Infections caused by Pneumocystis jirovecii (PJ), an opportunistic fungus, can have major consequences in terms of morbidity and mortality. These infections occur mainly in immunocompromised patients and are known for their pulmonary tropism (Pneumocystis pneumonia, PCP). Epidemiologically, more PJ infections are now encountered in the non-HIV (human immunodeficiency virus) population than in HIV-infected individuals. While prevention modalities have been studied in HIV-infected populations, evidence is scarce in non-HIV patients. The decision to prescribe prophylaxis for PJ requires assessment of the clinical context, as well as existing risk factors that may predispose an individual to develop PCP. Few indicators exist that are sufficiently sensitive and specific to predict the occurrence of PCP. While certain underlying conditions have clear recommendations for prophylaxis such as solid organ transplant recipients, evidence is scarce. The decision to use prophylaxis must be made while taking into consideration the overall context of the patient.

Pneumocystis pneumonia (PcP) caused by Pneumocystis jirovecii is one of the most common and serious opportunistic infections in immunocompromised patients. People at risk for developing Pneumocystis pneumonia include human immunodeficiency virus positive individuals, cancer patients, people receiving immunosuppressive therapy, organ transplant recipients and people with compromised immune systems. Despite effective treatment and prophylaxis, mortality is reported to be between 15-40%, even in people with immunodeficiency other than acquired immunodeficiency syndrome. Although the number of immunosuppressed patients is increasing, diagnostic and epidemiological studies for this agent are still insufficient. This study aimed to investigate the prevalance and epidemiological characteristics of P.jirovecii isolated from various patient groups. Among the 469 bronchoalveolar lavage fluids or sputum samples sent to the medical microbiology laboratory from various units, 114 samples were selected for indirect fluorescent antibody (IFA) testing and molecular studies based on an examination of the patients' files to determine underlying diseases, use of immunosuppressive drugs, corticosteroid treatments received and the presence of patchy or nodular ground-glass opacity on computed tomography scans and the presence of a cyst-like structure on May-Grunwald Giemsa staining. The presence of P.jirovecii was investigated by IFA and polymerase chain reaction methods and genotyping was performed by sequencing of mtLSU rRNA and internal transcribed spacer (ITS) region. The obtained ITS gene region DNA sequences were aligned and TCS network analysis was performed in the aligned region. As a result, positivity was found in eight samples out of 469 samples by using mtLSU rRNA genotyping, Genotype 1 (n= 3; 37.5%) was found to be the most common genotype in our samples. Genotype 2 (n= 2, 25%), genotype 4 (n= 2, 25%) and genotype 3 were the most frequently detected other genotypes, respectively. When the relationships between the sequences were examined, it was observed that our samples were generally related to the samples originating from Iran. In the present study, the genotyping analysis of the ITS region, constructed using the consensus sequence employed in the study by Lee et al., revealed that the most common genotype was Eh (n=3; 42.85%), followed by Bg (n= 2; 28.57%), Bi (n= 1; 14.28%) and Eg (n=1; 14.28%). Our study is the first genotyping study conducted in our country using the ITS gene region. Different epidemiological findings were found in P.jirovecii genotype frequencies in studies conducted in different geographies. This suggests that genetic variations in P.jirovecii have a geographical component and this may affect the distribution of P.jirovecii strains among humans. According to TCS network analysis, our samples are generally associated with samples originating from Iran. None of our samples are found alongside samples originating from India. However, in certain areas of the analysis, New World and Old-World samples exist together. It can be assumed that globalization and thus the increase in human movement over time has led to the spread of different genotypes to different geographical regions and the formation of genotypic mosaics in certain geographical regions. Man-made destruction of nature and the consequent intertwining of urban and rural boundaries, as well as global warming and climate change have undeniably contributed to these movements.

Intravesical Bacillus Calmette-Guerin (BCG) is a live attenuated vaccine for tuberculosis. Intravesical BCG (iBCG) administration is a highly effective immunotherapy for non-muscle invasive bladder cancer (NMIBC). Although live attenuated vaccines are generally contraindicated in solid organ transplant recipients (SOTR), iBCG has been utilized for NMIBC in SOTR. We describe the clinical manifestations, management, and outcomes of disseminated Mycobacterium bovis-BCG infection (Mb-BCGi) following iBCG therapy in SOTR for NMIBC. All adult patients (>18years of age) diagnosed with NMIBC who received iBCG across three tertiary referral and transplant centers between 2000 and 2025 were identified. The study cohort consisted of SOTR who had received iBCG for NMIBC and subsequently developed disseminated Mb-BCGi. English language literature review was performed to identify additional cases. A total of 4207 patients received iBCG during the study period. Thirty (0.71%) were SOTR, of whom two (6.7%) developed disseminated Mb-BCGi, including bloodstream infection and prostate abscesses. Literature review identified two additional disseminated Mb-BCGi cases in SOTR with lungs, bloodstream, and native kidney involvement, and one fatality. All cases required extended antimycobacterial therapy. Median times from SOT to Mb-BCGi and from iBCG to Mb-BCGi were 104 and 8months, respectively. SOTR appear to be at a higher risk of disseminated Mb-BCGi following iBCG. Administration of iBCG in SOTR with NMIBC warrants careful risk-benefit assessment and subsequent close monitoring.

ABSTRACT Background Live vaccination in patients with vascular anomalies (VA) receiving sirolimus remains controversial due to immunosuppressive effects and theoretical risks. Procedure This single‐center retrospective study included patients with VA less than 4 years old at the start of sirolimus therapy who were incompletely vaccinated. Immunologic evaluation during sirolimus therapy was categorized as normal, abnormal, or no/partial evaluation. Based on results, patients were encouraged to proceed with live attenuated vaccinations (varicella zoster virus [VZV]; measles–mumps–rubella [MMR]) or discussed with immunology. Vaccination outcomes were reviewed and reported descriptively. Results Among 45 eligible patients, 24 (53%) underwent complete immunologic evaluation. Thirteen of these (54%) had normal results; five of these (38%) were vaccinated while on sirolimus without complication. Eleven (46%) had abnormal evaluations; four of these (36%) were vaccinated while on sirolimus, with one developing a self‐limiting varicella‐like rash and fever. Twenty‐one patients (47%) had partial or no immunological evaluation; 10 of these (48%) proceeded with vaccination while on sirolimus without complications. Overall, 24 patients (53%) received live vaccines (19 on sirolimus, five after holding sirolimus therapy for at least 2 months), with only one experiencing a mild vaccine‐related event. No life‐threatening complications occurred. Conclusion In young patients with VA receiving sirolimus, live vaccine‐associated infection risk appears low and comparable to rates in solid organ transplant recipients on immunosuppression. Immunologic evaluation may help identify those at higher risk, though most tolerated vaccination without adverse events. Our practice prioritizes varicella vaccination first, given the availability of effective treatment for potential complications.

BackgroundKetamine has demonstrated efficacy in treatment-resistant depression, primarily in psychiatric or outpatient populations. Its use in ICU patients remains underexplored, with limited data beyond case reports and small series. This study evaluated the association between subanesthetic ketamine infusions and improvement in depressive symptoms and hemodynamic changes in ICU patients.MethodsWe conducted a retrospective study of adults admitted to the ICU who received IV ketamine (0.3-0.75 mg/kg over 40 min on three consecutive days) for depressive symptoms. Changes in depressive symptoms were assessed using routine clinical documentation by physicians, nurses, and occupational and physical therapists. Hemodynamic parameters (blood pressure and heart rate) were recorded before and up to 120 min after infusion. The primary outcome was to evaluate depressive symptoms while the secondary outcome was to assess hemodynamic changes post transfusion.ResultsThirty-four patients met criteria, including 18 solid organ transplant recipients. Median age was 59 years; 61.8% were male. Ketamine was associated with improvement in apparent sadness (90.0% vs 52.2%, P < .05) and reported sadness (95.0% vs 59.1%, P < .05). In transplant recipients, improvement in apparent sadness remained significant (80.0% vs 41.7%, P < .05). Hemodynamic parameters remained stable; heart rate increased transiently at 15-30 min post-infusion, returning to baseline by 60-90 min. Adverse effects observed were anxiety (12.5%), restlessness and/or agitation (10.4%), and dissociation (8.16%).ConclusionSubanesthetic ketamine improved specific depressive symptoms in critically ill ICU patients without significant hemodynamic instability. These findings support its potential as a rapid-acting antidepressant in the ICU, warranting further prospective trials.

Patients living with human immunodeficiency virus (HIV) infection have been gradually accepted as solid organ transplant recipients, although there is still concern that the burden of immunosuppression and HIV infection could increase the risk of post-transplant cancer. The risk of de novo cancer was evaluated in a prospective cohort of 272 HIV-positive and 816 matched HIV-negative liver transplant recipients in Spain (2002-2012). All tumors, except hepatocellular carcinoma recurrence and non-melanoma skin cancer, after liver transplant were considered as events and death as competing event in this study. Despite matching, patients with HIV were significantly younger (45.8 vs 49.3 years). Sixteen (5.9%) patients with HIV and 61 (7.5%) HIV-negative patients developed de novo cancers (P = .39) after a median follow-up of 59.8 and 72.3 months, respectively. The most frequently diagnosed types of tumors were non-Hodgkin lymphoma (n = 19), lung cancer (n = 14), and head and neck cancer (n = 14). Time of onset, distribution, and tumor stage at diagnosis were similar in both groups. The cumulative incidences of de novo cancer at 5 and 10 years were, respectively, 6% and 12% in patients with HIV and 6% and 13% in uninfected patients. Survival after cancer diagnosis did not differ between groups. The only factor related to the development of de novo cancers was a higher age at transplantation. Human immunodeficiency virus infection per se is not associated to a higher risk of de novo cancer after liver transplantation.

On Hybrid Skin Cancer Surveillance in Organ Transplant Recipients.

To define the incidence of donor-derived infection (DDI) in recipients of solid organ transplant (SOT) from donors with positive blood cultures and to assess the impact of shorter versus longer duration of targeted preemptive antibiotic therapy (PAT). Retrospective, single-center, cohort study. Mayo Clinic Arizona. Recipients transplanted between 1/1/2019 and 7/1/2024 who received an organ from a donor with positive blood cultures. The primary outcome was incidence of DDI. Secondary outcomes included duration of PAT and incidence of donor blood culture contamination. Among 199 SOT recipients from 167 unique donors with positive blood cultures, two recipients developed confirmed DDI within 30 days of SOT. Both cases were gram negative bacillary bacteremia not treated in donors and occurred immediately posttransplant prior to adequate recipient PAT. Six-month graft survival and recipient survival were 96.5% and 97.5% respectively. 139 recipients (69.8%) received PAT for a median duration of 7 days. There was no difference in rate of infections between recipients provided with ≤7 days versus 8-14 days of PAT for donor blood cultures; however, recipients who received 8-14 days had more Clostridioides difficile infections (CDIs) within 60 days of SOT (7.7% vs 1.5% ≤ 7 days, P = .040) and were more often discharged on intravenous antibiotics (32.3% vs 11.3%, P < .001). We observed a low rate of DDI following receipt of organs from donors with positive blood cultures. DDI occurred in cases without adequate donor/recipient treatment. Longer durations of targeted PAT resulted in more CDI and intravenous antibiotics on discharge.

Robotic Abdominal Wall Reconstruction in Transplant Patients: A Single Institution Case Series.

BackgroundImmunosuppressed organ transplant recipients experience higher rates of medically refractory chronic rhinosinusitis (CRS) requiring endoscopic sinus surgery (ESS).ObjectiveTo better understand the pathogenesis of CRS in immunosuppressed organ transplant recipients to aid in developing effective treatment protocols.MethodsStructured histopathology (SHP) reports of sinonasal mucosa were obtained for 27 transplant and 505 nontransplant patients with CRS undergoing ESS. SHP reports were compared to identify differences in the inflammatory environment between the 2 groups.ResultsSHP analysis revealed significantly higher rates of neutrophil infiltrate (48.1% vs 10.7%, P < .001), basement membrane thickening (74.1% vs 30.9%, P < .001), subepithelial edema (85.2% vs 25.7%, P < .001), and fibrosis (37.0% vs 16.8%, P = .008) in the sinus tissue of transplant patients compared to nontransplant patients, respectively.ConclusionCRS patients with a history of organ transplant overall displayed higher tissue neutrophilia and extensive tissue modeling on SHP. This patient population could potentially benefit from treatment modalities that are comparable to those used in patients with non-type 2 CRS.

Background/Objectives: Tuberculosis remains one of the preventable causes of mortality among liver transplant recipients. The prevalence of tuberculosis in solid organ transplant recipients is higher than in the general population. The aim of this study was to evaluate the incidence of latent tuberculosis infection (LTBI) and active tuberculosis after liver transplantation. Methods: This is a retrospective, single-center, case-control study. Adult liver transplant candidates who were evaluated between 1 January 2016 and 31 December 2022 were retrospectively assessed. Patients with pre-transplant tuberculin skin test (TST) and/or interferon-gamma release assay (IGRA) results who underwent transplantation were included in this study. Results: A total of 111 liver transplant recipients with available IGRA and/or TST results were included; 70 were men (63.1%) and 41 were women (36.9%), with a mean age of 53.5 ± 11.3 years. Demographic, clinical, and laboratory characteristics were evaluated. The most common indication for liver transplantation was viral hepatitis (33.3%), followed by cryptogenic cirrhosis (19.8%) and hepatocellular carcinoma (10.8%). All patients had a Bacillus Calmette-Guérin (BCG) vaccination scar. Ten patients received grafts from deceased donors, while 101 underwent living-donor liver transplantation. No patient received LTBI treatment before transplantation, whereas LTBI treatment was initiated in four patients after transplantation. None of the patients had a diagnosis of active tuberculosis prior to transplantation. Thoracic computed tomography revealed findings compatible with tuberculosis sequelae in 11 patients (9.9%). During a median follow-up period of 49 [27-64] months after transplantation, no cases of active tuberculosis were observed among patients with positive TST and/or IGRA results. Patients were divided into two groups according to their TST and IGRA results. Group 1 consisted of patients with IGRA positivity and/or a TST ≥ 5 mm, while Group 2 included patients with a TST < 5 mm and negative IGRA results. The only statistically significant difference between the groups was the administration of LTBI treatment (p = 0.027); four patients in Group 1 received LTBI therapy. None of these patients were able to continue prophylaxis due to treatment-related adverse effects. Conclusions: Prophylaxis with hepatotoxic agents poses a substantial risk in liver transplant candidates. Since the hepatotoxicity may cause early cessation of LTBI treatment, the risk-benefit ratio of post-transplant LTBI therapy should be carefully assessed. In situations where LTBI treatment is deferred, close clinical monitoring is strongly recommended.

Chagas disease (CD), a neglected tropical disease usually associated with Latin America, is increasingly recognized as an emerging infection in the United States. Screening for CD is recommended for solid organ transplant (SOT) candidates with epidemiologic risk factors; however, data on prevalence and post-transplant reactivation in the United States remain limited. We conducted a retrospective cohort study of SOT candidates and recipients screened for T. cruzi at a large transplant center in Miami, Florida. Demographics, clinical characteristics, and 2-year outcomes of recipients with CD were analyzed. Between August 1, 2013, and August 1, 2023, 6021 SOTs were performed. 1898 candidates (31%) were screened, and 21 (1.1%) tested positive for T. cruzi, of whom 10 were SOT recipients. All seropositive recipients were born in historically endemic areas. Median post-transplant surveillance was 13.5 (range 1-25) months. Seven patients developed Chagas disease reactivation (CDR) diagnosed by serum PCR; all were asymptomatic. Median time from transplantation to reactivation was 48days (range 22-426). Treatment with benznidazole for 60days cleared the parasitemia in all patients. At 2years, 80% (8/10) had graft survival, one patient died unrelated to CDR. We report a high incidence of CDR among SOT recipients at a US transplant center serving a predominantly immigrant population, with favorable 2-year outcomes. Most reactivation events occurred early post-transplant, although a later recurrence was also observed. Intensive monitoring for CDR proved effective in detecting reactivation prior to the onset of symptoms.

The Prevalence and Consequences of Supra-Normal Estimated Glomerular Filtration Rate in Pediatric Solid Organ Transplants: A Single Center Cohort.

The risk factors for donor-acquired (DA) CMV transmission in CMV-seronegative pediatric solid organ transplant (SOT) recipients (R-) receiving organs from CMV-seropositive donors (D+) remain unknown in the era of routine antiviral prophylaxis. DA-CMV transmission was defined as CMV antigenemia/DNAemia and/or seroconversion in a D+/R- recipient by 13 months post-transplant. DA-CMV transmission, along with donor and recipient demographics, was studied in a retrospective cohort of CMV D+/R- children who had a SOT at the Stollery Children's Hospital from 2000 to 2018. All patients were expected to receive at least 3 months of CMV-active antiviral prophylaxis. 105 CMV D+/R- pediatric SOT recipients (48 liver, 35 heart, 4 lung, 18 kidney) were analyzed; DA-CMV transmission occurred in 58 patients (55%). Frequency of DA-CMV transmission was highest in lung (75%), followed by liver (69%), then kidney (61%), and was lowest in heart recipients (31%). Median time to DA-CMV transmission was 4.8 months (3.4-6.7). In a multivariable cox regression model including organ, donor and recipient age and sex, risk of DA-CMV transmission was significantly lower in heart versus liver recipients (HR 0.30, 95% CI 0.14, 0.65, p = 0.003). Understanding factors that result in non-transmission of CMV to seronegative recipients despite receiving a seropositive organ may guide more targeted use of antiviral prophylaxis in pediatric SOT recipients.

Pneumocystis jirovecii, an atypical fungus, is a recognized cause of severe pneumonia in individuals with HIV. However, P jirovecii pneumonia (PJP) is now increasingly encountered among immunocompromised patients without HIV, including those receiving treatment for hematologic or solid organ malignancies, solid organ or bone marrow transplant recipients, patients with autoimmune diseases treated with immunosuppressive therapy, and patients requiring prolonged corticosteroid therapy; many of whom may not receive prophylaxis. This article summarizes characteristic and atypical chest CT findings of PJP in immunocompromised patients to support early recognition. Diffuse pulmonary ground-glass opacity (GGO) is the most common chest CT manifestation and should strongly suggest PJP in immunocompromised patients, although variant patterns, particularly peripheral and upper lobe predominant distributions, are frequently observed; midlung and basilar distributions are rare. Consolidation is also common, especially in more severely ill patients, but neither GGO nor consolidation distribution reliably differs across underlying causes of immunocompromise. Interlobular septal thickening and mosaic attenuation are additional CT findings, and, although lymphadenopathy and pleural effusion may occur, these often reflect the underlying condition causing immunocompromise or comorbid disease rather than PJP itself. Cyst formation may be observed and can predispose to pneumothorax. CT abnormalities often improve quickly after initiation of PJP-directed therapy, but not in all patients. Atypical CT manifestations, including nodules (with solid nodules potentially representing "granulomatous" PJP), masses, and cavitation, should raise suspicion for coinfection or other superimposed processes. Complex or mixed CT patterns in patients with PJP may result from the disease predisposing to immunocompromise or from its treatment, underscoring the importance of clinical context in interpreting chest CT findings. Keywords: CT, Pulmonary, Thorax, Lung, Infection, Transplantation, Pneumocystis jirovecii Pneumonia, Immunosuppression, Ground-Glass Opacity Supplemental material is available for this article. © RSNA, 2026.

The purpose of our study was to assess UTD status of routine childhood vaccinations at the time of organ transplant among our institution's pediatric SOT recipients and assess the reasons behind underimmunization. We reviewed vaccination records of pediatric recipients of heart, kidney, and liver transplants at Mayo Clinic, Rochester, MN who received a transplant between January 2011 and December 2024. All immunizations received prior to date of transplantation were included. Once immunization status was determined, the EMR was further reviewed to assess reasons why patients were not UTD. A total of 204 patients were included in the study after meeting inclusion criteria: 68 kidney, 80 heart, and 55 liver transplant recipients; one patient received both a liver and kidney transplant. Seventy-seven patients (37.7%) were UTD at the time of SOT. When excluding live vaccines, 90 patients (44.1%) were UTD. The series most commonly not UTD was HPV (59 patients not UTD, 28.9%); the most UTD series was pneumococcal vaccine (six patients not UTD, 2.9%). Among 127 patients not UTD, 30 (23.6%) patients were not UTD due to time-based factors, followed by 27 (21.3%) due to patient-based factors, 25 (19.7%) due to provider-based, 14 (11%) due to medically contraindicated, and 14 (11%) due to hospital policy factors. Seventeen patients (13.4%) were classified as multi-category. Less than 40% of pediatric SOT recipients were UTD on routine immunizations at time of transplant. This was due to a variety of factors. Strategies to increase uptake of immunizations prior to transplant among this vulnerable group should be further explored.

Immunocompromised patients include those with innate T or B cell suppression, acquired immunodeficiency states such as those caused by human immunodeficiency virus infection, and those with medication-induced immunosuppression (chemotherapy or immunotherapy, solid organ transplant recipients). Any of these entities can place patients at increased risk of severe respiratory infection. We propose an algorithmic approach to the diagnosis of pulmonary complications that can arise in the immunocompromised patient. The first step is to gather all relevant clinical data to understand the history leading up to presentation, as well as the specific underlying immunosuppressive state. Following this, the clinician must identify the predominant imaging pattern of disease to help narrow the differential diagnosis and guide clinical management. Third, the time course of the clinical and imaging findings should be classified as acute, subacute, or chronic. We define the distinction between acute/subacute and chronic disorders as before or after 12 weeks. At the conclusion of these steps, it is hoped that a tailored differential diagnosis will allow for a rapid and precise management plan of these challenging patients.

Solid organ transplant recipients are at increased risk of developing head and neck squamous cell carcinoma (HNSCC). These patients often require free flap reconstruction; however, data on outcomes in this immunosuppressed population remain limited and formal management guidelines are lacking. We conducted a systematic review and pooled proportions meta-analysis, and a retrospective institutional database review, to compare outcomes of head and neck free flap reconstruction in transplant versus non-transplant patients. Cancer-related mortality and time from surgery to death were also assessed. The systematic review yielded four eligible studies. Kidney transplantation and anterolateral thigh flaps were the most common. Prednisone was the predominant immunosuppressant. The pooled flap success rate was 97%, with recipient and donor site complication rates of 21% and 16%, respectively. Our database had 14 transplant patients who underwent head and neck reconstruction for oral SCC (n = 12) or osteoradionecrosis (n = 2). Tacrolimus was the most common immunosuppressant. Recipient/donor site dehiscence, skin graft loss, and reoperation were significantly higher in transplant patients. Rates of infection, salivary leak, hardware exposure, or hematoma were similar. Overall mortality was significantly higher in transplant patients (64% vs. 23%; p < 0.001), although the 2-year mortality did not differ on Kaplan-Meier analysis. Although free flap survival in transplant patients is comparable to non-transplant patients, postoperative complication rates are higher. Given their distinct risk profile and poorer prognosis, transplant patients with HNSCC may benefit from dedicated treatment guidelines.

ObjectiveHead/neck location and immunosuppression are independent risk factors related to cutaneous head and neck squamous cell carcinomas (cHNSCCs) in solid organ transplant recipients (SOTRs). Traditional staging criteria underperform in risk stratification. We aim to identify the utility of clinicopathologic factors for risk stratification of cHNSCCs in SOTRs.Study DesignRetrospective cohort study.SettingSingle tertiary center.MethodsSOTRs with surgically resected cHNSCCs between 2009 and 2019 were reviewed. Deeply invasive cHNSCCs extended deep to the subcutis. Data were extracted from electronic records. Overall survival was analyzed by level of invasion and transplant type using Mantel‐Cox test and by age at transplant and age at first posttransplant cHNSCC using univariate Cox regression. Level of invasion was evaluated using unpaired t‐tests for age at transplant, age at first posttransplant cHNSCC, and overall lifespan; ANOVA for transplant type; and chi‐square test for sex and ethnicity.ResultsOf 77 identified patients, 44 (100% White, 97.7% non‐Hispanic, 81.8% male) met criteria. Sixteen developed deep invasion. Deep invasion correlated with decreased overall survival (P = .0021) and shorter overall lifespan (P = .02). Age at first cHNSCC (HR = 1.00, 95% CI = 0.96‐1.04), age at transplant (HR = 1.02, 95% CI = 0.98‐1.07), and transplant type (P = .83) were unrelated to overall survival. Age at transplant approached significance (P = .07) for deep invasion. There was no difference in level of invasion by sex (P = .12), ethnicity (P = .18), or transplant type (P = .21).ConclusionDeeply invasive cHNSCCs are associated with decreased overall survival in SOTRs. Age at transplant approaches significance for deep invasion. Data on immunosuppression and genetic analysis may further enhance prognostication.

WCN26-4881 MANAGEMENT OF NOROVIRUS INFECTION IN SOLID ORGAN TRANSPLANT RECIPIENTS: A SCOPING REVIEW