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  • Goss MB
  • Munoz FM
  • Ruan W
  • Galván NTN
  • O'Mahony CA
  • et al.
Pediatr Transplant. 2021 Aug;25(5):e13880 doi: 10.1111/petr.13880.

We describe the successful pediatric liver transplant for unresectable hepatoblastoma in a 4-year-old male with COVID-19 prior to transplant. The first negative NP swab was documented 1 month after initial diagnosis, when SARS-CoV-2 antibodies were also detected. The patient was actively listed for liver transplant after completing four blocks of a SIOPEL-4 based regimen due to his PRETEXT IV disease which remained unresectable. Following three additional negative NP swabs and resolution of symptoms for 4 weeks, he underwent a whole-organ pediatric liver transplant. COVID-19 positivity determined via NP swab SARS-CoV-2 real-time RT-PCR (Hologic Aptima SARS-CoV-2 RT-PCR assay). IgG and IgM total SARS- CoV-2 antibodies detected by Ortho Clinical Diagnostics VITROS® Immunodiagnostics Products Anti-SARS-CoV-2 Test. Patient received standard prednisone and tacrolimus-based immunosuppression without induction therapy following transplant. Post-transplant course was remarkable for neutropenia and thrombocytopenia, with discharge home on post-transplant day #11. Surveillance tests have remained negative with persistent SARS-CoV-2 IgG antibodies at 6 weeks after transplant. We describe one of the earliest, if not the first case of liver transplant following recent recovery from COVID-19 in a pediatric patient with a lethal malignant liver tumor. A better understanding of how to balance the risk profile of transplant in the setting of COVID-19 with disease progression if transplant is not performed is needed. We followed existing ASTS guidelines to document clearance of the viral infection and resolution of symptoms before transplant. This case highlights that pediatric liver transplantation can be safely performed upon clearance of COVID-19.

  • Wei L
  • Liu B
  • Zhao Y
  • Chen Z
Ann Palliat Med. 2021 Jun;10(6):7003-7007 doi: 10.21037/apm-20-996.

Coronavirus disease 2019 (COVID-19) pandemic gripped the globe. SARS-CoV-2 is highly infectious and is susceptible to all populations. Immunosuppressed patients have greater risk for opportunistic infections. However, the understanding regarding the biological characteristics of SARS-CoV-2 in immunosuppressed patients remains unclear. Herein, we present a case of prolonged shedding of SARS-CoV-2 in a liver transplant patient with COVID-19. A 61-year-old male post liver transplant was confirmed COVID-19 infection on day 10 of illness onset. The patient has received immunosuppressive treatment for over 11 years and has a history of hypertension for 10 years. With antiviral treatment and temporary discontinuation of tacrolimus immunosuppression, he had complete clinical symptoms relieve on day 24. However, recurrently positive tests of SARS-CoV-2 RNA were presented on day 35 and on day 39 after two consecutive negative tests. IgG antibody test for SARS-CoV-2 was positive with IgM negative on day 41. The final shedding duration lasted 52 days. Prolonged shedding of SARS-CoV-2 should be a matter of concern and might attribute to long-term immunosuppression. Therefore, dynamic surveillance and prolonged quarantine are required for immunocompromised individuals. Further data should be collected to investigate if there is a universal prolonged shedding window of SARS-CoV-2 in immunosuppressed patients.

  • Querido S
  • Calça R
  • Weigert A
  • Francisco D
  • Adragão T
  • et al.
Transpl Infect Dis. 2021 Apr;23(2):e13524 doi: 10.1111/tid.13524.

Kidney transplant (KT) recipients are at an increased risk for severe COVID-19 because of their immunosuppressed state. A 42-year-old KT patient was diagnosed with COVID-19 three months after KT. Despite lymphopenia and several risk factors, he had a mild disease course. Nasopharyngeal real-time reverse transcriptase polymerase chain reaction for SARS-CoV-2 became negative 48 days after detection. SARS-CoV-2 IgG antibodies became negative after day 40. TTV DNA load increased with the onset COVID-19 and reduced after its resolution. This is the first report where TTV DNA load was measured during the course of COVID-19.

  • Trujillo H
  • Fernández-Ruiz M
  • Gutiérrez E
  • Sevillano Á
  • Caravaca-Fontán F
  • et al.
Transpl Infect Dis. 2021 Apr;23(2):e13501 doi: 10.1111/tid.13501.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might increase the risk of invasive pulmonary aspergillosis (IPA). Although several case reports and small series have been reported in the general population, scarce information is available regarding coronavirus disease 2019 (COVID-19)-associated IPA in the setting of solid organ transplantation. We describe a case of a kidney transplant recipient with severe COVID-19 that was subsequently diagnosed with probable IPA on the basis of the repeated isolation of Aspergillus fumigatus in sputum cultures, repeatedly increased serum (1 → 3)-β-d-glucan levels, and enlarging cavitary nodules in the CT scan. The evolution was favorable after initiation of isavuconazole and nebulized liposomal amphotericin B combination therapy and the withdrawal of immunosuppression.

  • Chowdary P
  • Shetty S
  • Booth J
  • Khurram MA
  • Yaqoob M
  • et al.
Transpl Infect Dis. 2021 Apr;23(2):e13500 doi: 10.1111/tid.13500.

There is still no consensus on the optimal management of COVID-19 within the general population due to the emerging evidence base. High-risk groups, including kidney transplant recipients living with HIV present unique additional challenges. Here we discuss two kidney transplant recipients living with HIV with SARS-CoV-2 infection and their clinical course, and review the existing literature for this subset of challenging patients.

  • Niess H
  • Börner N
  • Muenchhoff M
  • Khatamzas E
  • Stangl M
  • et al.
Am J Transplant. 2021 Apr;21(4):1629-1632 doi: 10.1111/ajt.16349.

To date, little is known about the duration and effectiveness of immunity as well as possible adverse late effects after an infection with SARS-CoV-2. Thus it is unclear, when and if liver transplantation can be safely offered to patients who suffered from COVID-19. Here, we report on a successful liver transplantation shortly after convalescence from COVID-19 with subsequent partial seroreversion as well as recurrence and prolonged shedding of viral RNA.

  • Dhand A
  • Bodin R
  • Wolf DC
  • Schluger A
  • Nabors C
  • et al.
Transpl Infect Dis. 2021 Apr;23(2):e13492 doi: 10.1111/tid.13492.

Transplantation in potential candidates who have recently recovered from COVID-19 is a challenge with uncertainties regarding the diagnosis, multi-organ systemic involvement, prolonged viral shedding in immunocompromised patients, and optimal immunosuppression. A 42 year male with alcoholic hepatitis underwent a successful deceased donor liver transplantation 71 days after the initial diagnosis of COVID-19. At the time of transplant, he was SARS-CoV-2 PCR negative for 24 days and had a MELD score of 33. His post-operative course was complicated by acute rejection which responded to intense immune-suppression using T-cell depletion and steroids. He was discharged with normal end-organ function and no evidence of any active infection including COVID-19. Prospective organ transplant recipients who have recovered from COVID-19 can be considered for transplantation after careful pre-transplant evaluation, donor selection, and individualized risk-benefit analysis.

  • Goodlet KJ
  • Bansal S
  • Arjuna A
  • Nailor MD
  • Buddhdev B
  • et al.
Transpl Infect Dis. 2021 Apr;23(2):e13480 doi: 10.1111/tid.13480.

Exosomes isolated from plasma of lung transplant recipients with allograft injury contain donor-derived lung self-antigens (collagen V and Kα1 tubulin) and human leukocyte antigen (HLA) molecules. We present a case of a 76-year-old, female lung transplant recipient treated for acute cellular rejection with methylprednisolone and anti-thymocyte globulin, who subsequently contracted SARS-CoV-2 and developed a sharp increase in the mean fluorescent intensity of anti-HLA antibodies. Analysis of circulating exosomes during rejection, but before SARS-CoV-2 infection, revealed the presence of lung self-antigens and HLA class II molecules. After the patient contracted SARS-CoV-2, exosomes with the SARS-CoV-2 spike protein were also found. After resolution of infectious symptoms, exosomes with SARS-CoV-2 spike protein were no longer detected; however, exosomes with lung self-antigens and HLA class II molecules persisted, which coincided with a progressive decline in spirometric flows, suggesting chronic lung allograft dysfunction. We propose that the analysis of circulating exosomes may be used to detect allograft injury mediated by both rejection and infection. Furthermore, the detection of exosomes containing viral proteins may be helpful in identifying allograft injury driven by viral pathogens.

  • Fung M
  • Nambiar A
  • Pandey S
  • Aldrich JM
  • Teraoka J
  • et al.
Transpl Infect Dis. 2021 Apr;23(2):e13477 doi: 10.1111/tid.13477.

Immunosuppressed patients such as solid organ transplant and hematologic malignancy patients appear to be at increased risk for morbidity and mortality due to coronavirus disease 2019 (COVID-19) caused by SARS coronavirus 2 (SARS-CoV-2). Convalescent plasma, a method of passive immunization that has been applied to prior viral pandemics, holds promise as a potential treatment for COVID-19. Immunocompromised patients may experience more benefit from convalescent plasma given underlying deficits in B and T cell immunity as well as contraindications to antiviral and immunomodulatory therapy. We describe our institutional experience with four immunosuppressed patients (two kidney transplant recipients, one lung transplant recipient, and one chronic myelogenous leukemia patient) treated with COVID-19 convalescent plasma through the Expanded Access Program (NCT04338360). All patients clinically improved after administration (two fully recovered and two discharged to skilled nursing facilities) and none experienced a transfusion reaction. We also report the characteristics of convalescent plasma product from a local blood center including positive SARS-CoV-2 IgG and negative SARS-CoV-2 PCR in all samples tested. This preliminary evidence suggest that convalescent plasma may be safe among immunosuppressed patients with COVID-19 and emphasizes the need for further data on the efficacy of convalescent plasma as either primary or adjunctive therapy for COVID-19.

  • Barros N
  • Sharfuddin AA
  • Powelson J
  • Yaqub M
  • Adebiyi OO
  • et al.
Clin Transplant. 2021 Feb;35(2):e14149 doi: 10.1111/ctr.14149.