Despite recent advances, cytomegalovirus (CMV) infections remain one of the most common complications affecting solid organ transplant recipients, conveying higher risks of complications, graft loss, morbidity, and mortality. Research in the field and development of prior consensus guidelines supported by The Transplantation Society has allowed a more standardized approach to CMV management. An international multidisciplinary panel of experts was convened to expand and revise evidence and expert opinion-based consensus guidelines on CMV management including prevention, treatment, diagnostics, immunology, drug resistance, and pediatric issues. Highlights include advances in molecular and immunologic diagnostics, improved understanding of diagnostic thresholds, optimized methods of prevention, advances in the use of novel antiviral therapies and certain immunosuppressive agents, and more savvy approaches to treatment resistant/refractory disease. The following report summarizes the updated recommendations.

Cytomegalovirus (CMV) continues to be one of the most common infections after solid-organ transplantation, resulting in significant morbidity, graft loss, and adverse outcomes. Management of CMV varies considerably among transplant centers but has been become more standardized by publication of consensus guidelines by the Infectious Diseases Section of The Transplantation Society. An international panel of experts was reconvened in October 2012 to revise and expand evidence and expert opinion-based consensus guidelines on CMV management, including diagnostics, immunology, prevention, treatment, drug resistance, and pediatric issues. The following report summarizes the recommendations.

Anidulafungin was shown to be noninferior to fluconazole in the treatment of invasive candidiasis. (ClinicalTrials.gov number, NCT00056368 [ClinicalTrials.gov]).

Cytomegalovirus (CMV) remains one of the most common infections after solid organ transplantation, resulting in significant morbidity, graft loss, and occasional mortality. Management of CMV varies considerably among transplant centers. A panel of experts on CMV and solid organ transplant was convened by The Infectious Diseases Section of The Transplantation Society to develop evidence and expert opinion-based consensus guidelines on CMV management including diagnostics, immunology, prevention, treatment, drug resistance, and pediatric issues.

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Summary Background There are few data on the epidemiology and outcomes of influenza infection in recipients of solid-organ transplants. We aimed to establish the outcomes of pandemic influenza A H1N1 and factors leading to severe disease in a cohort of patients who had received transplants. Methods We did a multicentre cohort study of adults and children who had received organ transplants with microbiological confirmation of influenza A infection from April to December, 2009. Centres were identified through the American Society of Transplantation Influenza Collaborative Study Group. Demographics, clinical presentation, treatment, and outcomes were assessed. Severity of disease was measured by admission to hospital and intensive care units (ICUs). The data were analysed with descriptive statistics. Proportions were compared by use of χ2 tests. We used univariate analysis to identify factors leading to pneumonia, admission to hospital, and admission to an ICU. Multivariate analysis was done by use of a stepwise logistic regression model. We analysed deaths with Kaplan-Meier survival analysis. Findings We assessed 237 cases of medically attended influenza A H1N1 reported from 26 transplant centres during the study period. Transplant types included kidney, liver, heart, lung, and others. Both adults (154 patients; median age 47 years) and children (83; 9 years) were assessed. Median time from transplant was 3.6 years. 167 (71%) of 237 patients were admitted to hospital. Data on complications were available for 230 patients; 73 (32%) had pneumonia, 37 (16%) were admitted to ICUs, and ten (4%) died. Antiviral treatment was used in 223 (94%) patients (primarily oseltamivir monotherapy). Seven (8%) patients given antiviral drugs within 48 h of symptom onset were admitted to an ICU compared with 28 (22.4%) given antivirals later (p=0.007). Children who received transplants were less likely to present with pneumonia than adults, but rates of admission to hospital and ICU were similar. Interpretation Influenza A H1N1 caused substantial morbidity in recipients of solid-organ transplants during the 2009–10 pandemic. Starting antiviral therapy early is associated with clinical benefit as measured by need for ICU admission and mechanical ventilation.

These updated guidelines of the AST IDCOP review vaccination of solid organ transplant candidates and recipients. General principles of vaccination as well as the use of specific vaccines in this population are discussed. Vaccination should be reviewed in the pre‐transplant setting and appropriate vaccines updated. Both inactivated and live vaccines can be given pre‐transplant. The timing of vaccination post‐transplant should be taken into account. In the post‐transplant setting, inactivated vaccines can be administered starting at 3 months post‐transplant with the exception of influenza which can be given as early as one month. Inactivated vaccines can be safely administered post‐transplant. There is accumulating data that live‐attenuated vaccines can also be given to select post‐transplant patients. Close contacts of transplant patients can receive most routine live vaccines. Specific vaccines including pneumococcal, influenza, hepatitis B, HPV, and meningococcal vaccines are discussed. Newer vaccines for seasonal influenza vaccine and herpes zoster are highlighted. Live‐attenuated vaccines such as measles, mumps, rubella, and varicella are also discussed. Emerging data on live‐attenuated vaccines post‐transplant are highlighted.

All Rights Reserved. No part of the contents of this document may be reproduced or transmitted in any form or by any means without the written permission of the publisher. 4 Standard Guidance A. General Provisions A.1 Basis and Scope A.1.1 This document sets forth the conditions that a laboratory must satisfy in order to be accredited by the American Society for Histocompatibility and Immunogenetics (ASHI) to perform testing on human specimens. These Standards have been established by the ASHI Quality Assurance and Standards Committee following review, and response to, public comments. These Standards have been approved by the ASHI Board of Directors. These Standards have been established to help ensure accurate and dependable immunogenetics, histocompatibility, and transplantation testing consistent with the current state of wellestablished laboratory procedures. A.1.2 All laboratories requesting ASHI accreditation must meet the same requirements, regardless of their location in the U.S. or a foreign country and regardless of whether or not they are using ASHI accreditation for compliance with CLIA regulations. Re: A.1.2-Certain rare cases in which Standards are indicated to apply only to UNOS laboratories or only to U.S. Laboratories (e.g., the requirement to include the FDA disclaimer on reports) are exceptions to Standard A.1.2 A.2 Abbreviations ARB Accreditation Review Board ASHI The American Society for Histocompatibility and Immunogenetics. CDC Centers for Disease Control and Prevention CFR US Code of Federal Regulations CLIA Clinical Laboratory Improvement Amendments of 1988. CLIA regulations are defined in 42 CFR 493. CMS US Centers for Medicare and Medicaid Services CPRA Calculated Panel Reactive Antibody CREG Cross Reactive Group DNA Deoxyribonucleic acid EFI European Federation for Immunogenetics ELISA Enzyme-linked immunosorbent assay