Long-Term Infectious Complications of Kidney Transplantation

Agrawal, Akanksha; Ison, Michael G.; Danziger‐Isakov, Lara

doi:10.2215/cjn.15971020

Cited by 61 publications

(73 citation statements)

References 101 publications

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“…Since the incidence of T-cell-mediated rejection (TCMR) has dramatically fallen over recent decades, BKPyV infection has emerged as a relevant cause of premature renal graft failure and loss, with incidence rates of associated nephropathy ranging from 1% to 5%. 83 A key role has been identified for BKPyV-specific T-cell-mediated and, to a lesser extent, antibody responses to prevent uncontrolled viral replication and cytopathic damage of the renal tubule epithelium. 84 Therefore, increasing research has been performed to explore the predictive value of blood TTV load for the specific outcome of BKPyV viremia, with mixed results.…”

Section: Association Between Ttv Load and Bk Polyomavirus Infectionmentioning

confidence: 99%

Viruses, friends, and foes: The case of Torque Teno Virus and the net state of immunosuppression

Redondo

Navarro

Paz‐Artal

et al. 2022

Transplant Infectious Dis

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Section: Association Between Ttv Load and Bk Polyomavirus Infectionmentioning

confidence: 99%

Viruses, friends, and foes: The case of Torque Teno Virus and the net state of immunosuppression

Redondo

Navarro

Paz‐Artal

et al. 2022

Transplant Infectious Dis

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“…Immunosuppression in transplantation is a balancing act, with rejection on one side and infection on the other side (13,14). Infectious diseases contribute significantly to death in kidney transplant recipients (KTRs) (15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

B Cell Composition Is Altered After Kidney Transplantation and Transitional B Cells Correlate With SARS-CoV-2 Vaccination Response

et al. 2022

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BackgroundThe COVID-19 pandemic has major implications on kidney transplant recipients (KTRs) since they show increased mortality due to impaired immune responses to SARS-CoV-2 infection and a reduced efficacy of SARS-CoV-2 vaccination. Surprisingly, dialysis patients have shown superior seroconversion rates after vaccination compared to KTRs. Therefore, we investigated peripheral blood B cell (BC) composition before and after kidney transplantation (KT) and aimed to screen the BC compartment to explain impaired antibody generation.MethodsA total of 105 patients were recruited, and multicolor flow cytometric phenotyping of peripheral venous blood BC subpopulations was performed before and 1 year after KT. Complete follow-up was available for 71 individuals. Anti-SARS-CoV-2 antibodies were collected retrospectively and were available for 40 subjects, who had received two doses of an mRNA-based vaccine (BNT162b2 or mRNA-1273).ResultsOverall, relative BC frequencies within lymphocytes decreased, and their absolute counts trended in the same direction 1 year after KT as compared to CKD G5 patients. Frequencies and absolute numbers of naïve BCs remained stable. Frequencies of double negative BCs, a heterogeneous subpopulation of antigen experienced BCs lacking CD27 expression, were increased after KT, yet their absolute counts were similar at both time points. Transitional BCs (TrBCs) and plasmablasts were significantly reduced after KT in absolute and relative terms. Memory BCs were affected differently since class-switched and IgM-only subsets decreased after KT, but unswitched and IgD-only memory BCs remained unchanged. CD86+ and CD5+ expression on BCs was downregulated after KT. Correlational analysis revealed that TrBCs were the only subset to correlate with titer levels after SARS-CoV-2 vaccination. Responders showed higher TrBCs, both absolute and relative, than non-responders.ConclusionTogether, after 1 year, KTRs showed persistent and profound compositional changes within the BC compartment. Low TrBCs, 1 year after KT, may account for the low serological response to SARS-CoV-2 vaccination in KTRs compared to dialysis patients. Our findings need confirmation in further studies as they may guide vaccination strategies.

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“…The usual timeline of infections in solid organ transplant recipients is also influenced by the graft function and at times higher than the usual immunosuppressive therapy, leading to increased risk of opportunistic infections. 33 Outside the peri‐transplant period, most of the care of solid organ transplant recipients is provided by their primary care physicians. Lack of experience in taking care of immunosuppressed patients, and diagnostic uncertainties with additional concerns for atypical presentation of infections, delayed symptoms onset with quick progression to severe disease, as well as worst‐case scenarios, such as loss of a precious transplanted organ, progression to severe disease requiring hospitalization or death, especially in the outpatient setting where patients cannot be observed closely may lead to either unwarranted or broader or more prolonged than necessary antibiotic prescriptions.…”

Section: Peri‐operative Antimicrobial Stewardshipmentioning

confidence: 99%

Outpatient and peri‐operative antibiotic stewardship in solid organ transplantation

Kinn

İnce

2022

Transplant Infectious Dis

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Background:The consequences of inappropriate antimicrobial use including resistance are increasingly recognized as a global public health threat and many steps have been taken over the last few decades to advance antimicrobial stewardship initiatives with most organ transplant centers currently part of institutions with active antimicrobial stewardship programs.Methods: A review of the literature was conducted and articles were categorized according to the topic and relevance in the judgment of the two authors.Results: A summary review of the currently available literature was created with a focus on periprocedural and outpatient antimicrobial stewardship. Limitations in the data were significant and discussed in the review. Conclusion:The principles of antimicrobial stewardship remain important throughout all phases starting with periprocedural prophylactic antimicrobial selection all the way through to discharge and subsequent healthcare encounters. Despite the broad advances in stewardship initiatives and the rapidly progressing supportive data overall there continue to be significant opportunities for additional research within various special patient populations including recipients of solid organ transplantation (SOT).The recent white paper published in the American Journal of Transplantation called to action the transplant and stewardship communities to have an increased focus and awareness of the issues that antimicrobial overuse can present in the SOT patient population. This is an important step that will hopefully generate more data in this group of patients that arguably faces the greatest vulnerability to the consequences of increased antimicrobial resistance.

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Long-Term Infectious Complications of Kidney Transplantation

Cited by 61 publications

References 101 publications

Viruses, friends, and foes: The case of Torque Teno Virus and the net state of immunosuppression

Viruses, friends, and foes: The case of Torque Teno Virus and the net state of immunosuppression

B Cell Composition Is Altered After Kidney Transplantation and Transitional B Cells Correlate With SARS-CoV-2 Vaccination Response

Outpatient and peri‐operative antibiotic stewardship in solid organ transplantation

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