Diagnostic and Management Strategies for Donor-derived Infections

Chong, Pearlie P.; Razonable, Raymund R.

doi:10.1016/j.idc.2013.02.001

Cited by 10 publications

(2 citation statements)

References 64 publications

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“…Assessment of the risk to transmit pathogens from the donor to the recipient is of critical importance to increase safety of organ transplantation and to guide appropriate preventive management strategies (1)(2)(3). In this study, we have performed a detailed comparative analysis of the performance characteristics of three assay principles for the detection of cellular immunity toward CMV and M. tuberculosis in samples from deceased donors.…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Assays for Detection of Cell-Mediated Immunity Toward Cytomegalovirus and M. tuberculosis in Samples From Deceased Organ Donors

Schmidt

Schub

Wolf

et al. 2014

American Journal of Transplantation

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Cell-mediated immunity assays could be valuable for risk assessment of organ donors, but no data exist on their feasibility in deceased donors. In this study, 105 deceased donors (52.3 AE 16.9 years) were screened at the time of organ procurement. Pathogen-specific stimulation was performed using a cytomegalovirus (CMV) lysate, tuberculin (purified protein derivative [PPD]) and soluble Mycobacterium tuberculosis-specific ESAT-6/CFP-10 proteins in combination with an inhouse fluorescence-activated cell sorting (FACS) assay or commercial assay formats (QuantiFERON-CMV/TB for ELISA, T-SPOT.TB for ELISPOT). CMV-IgG antibody titers were determined as gold standard for CMV infection; 51.4% of samples were CMV seropositive. Indeterminate results were observed in 47.6% of ELISA, 12.5% of FACS and 0% of ELISPOT assays. Agreement with serology was highest for FACS (95.6%, k ¼ 0.91), followed by ELISPOT (84.0%, k ¼ 0.68) and ELISA (80.0%, k ¼ 0.60). Agreement between ELISA and serology increased if the CMV lysate was used as stimulus (96.7%, k ¼ 0.92). Among the T cell assays, agreement between ELISPOT and FACS was highest (k ¼ 0.70). PPDpositive results among valid samples differed between assays (26.5% for ELISA, 23.1% for FACS and 50.5% for ELISPOT); 2.0% were QuantiFERON-TB positive, 3.3% were ESAT-6/CFP-10-positive in FACS and 13.4% were positive in the T-SPOT.TB assay. In conclusion, cellular immunity may be analyzed from samples of deceased donors, although the assays differ in the rate of positivity and indeterminate results.

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Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Assays for Detection of Cell-Mediated Immunity Toward Cytomegalovirus and M. tuberculosis in Samples From Deceased Organ Donors

Schmidt

Schub

Wolf

et al. 2014

American Journal of Transplantation

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“…50 The relatively high-incidence rate of acute rejection after the first posttransplant year (1.06 events/TY) in fVCA could be potentially explained by poor adherence and tapering immunosuppression regimens to treat immunosuppression-related complications. 31,53 These observations support the idea that in the long-term, medical teams should carefully consider tapering their patients’ immunosuppression regimens because it can potentially induce an increase of acute rejection episodes. The dose variation needed to sufficiently suppress the immune system between each CMR episode could also play a role.…”

Section: Discussionmentioning

confidence: 71%

Long-term Outcomes After Facial Allotransplantation: Systematic Review of the Literature

et al. 2021

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Original Clinical Science-General Background. Facial vascularized composite allotransplantation (fVCA) represents a reconstructive approach that enables superior improvements in functional and esthetic restoration compared with conventional craniomaxillofacial reconstruction. Outcome reports of fVCA are usually limited to short-term follow-up or single-center experiences. We merge scientific literature on reported long-term outcome data to better define the risks and benefits of fVCA. Methods. We conducted a systematic review of PubMed/MEDLINE databases in accordance with PRISMA guidelines. English full-text articles providing data on at least 1 unique fVCA patient, with ≥3 years follow-up, were included. Results. The search yielded 1812 articles, of which 28 were ultimately included. We retrieved data on 23 fVCA patients with mean follow-up of 5.3 years. More than half of the patients showed improved quality of life, eating, speech, and motor and sensory function following fVCA. On average, the patients had 1 acute cell-mediated rejection and infectious episode per year. The incidence rates of acute rejection and infectious complications were high within first-year posttransplant but declined thereafter. Sixty-five percent of the patients developed at least 1 neoplastic or metabolic complication after transplantation. Chronic vascular rejection was confirmed in 2 patients, leading to allograft loss after 8 and 9 years. Two patient deaths occurred 3.5 and 10.5 years after transplant due to suicide and lung cancer, respectively. Conclusions. Allograft functionality and improvements in quality of life suggest a positive risk-benefit ratio for fVCA. Recurrent acute rejection episodes, chronic rejection, immunosuppression-related complications, and heterogeneity in outcome reporting present ongoing challenges in this field.

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