and compared them to five patients not on exogenous immunosuppression. Results We found that the solid organ transplant patients on full immunosuppression are at risk of having a delayed antibody response and poor outcome. We did not find evidence that inhaled steroids nor etanercept predispose patients to delayed immune response to SARS-CoV-2. Conclusion The data presented here suggest that solid organ transplant recipients may be good candidates for early targeted intervention against SARS-CoV-2.

scholarly journals Immune Response to BNT162b2 in Solid Organ Transplant Recipients: Negative Impact of Mycophenolate and High Responsiveness of SARS-CoV-2 Recovered Subjects against Delta Variant

2021 ◽  
Vol 9 (12) ◽  
pp. 2622
Author(s):  
Irene Cassaniti ◽  
Federica Bergami ◽  
Francesca Arena ◽  
Jose Camilla Sammartino ◽  
Alessandro Ferrari ◽  
...  
Keyword(s):  
Immune Response ◽  
T Cell ◽  
Negative Impact ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
T Cell Response ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

The immunogenicity of severe acute respiratory syndrome 2 virus (SARS-CoV-2) vaccines in immunocompromised patients remains to be further explored. Here, we evaluated the immunogenicity elicited by complete vaccination with BNT162b2 vaccine in solid organ transplant recipients (SOTRs). A cohort of 110 SOTRs from Northern Italy were vaccinated with two doses of BNT162b2 mRNA vaccine and prospectively monitored at baseline and after 42 days. Both SARS-CoV-2 naïve and recovered subjects were included. Humoral response elicited by vaccination, including SARS-CoV-2 neutralizing antibodies (SARS-CoV-2 NT Abs), was evaluated; additionally, ex-vivo ELISpot assay was performed for the quantification of Spike-specific T-cell response. Results were compared with those obtained in a cohort of healthy subjects. In a subset of patients, humoral and T-cell responses against delta variant were also evaluated. Less than 20% of transplanted subjects developed a positive humoral and cell-mediated response after complete vaccination schedule. Overall, median levels of immune response elicited by vaccination were significantly lower with respect to controls in SARS-CoV-2 naïve transplant, but not in SARS-CoV-2 recovered transplanted patients. Additionally, a significant impairment of both humoral and cell-mediated response was observed in mycophenolate-treated patients. Positive delta-SARS-CoV-2 NT Abs levels were detected in almost all the SARS-CoV-2 recovered subjects but not in previously uninfected patients. Our study supports previous observations of a low level of seroconversion after vaccination in transplanted patients.

Cytomegalovirus in Solid Organ Transplant Recipients: Clinical Updates, Challenges and Future Directions

2020 ◽  
Vol 26 (28) ◽  
pp. 3497-3506
Author(s):  
Raymund R. Razonable
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Future Directions ◽  
Prevention And Treatment ◽  
Solid Organ Transplant Recipients

Cytomegalovirus is the classic opportunistic infection after solid organ transplantation. This review will discuss updates and future directions in the diagnosis, prevention and treatment of CMV infection in solid organ transplant recipients. Antiviral prophylaxis and pre-emptive therapy are the mainstays of CMV prevention, but they should not be mutually exclusive and each strategy should be considered depending on a specific situation. The lack of a widely applicable viral load threshold for diagnosis and preemptive therapy is emphasized as a major factor that should pave the way for an individualized approach to prevention. Valganciclovir and intravenous ganciclovir remain as drugs of choice for CMV management, and strategies for managing drug-resistant CMV infection are enumerated. There is increasing use of CMV-specific cell-mediated immune assays to stratify the risk of CMV infection after solid organ transplantation, and their potential role in optimizing CMV prevention and treatment efforts is discussed.

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