Cellular Therapies in Transplantation - Regulatory T Cell Therapies and Virus Specific Therapies.

Mycobacterium tuberculosis in Solid Organ Transplant Recipients

Assessing and restoring adaptive immunity to HSV, VZV, and HHV-6 in solid organ and hematopoietic cell transplant recipients

Introduction: Infection in Solid Organ Transplant Recipients

The reduced incidence of respiratory viral infections in transplant recipients during the COVID-19 pandemic – A retrospective observational cross-sectional analysis of admissions to a tertiary haematology unit

This chapter discusses the role of nucleic acid tests in the diagnosis and management of herpes simplex virus (HSV), varicella-zoster virus (VZV), human herpesvirus 6 (HHV-6), cytomegalovirus (CMV), Epstein-Barr virus (EBV), BK virus (BKV), parvovirus (erythrovirus) B19, and adenovirus in hematopoietic and solid-organ transplant recipients. HSV most commonly causes reactivation of oral or genital mucocutaneous lesions in transplant recipients. The majority of transplant recipients are VZV seropositive pretransplantation, and at risk for VZV reactivation, most commonly in the form of zoster. Due to the severity of primary VZV infection in transplant recipients, solid-organ transplant candidates should be screened for antibody to VZV prior to transplantation, and consideration should be given to administration of the varicella vaccine prior to transplantation to solid-organ transplant candidates who have no history of prior VZV disease and are VZV seronegative. To complicate the matter, some pediatric liver and heart transplant recipients may exhibit chronic high EBV viral loads. Molecular diagnostics play a paramount role in the diagnosis and management of transplant recipients with infections caused by viruses. These methods have greatly enhanced diagnosis of viral infections due to the increase in speed and sensitivity compared to traditional antigen detection or culture methods. In addition, routine monitoring of transplant recipients for CMV, EBV, and BKV viremia using these methods has become the standard of care at many transplant centers, and this monitoring has facilitated earlier clinical interventions that have dramatically reduced morbidity caused by these viruses.

Community-acquired respiratory viruses

Parasitic Infections in Solid Organ Transplantation

Human Herpesvirus 6, 7 and 8 in Solid Organ Transplantation

Viral infections are some of the most common complications in transplant recipients as a result of these patients' immunocompromised status. The ability to accurately detect and identify viral pathogens in transplant patients is important to tailor therapy and improve outcomes. In this chapter, we review the role of molecular tests in the diagnosis and management of human adenovirus (HAdV), BK virus (BKV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), herpes simplex virus (HSV), parvovirus B19, and varicella-zoster virus (VZV) in hematopoietic stem cell transplant (HSCT) and solid-organ transplant (SOT) recipients.

Fever, Hepatosplenomegaly and a Skin Nodule in a Kidney–Pancreas Transplant Recipient

Chimeric antigen receptor Treg therapy in transplantation

Advances in the care of immunocompromised hosts have been driven by the development of a variety of increasingly potent immunosuppressive agents for use in solid-organ and hematopoietic stem cell transplant recipients. Routine prophylaxis with trimethoprim-sulfamethoxazole and antiviral agents has reduced the incidence of Pneumocystis pneumonia, nocardiosis, and respiratory, urinary, and gastrointestinal infections due to susceptible pathogens and cytomegalovirus (CMV) infection. Data from retrospective studies allow some generalizations about respiratory viral infections in transplant recipients. Direct detection of viral antigens in respiratory tract specimens using monoclonal antibodies may have increased sensitivity compared with the rapid, commercially available methods. The possibility that immune status plays a pivotal role in the transmission of severe acute respiratory syndrome (SARS) was suggested by the identification of individuals who appeared to be “super spreaders” of infection. Adenoviral disease is best described in pediatric liver transplant recipients but is also described in individuals following kidney, small bowel, lung, and heart transplantation. Vaccination is recommended annually, as much of the burden of influenza is related to secondary superinfections, graft rejection (in lung transplant recipients), or graft-versus-host disease (in HSCT recipients). Respiratory viral infections are a risk factor for graft rejection, particularly chronic graft rejection in lung transplant recipients.

Parasitic Infections in Solid Organ Transplant Recipients

Posttransplant Lymphoproliferative Disorder Following Kidney Transplant

Respiratory viral infections (RVIs) are among the leading cause of morbidity and mortality in pediatric hematopoietic stem cell transplant (HCT) and solid organ transplant (SOT) recipients. Transplant recipients remain at high risk for super imposed bacterial and fungal pneumonia, chronic graft dysfunction, and graft failure as a result of RVIs. Recent multicenter retrospective studies and prospective studies utilizing contemporary molecular diagnostic techniques have better delineated the epidemiology and outcomes of RVIs in pediatric transplant recipients and have advanced the development of preventative vaccines and treatment interventions in this population. In this review, we will define the epidemiology and outcomes of RVIs in SOT and HSCT recipients, describe the available assays for diagnosing a suspected RVI, highlight evolving management and vaccination strategies, review the risk of donor derived RVI in SOT recipients, and discuss considerations for delaying transplantation in the presence of an RVI.