Your search

The diagnosis of nontuberculous mycobacterial infections is challenging in pediatric solid organ transplant and hematopoietic cell transplant recipients due to the absence of specific clinical manifestations, limitations of sampling, prolonged times for culture and identification, and difficulty discerning colonization from clinical disease. Treatment is dependent on the nontuberculous mycobacterial species, disease type, and pattern of drug resistance. Treatment of nontuberculous...

Respiratory viral infections (RVIs) are among the leading cause of morbidity and mortality in pediatric hematopoietic stem cell transplant (HCT) and solid organ transplant (SOT) recipients. Transplant recipients remain at high risk for super imposed bacterial and fungal pneumonia, chronic graft dysfunction, and graft failure as a result of RVIs. Recent multicenter retrospective studies and prospective studies utilizing contemporary molecular diagnostic techniques have better delineated the...

Pediatric Infectious Disease (ID) clinicians play a critical role in helping prevent and mitigate infectious risks in children peri- and post-transplantation. Prevention starts during the pre-transplant evaluation and persists throughout the solid organ transplant and hematopoietic cell transplant continuum. The pre-transplant evaluation is an opportunity to screen for latent infections, plan preventative strategies, optimize immunizations, and discuss risk mitigation practices. An ideal...

Invasive fungal disease (IFD) remains a significant cause of morbidity and mortality in children undergoing transplantation. There is a growing armamentarium of novel antifungal agents recently approved for use or in late stages of clinical development. The overarching goal of this review is to discuss the mechanisms of action, spectrum of activity, stage of development, and pediatric-specific data for the following agents: encochleated amphotericin B deoxycholate, fosmanogepix,...

Despite current prophylaxis regimens, cytomegalovirus (CMV) is common in hematopoietic cell transplantation (HCT) and solid organ transplantation (SOT) and remains a significant cause of morbidity and mortality. Newer antiviral medications are reshaping the landscape for prevention and treatment of CMV DNAemia, infection, and disease. Letermovir is approved for CMV prevention in adult HCT patients and is attractive due to the absence of marrow suppression seen with...

Epstein-Barr Virus (EBV) diseases, including EBV-associated post-transplant lymphoproliferative disorder (PTLD) remain important causes of morbidity and mortality in children undergoing solid organ transplantation (SOT) and hematopoietic cell transplantation (HCT). Despite progress in the prevention of EBV disease including PTLD (EBV/PTLD) in HCT, key questions in the prevention, and management of these infectious complications remain unanswered. The goal of this manuscript is to highlight...

Kidney transplantation is often the preferred treatment for those with end-stage renal disease. The discipline of kidney transplantation has grown tremendously over the past 50 years.  Patients with end-stage renal disease have better long-term survival if they are placed on the waiting list and eventually undergo kidney transplantation than those who stay on dialysis. Furthermore, those who undergo transplantation often experience a better quality of life and a projected survival benefit of...

Patients with advanced heart failure requiring mechanical circulatory support and inotropic support have a poor prognosis. Cardiac transplantation in a selected cohort of such patients can be the treatment of choice. The early experience with heart transplants was disappointing. In 1967, the first patient to receive a heart transplant died of an overwhelming infection after 17 days. However, with the advent of immunosuppressive therapies and a better understanding of human anatomy and...

The first fruitful pancreatic transplant was carried out by WD Kelly in the year 1966. The results of pancreas transplantation have greatly improved as compared to the first one done in 1966, due to technical improvements and better immunosuppressive therapy over the last three decades. Transplantation of the pancreas is the only near cure treatment for type 1 diabetic patients. After the making of the International Pancreas Transplant Registry in 1984, data on more than 48000 pancreas...

Multivisceral transplantation (MVT) can be categorized into many different organ combinations, but for this review, the focus will be on concurrent transplantation of the intestine, stomach, hepatobiliary system, and the pancreaticoduodenal complex – which can also be performed in a modified fashion by “cherry-picking” different organs that suit the recipient’s condition. Some approach MVT by the replacement of any organ that relies on the superior mesenteric and celiac artery. The concept...

Cirrhosis and decompensated liver disease were the ninth leading cause of death for males in 2016 in the United States. Liver transplantation (LT) is a lifesaving gift and proven intervention in managing patients with acute and chronic end-stage liver disease. It restores normal health, lifestyle and extends lifespan by 15 years. The advent of liver transplantation came as a safety net to treat various liver diseases when all other medical interventions have failed. According to the...

Lung transplantation is a well-established life-saving treatment to improve the quality of life of patients with end-stage respiratory failure not responding to other medical or surgical interventions. The 36th adult lung and heart-lung transplant report summarize data from 69,200 adult lung transplants that have been performed through June 30, 2018, and reported to the International Thoracic Organ Transplant Registry. The US Organ Procurement and Transplantation Network (OPTN) and the...

Deceased donor and organ perfusion fluid cultures are obtained in order to inform recipient antimicrobial management and therefore reduce the risk of donor-derived bacterial and fungal infections. However, important heterogeneity exists in laboratory practice across organ procurement organizations and clinical management of culture results across transplant centers. While not standardized, the clinical approach to donors with positive bacterial and/or fungal cultures should be informed by...

Abstract Successful solid organ transplantation reflects meticulous attention to the details of immunosuppression, balancing risks for graft rejection against risks for infection. The “net state of immune suppression” is a conceptual framework of all factors contributing to infectious risk. Assays that measure immune function in the immunosuppressed transplant recipient relative to infectious risk and allograft function are lacking. The best measures of integrated immune function...

This updated section of the guideline from the Infectious Diseases Community of Practice of the American Society of Transplantation reviews the screening of donor and candidate prior to solid organ transplantation. Screening of donor and candidate is vital for optimizing post‐transplant outcomes. Risk assessment based on detailed history and appropriate diagnostic evaluation is essential. Serologic screening for certain viral infections is important and aids in immunization counseling and...

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation provide an update on potential drug-drug interactions between anti-infectives and immunosuppressants, which are most notable with calcineurin and mTOR inhibitors. Drug-drug interactions may occur through pharmacokinetic mechanisms leading to altered drug concentrations of either the anti-infective or immunosuppressive drug, or by pharmacodynamic interactions increasing or...

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation will review the current state of the art of donor-derived infections. Specifically, the guideline will summarize standardized definitions and approaches to defining imputability, updated data on the epidemiology of donor-derived infections, and approaches to risk mitigation against transmission of infections. This update will additionally provide guidance on the use of HIV+...

The central issue in organ transplantation remains suppression of allograft rejection. Thus, development of immunosuppressive drugs is the key to successful allograft function. Immunosuppressive agents are used for induction (intense immunosuppression in the initial days after transplantation), maintenance, and reversal of established rejection. This review focuses on agents that are either approved or in phase 2 or phase 3 trials in kidney transplantation, but many issues covered here are...