Cytopenias in Transplant Patients

Mj, Barry; Chandra, Sunandana; Hymes, Kenneth B.

doi:10.1007/978-1-4939-9034-4_10

Cited by 7 publications

(5 citation statements)

References 81 publications

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“…With the increasing incidence of NTM infections, it is important to optimize patient tolerability and adherence to therapy [ 16 ]. Evaluating the risks vs benefits of linezolid compared with tedizolid for prolonged durations of therapy, especially in a population possessing baseline risks for cytopenias, will help guide safe antimicrobial therapy [ 17 ]. The purpose of the study was to compare the safety and tolerability of tedizolid and linezolid throughout the treatment course and to describe the microbiological and clinical outcomes of tedizolid- or linezolid-containing regimens for the treatment of NTM in SOT recipients.…”

mentioning

confidence: 99%

Tedizolid vs Linezolid for the Treatment of Nontuberculous Mycobacteria Infections in Solid Organ Transplant Recipients

Poon

Hoz

Hynan

et al. 2021

Open Forum Infectious Diseases

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Background Treatment options for nontuberculous mycobacteria (NTM) infections are limited by the pathogen’s intrinsic resistance profile and toxicities. Tedizolid and linezolid display in vitro activity against NTM species. However, safety data and treatment outcomes are limited in the solid organ transplant (SOT) population. Methods This was a single center retrospective cohort study of adult SOT recipients receiving linezolid or tedizolid for an NTM infection from January 1, 2010 to August 31, 2019. The primary outcome compared the hematologic safety profiles of tedizolid versus linezolid. We also described non-hematological adverse drug events (ADEs) and therapy discontinuation rates. In exploratory analysis, we assessed symptomatic microbiologic and clinical outcomes in those receiving tedizolid or linezolid for at least four weeks. Results Twenty-four patients were included (15 tedizolid, 9 linezolid). No differences were identified comparing the effects of tedizolid versus linezolid on platelet counts, absolute neutrophil counts (ANC), and hemoglobin over seven weeks using mixed-effects ANOVA models. ANC was significantly decreased in both groups after seven weeks of therapy (p=0.04). Approximately 20% of patients in each arm discontinued therapy due to an ADE. Seven of 12 (58%) and two of three (67%) patients were cured or clinically cured with tedizolid and linezolid-containing regimens, respectively. Conclusions This study suggests no significant safety benefit of tedizolid over linezolid for the treatment of NTM infections in SOT recipients. Tedizolid or linezolid-containing regimens demonstrated a potential benefit in symptomatic and microbiologic improvement. Larger cohorts are needed to further delineate the comparative role of linezolid and tedizolid for the treatment of NTM infections in SOT recipients.

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confidence: 99%

Tedizolid vs Linezolid for the Treatment of Nontuberculous Mycobacteria Infections in Solid Organ Transplant Recipients

Poon

Hoz

Hynan

et al. 2021

Open Forum Infectious Diseases

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“…Cytopenia, including leukopenia, anemia, and thrombocytopenia, occurs after a solid organ transplant. The etiology of cytopenia is multifactorial and includes drugs, infections, and post-transplant lymphoproliferative disorders [27]. It also increases the risk of developing further complications, such as opportunistic infections, and may contribute to poor prognosis in patients undergoing LTX.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the modified hemophagocytic syndrome diagnostic score as a prognostic factor in lung transplantation patients

Choi

Kim

Lee

et al. 2021

Preprint

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Background: Lung transplantation (LTX) is an established treatment for end-stage lung disease; however, the post-LTX mortality rate remains high. This study aimed to evaluate the prognostic value of the modified reactive hemophagocytic syndrome diagnostic score (mHScore) and its individual components on mortality after LTX.Methods: We retrospectively analyzed 294 patients who underwent LTX at Severance Hospital, Yonsei University, Korea, from January 2012 and December 2020, and classified them into high (n=114, mHScore > 104.0) and low mHScore (n=180, mHScore ≤ 104.0) groups. Triglyceride, ferritin, serum glutamic oxaloacetic transaminase, fibrinogen, and cytopenia were used to calculate the mHScore. We compared baseline characteristics and mortality rates as LTX prognostic factors.Results: The high mHScore group had significantly more cytopenia and higher ferritin, triglyceride, lactate dehydrogenase, and C-reactive protein levels than the low mHScore group. The mortality rate was significantly higher in the high than in the low mHScore group (hazard ratio, 4.429, p < 0.001). Multivariate regression analysis revealed that a high mHScore was significantly associated with postoperative mortality, even after adjusting for other confounding factors. A high mHScore was also associated with postoperative complications.Conclusions: The mHScore can be used to estimate post-LTX prognosis and predict postoperative mortality.

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“…This raises concern about their ability to mount an effective immune response to COVID 19 vaccination. And therefore warrant the investigation of the impact of both leukopenia and drugs on the immunogenicity of Covid19 vaccine among LTR (8)(9)(10). Finally, studies have shown that comorbidities such as diabetes, hypertension, or heart disease may have a reduced immune response to the vaccine compared to those without underlying health conditions, but this still needs to be demonstrated in the setting of .…”

Section: Introductionmentioning

confidence: 99%

Factors influencing immunogenicity and safety of SARS-CoV-2 vaccine in liver transplantation recipients: a systematic review and meta-analysis

Luo,

Lessomo,

et al. 2023

Front. Immunol.

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BackgroundThis review summarizes the factors influencing the efficacy and safety of the COVID-19 vaccine in LTR through meta-analysis, hoping to provide strategies for vaccine use.MethodsElectronic databases were screened for studies on mRNA vaccines in LTR. The primary outcome was the pooled seroconversion rate, and the secondary outcome was the incidence of adverse events+breakthrough infections. Subgroup analyses were made based on BMI, associated comorbidities, presence of baseline leukopenia, time since transplant, and drugs used.ResultIn total, 31 articles got included. The pooled seroconversion rate after at least two doses of SARS-CoV-2 vaccination was 72% (95% CI [0.52-0.91). With significant heterogeneity among studies I2 = 99.9%, the seroconversion rate was about 72% (95%CI [0.66-0.75]), from the studies reporting two doses of vaccine slightly higher around 75%(95%CI [0.29-1.22]) from studies reporting three doses. The pooled seroconversion rate within the lower to normal BMI group was 74% (95% CI [0.22-1.27], Pi=0.005) against 67% (95% CI [0.52-0.81], Pi=0.000) in the high BMI group. The pooled seroconversion rate in the ‘‘positive leukopenia’’ group was the lowest, 59%. Leukopenia could influence the vaccine seroconversion rate in LTR. From the time since transplant analysis after setting seven years as cut off point, the pooled seroconversion rate after at least two doses of COVID-19 vaccination was 53% (95% CI [0.18-0.83], P=0.003, I2 = 99.6%) in <7years group and 83% (95% CI [0.76-0.90], P=0.000 I2 = 95.7%) in > 7years group. The only time since transplantation had reached statistical significance to be considered a risk factor predictor of poor serological response (OR=1.27 95%CI [1.03-1.55], P=0.024). The breakthrough infection rate after vaccination was very low2% (95% CI 0.01-0.03, I2 = 63.0%), and the overall incidence of adverse events, which included mainly pain at the injection site and fatigue, was 18% (95%CI [0.11-0.25], I2 = 98.6%, Pi=0.000).ConclusionThe seroconversion rate in LTR vaccinated with at least two doses of mRNA COVID-19 vaccine could be significantly affected by the vaccine type, immunosuppressant used, BMI, leukopenia, associated comorbidities, and time since transplantation. Nevertheless, booster doses are still recommended for LTR.

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Cytopenias in Transplant Patients

Cited by 7 publications

References 81 publications

Tedizolid vs Linezolid for the Treatment of Nontuberculous Mycobacteria Infections in Solid Organ Transplant Recipients

Tedizolid vs Linezolid for the Treatment of Nontuberculous Mycobacteria Infections in Solid Organ Transplant Recipients

Usefulness of the modified hemophagocytic syndrome diagnostic score as a prognostic factor in lung transplantation patients

Factors influencing immunogenicity and safety of SARS-CoV-2 vaccine in liver transplantation recipients: a systematic review and meta-analysis

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