The Immunocompromised Surgical Patient and Opportunistic Infections

2017 ◽  
Author(s):  
Kiran Gajurel ◽  
Aruna K Subramanian
Keyword(s):  
De Novo ◽  
Opportunistic Infections ◽  
Organ Transplant ◽  
Surgical Excision ◽  
Suppressive Therapy ◽  
Surgical Patient ◽  
Solid Organ ◽  
Fungal Sinusitis ◽  
Delay In Diagnosis ◽  
Immunosuppressive Medications

Immunosuppressive medications used to prevent allograft rejection render solid-organ transplant recipients vulnerable to various opportunistic infections. These infections include bacteria, viruses, fungi, and parasites and occur either via reactivation of previously acquired latent infection or de novo acquisition from the donor organ itself or the environment after the transplantation. The type and clinical course of the infection depend on various factors, including the transplanted organ, nature of immunosuppressive regimens, timing of infection relative to the organ transplant, and type and duration of prophylaxis. Proper donor and recipient screening for preventable infections and posttransplantation prophylaxis are instrumental in preventing morbid infections. Posttransplantation infections may present with subtle findings and thus may cause a delay in diagnosis and treatment, resulting in a poor outcome. Appropriate pathogen-specific tests should be requested promptly for early diagnosis. Since these infections may have overlapping clinical and radiologic features, tissue biopsy, if feasible, should be done to establish a definitive diagnosis. Surgical excision or débridement should be attempted in patients presenting with abscesses or invasive fungal sinusitis along with antimicrobial therapy. After the completion of treatment, suppressive therapy may be required in certain infections to prevent a relapse as long as the patient remains immunosuppressed. This review contains 3 tables, and 82 references. Key words: allograft, donor, immunocompromised, infection, opportunistic, organ, transplant 

The Immunocompromised Surgical Patient and Opportunistic Infections

2017 ◽  
Author(s):  
Kiran Gajurel ◽  
Aruna K Subramanian
Keyword(s):  
De Novo ◽  
Opportunistic Infections ◽  
Organ Transplant ◽  
Surgical Excision ◽  
Suppressive Therapy ◽  
Surgical Patient ◽  
Solid Organ ◽  
Fungal Sinusitis ◽  
Delay In Diagnosis ◽  
Immunosuppressive Medications

Immunosuppressive medications used to prevent allograft rejection render solid-organ transplant recipients vulnerable to various opportunistic infections. These infections include bacteria, viruses, fungi, and parasites and occur either via reactivation of previously acquired latent infection or de novo acquisition from the donor organ itself or the environment after the transplantation. The type and clinical course of the infection depend on various factors, including the transplanted organ, nature of immunosuppressive regimens, timing of infection relative to the organ transplant, and type and duration of prophylaxis. Proper donor and recipient screening for preventable infections and posttransplantation prophylaxis are instrumental in preventing morbid infections. Posttransplantation infections may present with subtle findings and thus may cause a delay in diagnosis and treatment, resulting in a poor outcome. Appropriate pathogen-specific tests should be requested promptly for early diagnosis. Since these infections may have overlapping clinical and radiologic features, tissue biopsy, if feasible, should be done to establish a definitive diagnosis. Surgical excision or débridement should be attempted in patients presenting with abscesses or invasive fungal sinusitis along with antimicrobial therapy. After the completion of treatment, suppressive therapy may be required in certain infections to prevent a relapse as long as the patient remains immunosuppressed. This review contains 3 tables, and 82 references. Key words: allograft, donor, immunocompromised, infection, opportunistic, organ, transplant 

Characteristics and Survival Patterns of Solid Organ Transplant Patients Developing De Novo Colon and Rectal Cancer

2004 ◽  
Vol 47 (11) ◽  
pp. 1898-1903 ◽  
Author(s):  
Harry T. Papaconstantinou ◽  
Bradford Sklow ◽  
Michael J. Hanaway ◽  
Thomas G. Gross ◽  
Thomas M. Beebe ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
De Novo ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Patients ◽  
Colon And Rectal Cancer ◽  
Survival Patterns

Fecal Microbiota Transplantation Donor Screening Updates and Research Gaps for Solid Organ Transplant Recipients

2021 ◽  
Author(s):  
Nirja Mehta ◽  
Tiffany Wang ◽  
Rachel J. Friedman-Moraco ◽  
Cynthia Carpentieri ◽  
Aneesh K. Mehta ◽  
...  
Keyword(s):  
Opportunistic Infections ◽  
Fecal Microbiota Transplantation ◽  
Organ Transplant ◽  
Fecal Microbiota ◽  
Solid Organ Transplant ◽  
Pathogen Transmission ◽  
Solid Organ ◽  
Fecal Microbiota Transplant ◽  
Donor Screening ◽  
Clostridioides Difficile

In this review, we discuss stool donor screening considerations to mitigate potential risks of pathogen transmission through fecal microbiota transplant (FMT) in solid organ transplant (SOT) recipients. SOT recipients have a higher risk for Clostridioides difficile infection (CDI) and are more likely to have severe CDI. FMT has been shown to be a valuable tool in the treatment of recurrent CDI (RCDI), however guidelines for screening for opportunistic infections transmitted through FMT are underdeveloped. We review reported adverse effects of FMT as they pertain to an immunocompromised population and discuss current understanding and recommendations for screening found in the literature while noting gaps in research. We conclude that while FMT is being performed in the SOT population, typically with positive results, there remain many unanswered questions which may have major safety implications and warrant further study.

De novo malignancy in recipients of solid organ transplant from donors with intracranial cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13507-e13507
Author(s):  
Katie Carsky ◽  
Christopher Carr ◽  
Cassidy Werner ◽  
Helmi Khadra ◽  
John Blair Hamner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Organ Donation ◽  
De Novo ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Cns Tumors ◽  
Solid Organ ◽  
Large Dataset ◽  
Additional Risk ◽  
De Novo Malignancy

e13507 Background: In 2016, 33,610 organ transplants were performed in the US. Nevertheless, there is a critical deficiency of available organs. Currently, malignant neoplasms in the donor preclude organ donation, with some exceptions, such as certain CNS tumors without metastatic disease. The literature illustrates the risk of CNS tumor transmission with organ transplantation as 0-3% in the absence of additional risk factors, but organs from fewer than 0.5% of the 13,000 patients that die of glioma annually are procured. Given the critical need, we sought to reaffirm the safety of organs from donors with intracranial cancer by examining de novo malignancy outcomes in a large dataset. Methods: We examined the UNOS database to determine whether recipients of solid organ transplant from donors with intracranial cancer were at increased risk of de novo malignancy. Included were 119,430 subjects ages 18 to 65 who underwent heart, heart and lung, intestine, kidney, kidney and pancreas, liver, lung, or pancreas transplant from 1987 to 2012 and for whom there was complete data on donor history of intracranial cancer. 2-by-2 contingency tables were used to calculate odds ratios of exposure to donors with intracranial cancer. Outcomes included five-year survival, composite development of any malignancy, and development of specific malignancies including melanoma, esophageal, stomach, small intestine, pancreas, larynx, mouth, colorectal, primary liver tumor, and metastasis to liver. A p value of ≤ 0.05 was statistically significant. Results: 718 (0.60%) organs came from donors with intracranial cancer. 437 (79.02%) recipients of organs from donors with intracranial cancer survived 5 years, versus 71,055 (77.64%) recipients of organs from donors without intracranial cancer (p = 0.47). 113 (15.74%) recipients of organs from donors with intracranial cancer developed de novo malignancy, versus 17,963 (15.13%) recipients of organs from donors without intracranial cancer (p = 0.60). Of 17 contingency analyses of development of specific malignancies, we detected only 1 statistically significant positive association, de novo colorectal cancer in recipients of solid organ transplant from donors with intracranial cancer (p = 0.048, OR = 2.56). Given the large number of analyses and marginal significance of this in a very large dataset, it is likely type I error. Conclusions: Metastasis of primary CNS tumors beyond the CNS is a rare occurrence without additional risk factors. With the current organ shortage, donors with primary CNS malignancy are ideal candidates for organ donation.

scholarly journals Post-transplant Lymphoproliferative Disorders: Single Center Case Series and Literature Review

2020 ◽  
pp. 1-6
Author(s):  
Sumayyah Altamimi ◽  
◽  
Mohamed Al Shuaibi ◽  
Mohamed Alnahdi ◽  
Abdulrahman Altheaby ◽  
...  
Keyword(s):  
De Novo ◽  
Organ Transplant ◽  
Tumor Development ◽  
Case Series ◽  
Standard Of Care ◽  
Lymphoproliferative Disorders ◽  
Outcome Analysis ◽  
Solid Organ ◽  
Hematopoietic Stem ◽  
Post Transplant

Post-transplant lymphoproliferative disorders (PTLD) are referred to lymphoid and/or plasmacytic proliferation which occur as result of immunosuppression therapy in patient underwent solid organ or allogeneic hematopoietic stem cell transplantation. Among solid organ transplant recipients, it accounts approximately 20% of all cancers. Epstein-Barr virus (EBV) has been linked to the pathogenesis of PTLD when EBV was identified in the tumor biopsies. In most affected patients, PTLD occurs as a result of proliferation of EBV positive B cell following immunosuppression and impaired Tcell immune activity. EBV negative PTLD has been documented but no clear etiology has been confirmed, however theories of previous exposure to EBV which is completely cleared at the time of PTLD is diagnosed, different viruses or chronic antigenic stimulation all been considered as provoking factors for tumor development. Clinical symptomatology at presentation of patients with PTLD is usually indistinct from de novo lymphoproliferative disorders and chemotherapy protocols in this group of patients are generally similar to the standard of care of lymphoma treatment according to the subtype in addition to cessation or dose reduction of immunosuppressive therapy. We report our experience and outcome analysis in PTLD management among 23 patients from our institution treated between 2011 and 2019.

Incidence and Treatment of Cancer in Transplant Recipients

1998 ◽  
Vol 8 (2) ◽  
pp. 105-112 ◽  
Author(s):  
Maureen P. Flattery
Keyword(s):  
De Novo ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Cardiac Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Organ Rejection ◽  
Increased Risk ◽  
Actuarial Risk

Solid organ transplantation has been an accepted mode of therapy for the treatment of end-stage organ diseases for many years. Recipients' survival, however, has been hindered by organ rejection and the comorbid diseases that develop as a result of immunosuppressive therapy. In particular, organ transplant recipients have an increased risk of developing cancer de novo after transplantation. Prevalence ranges from 4 to 18% with an average incidence of 6%. Data submitted to the Cincinnati transplant tumor registry have revealed that cancers prevalent in the general population exhibited no increase in rate and may even show a slight decline in the transplant population. Length of survival after transplantation is associated with the likelihood of having cancer; the longer the recipient survives, the greater the chance. The actuarial risk among 124 cardiac transplant recipients was 2.7+/-1.9% at 1 year and 25.6+/-11% at 5 years. This article will review the current literature on the incidence and treatment of cancer in solid organ transplant recipients.

Is rituximab (R) the optimal therapeutic intervention (TI) for post-transplant lymphoproliferative disorder (PTLD) following solid organ transplant (SOT)?

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8074-8074
Author(s):  
R. E. Tsao ◽  
T. Jin ◽  
B. Richendollar ◽  
E. Hsi ◽  
B. Pohlman
Keyword(s):  
De Novo ◽  
Univariate Analysis ◽  
Cleveland Clinic ◽  
Organ Transplant ◽  
Clinical Information ◽  
Initial Study ◽  
Solid Organ ◽  
Younger Age ◽  
Study Results

8074 Background: PTLD is a rare, often fatal, complication of SOT. Most are derived from CD20+ B-cells. Historically, patients (pts) received a variety of TIs ranging from decreased immunosuppression to chemotherapy (CT). Based on promising initial study results, most pts now receive rituximab (R) without CT as part of 1st TI. Methods: We searched the Cleveland Clinic pathology archives for SOT pts, who were diagnosed with PTLD between 1987 and 2006; reviewed the medical records; extracted clinical information and outcomes; and analyzed the data by Cox proportional univariate and multivariate analyses. Results: We identified 55 SOT pts (heart, 18; lung, 16; kidney 14; liver, 6; pancreas, 1), who were diagnosed with PTLD at median age 47 years (range 7–66). The median time from SOT to PTLD was 1.7 years (range .2–20.9). 1st TI (usually >1) included “complete” resection (4), decreased immunosuppresion (53), acyclovir or ganciclovir (28), interferon (4), radiation therapy (6), CT (12), and/or R (17). Response to 1st TI was CR (30) or PR (10). The median follow-up among surviving pts is 5.0 years (range .1–11.4). 29 (including 5 CT and 5 R) pts have died; only 2 CT but all 5 R pts died from PTLD. On univariate analysis, younger age+, <2 prior rejection episodes+*, PS <2+*, normal LDH+*, <2 extranodal sites+, lower IPI+*, >1 1st TI+, and 1st TI with CT* were associated with an improved overall survival (OS)+ and/or PTLD-specific survival (PSS)*. On multivariate analysis, only PS <2 (HR 0.04 [CI 0.01–0.14], p<0.001) and >1 1st TI (HR 0.43 [CI 0.19–0.97], p=0.041) were associated with improved OS while PS <2 (HR 0.04 [0.01- 0.16], p<0.001) and 1st TI with CT (HR 0.19 [CI 0.04–0.84], p<0.028) were associated with improved PSS. Conclusions: A significant minority of SOT pts that receive R without CT as part of 1st TI still die from PTLD. PS is the most important predictor of outcome. In conjunction with the improved survival observed in de novo B-cell NHL pts treated with R+CT (compared to CT alone), this retrospective analysis suggests that some SOT PTLD pts should receive R+CT as part of 1st TI. No significant financial relationships to disclose.

Invasive Fungal Sinusitis: Clinical Pathologic Characteristics of Acute vs. Chronic Infections

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S83-S83
Author(s):  
Y Kitagawa ◽  
H Mesa ◽  
J Lavik
Keyword(s):  
Diabetes Mellitus ◽  
Organ Transplant ◽  
Solid Organ ◽  
Fungal Sinusitis ◽  
Recreational Drug ◽  
Chronic Infections ◽  
Invasive Fungal Sinusitis ◽  
Transplant Patients ◽  
Pathologic Classification ◽  
Fungal Organisms

Abstract Introduction/Objective Invasive fungal sinusitis is a serious condition requiring early diagnosis and treatment. It has been classified into acute, chronic and granulomatous forms. This study aims to investigate clinical pathologic aspects such as a) Frequency of mass forming lesions, b) Frequency of granulomatous reaction, c) Frequency of acute inflammatory reaction and d) Frequency of angioinvasion, perineural invasion and necrosis, to determine if these factors allow a more meaningful clinical-pathologic classification. Methods/Case Report Cases of invasive fungal sinusitis with surgical pathology specimens available in our laboratory since January 1, 2006 to date were gathered. Electronic medical records, histopathologic diagnostic material and laboratory fungal identification results were reviewed. Results (if a Case Study enter NA) Thirty-one cases of invasive fungal sinusitis were found: Twenty-two were acute (&lt; 4wk duration) and 9 chronic. Patient comorbidities in acute cases were malignancies: 45%, diabetes mellitus: 26% and solid organ transplant: 10%. Among patients with malignancies, 5 cases had relapsed/refractory acute myeloid leukemia with neutropenia &lt; 1000/uL. Patients with diabetes mellitus exhibited an average HbA1c of 10.0%. Two out of 3 transplant patients had graft versus host disease. The most common causative fungi were species of Aspergillus, Candida and mucormycetes. By contrast, a third of the chronic cases had a history of recreational drug use and six presented with space occupying lesions seen on imaging studies. Upon histologic review, four of these showed granulomas and the majority of cases exhibited extensive necrosis. Among necrotic cases, perineural and vascular invasion by fungal organisms was identified. Conclusion We report the contrasting clinical pathologic characteristics of acute and chronic invasive fungal sinusitis in a series of cases treated at University affiliated tertiary/quaternary-care Hospitals. Acute invasive sinusitis is usually a complication of severe systemic diseases. Chronic cases are caused by various medical conditions including the use of recreational drug and may mimic neoplasms on imaging.

Indirect Effects of Cytomegalovirus Infection

2009 ◽  
Vol 03 (01) ◽  
pp. 41 ◽  
Author(s):  
Götz Ulrich Grigoleit ◽  
Markus Kapp ◽  
Hermann Einsele ◽  
◽  
◽  
...  
Keyword(s):  
Indirect Effects ◽  
Opportunistic Infections ◽  
Organ Transplant ◽  
Clinical Manifestations ◽  
Treatment Strategies ◽  
Haematopoietic Stem Cell ◽  
Solid Organ ◽  
Direct Effects ◽  
Cmv Infection ◽  
Increased Risk

Primary cytomegalovirus (CMV) infection often presents as an asymptomatic self-limiting disease in immunocompetent individuals and is followed by latent persistence in different host tissues. However, solid organ transplant (SOT) recipients and patients undergoing allogeneic haematopoietic stem cell transplantation (alloHSCT) are at risk of life-threatening complications caused by CMV infection. Direct effects (or CMV disease) are marked by viral proliferation in a variety of tissues and organs. Clinical manifestations that are observed after SOT and alloHSCT are gastroenteritis, pneumonitis, hepatitis, uveitis, retinitis, encephalitis and graft rejection. In contrast to the direct effects, indirect effects are a consequence of the maintenance of persistent low-level viral replication and have been associated with an increased risk of rejection and graft dysfunction, graft-versus-host disease, accelerated atherosclerosis, opportunistic infections, malignancies, posttransplant diabetes and Guillain-Barré syndrome. This article aims to summarise these indirect effects of CMV, their possible causes and possible treatment strategies.

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