Influence of the microbiome on solid organ transplant survival

Pirozzolo, Isabella; Li, Zhipeng; Sepulveda, Martin; Alegre, Maria‐Luisa

doi:10.1016/j.healun.2021.04.004

Cited by 10 publications

(7 citation statements)

References 77 publications

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“…Other adverse effects include side effect profiles, drug-drug interactions, and the possible impact on graft survival and rejection. 9, 10 So the need for measured antimicrobial prescribing and monitoring is of particular importance in this community who are often more likely to develop drug-resistant infections but are unfortunately highly likely to require the use of antimicrobials during the remainder of their posttransplant lives.…”

Section: Infections In the Solid Organ Transplant Patient Communitymentioning

confidence: 99%

“…Recurrent use of antimicrobials in SOT recipients can lead to the development of multidrug‐resistant (MDR) pathogens, 6–8 but it also disrupts the overall microbiome and can lead to Clostridium difficile . Other adverse effects include side effect profiles, drug–drug interactions, and the possible impact on graft survival and rejection 9,10 …”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial stewardship in solid organ transplant—Opportunities in the National Health Service

Murthy

Wey

2023

Transplant Infectious Dis

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Background Antimicrobial stewardship (AMS) is an intervention, which ensures the appropriateness of antimicrobial use to avoid in part the rising problem of antimicrobial resistance and negative effects of inappropriate antimicrobial use. In the solid organ transplant (SOT) population, which is prone to a particularly high risk of infection resulting from immunosuppression and anatomical issues with each type of SOT, the need for good stewardship has never been more important. This article looks at current AMS practice in SOT units in the United Kingdom and how things could be improved in the future. Methods The current practice of AMS alongside national antimicrobial resistance rates were reviewed using national mandatory reporting data. The background to the current practice and policies in place in the National Health Service (NHS) were also reviewed and possibilities for future approaches explored. Results AMS is a requirement within all NHS hospitals in the United Kingdom as per government policy. Mandatory reporting of specific bloodstream infections (BSIs) and antimicrobial consumption alongside financial incentives has been the approach nationwide. Gram‐negative resistance rates in BSIs have been increasing prior to the COVID‐19 pandemic. Little SOT‐specific data on antimicrobial resistance exists, and the general approach to AMS in SOT units has generally modeled the national approach. Conclusion Although there is a good, standardized approach to AMS in the NHS, there is a need for SOT‐specific AMS approaches to be developed in the United Kingdom. More data is required on antimicrobial resistance rates, and studies are needed to investigate optimal antimicrobial prophylaxis regimens for each solid organ group. Tools to aid AMS efforts and novel treatment options for complex multiresistant infection must also be explored amongst transplant centers.

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Section: Infections In the Solid Organ Transplant Patient Communitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antimicrobial stewardship in solid organ transplant—Opportunities in the National Health Service

Murthy

Wey

2023

Transplant Infectious Dis

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“…The focus of microbiome research has transitioned from solely descriptive cross‐sectional analysis of composition to a longitudinal scale study [17], permitting an observation of the host response to study how the interaction benefits or destroys diversity, as well as the modulation of donor/recipient cells, alteration of the alloimmune response and posttransplant complications [18]. More precise tools, such as transcriptomics and single‐cell sequencing, allow a more complementary data profile [19].…”

Section: Microbial Composition and Diversity In Lung Allotransplantationmentioning

confidence: 99%

Microbiosis in lung allotransplantation and xenotransplantation: State of the art and future perspective

Jiao

Tian

et al. 2022

Health Care Science

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The respiratory tract is known to harbor a microbial community including bacteria, viruses, and fungi. New techniques contribute enormously to the identification of unknown or culture-independent species and reveal the interaction of the community with the host immune system. The existing respiratory microbiome and substantial equilibrium of the transplanted microbiome from donor lung grafts provide an extreme bloom of dynamic changes in the microenvironment in lung transplantation (LT) recipients. Dysbiosis in grafts are not only related to the modified microbial components but also involve the kinetics of the host-graft "talk," which signifies the destination of graft allograft injury, acute rejection, infection, and chronic allograft dysfunction development in short-and long-term survival. Microbiome-derived factors may contribute to lung xenograft survival when using genetically multimodified pig-derived organs. Here, we review the most advanced knowledge of the dynamics and resilience of microbial communities in transplanted lungs with various pretransplant indications. Conceptual and analytical points of view have been illustrated along the time series, gaining insight into the microbiome and lung grafts. Future endeavors on precise tools, sophisticated models, and novel targeted regimens are needed to improve the long-term survival in these patients.

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“…As such, clearer guidelines and active involvement of transplant infectious diseases experts may lead to improved utilization of organs from those donors with MDROs. Also, emerging data regarding allograft microbiota and its role in graft function and rejection could eventually change our perspective on peri‐transplant antimicrobial practices 52,53 …”

Section: Introductionmentioning

confidence: 99%

Utility of deceased donor cultures in solid organ transplantation in preventing donor‐derived bacterial and fungal infectious diseases transmission

Boutin

Pouch

Ison

2023

Transplant Infectious Dis

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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 the risk of donor‐derived infection (DDI) and the consequence of organ non‐utilization and account for potential unintended effects of antimicrobial use in the recipient. In this review, we summarize the literature on bacterial and fungal DDIs, describe the significance of positive cultures by anatomic site, and summarize current guidance on the management of positive cultures from donors or preservation fluids.

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Influence of the microbiome on solid organ transplant survival

Cited by 10 publications

References 77 publications

Antimicrobial stewardship in solid organ transplant—Opportunities in the National Health Service

Antimicrobial stewardship in solid organ transplant—Opportunities in the National Health Service

Microbiosis in lung allotransplantation and xenotransplantation: State of the art and future perspective

Utility of deceased donor cultures in solid organ transplantation in preventing donor‐derived bacterial and fungal infectious diseases transmission

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