Outcomes In Transplant Recipients Research Articles

Impact of preoperative bloodstream infection on outcomes of pediatric liver transplant recipients treated for acute liver failure.

Acute liver failure (ALF) is a component of multisystem organ failure that causes severe liver dysfunction in patients without underlying chronic liver disease. The patients with ALF are prone to have infections, including bacteremia. However, studies of the infectious impact for post liver transplantation (LT) in pediatric ALF are limited. We aimed to evaluate our current practice for pediatric LT cases of ALF with preoperative bacteremia. The records of all patients under 18 years old undergoing LT for ALF in our center from November 2005 to December 2021 were collected. They were divided into two groups: those with a preoperative bloodstream infection (BSI) and those without (NBSI). We compared the preoperative status and also reviewed the details of the BSI group. Intraoperative course and postoperative outcomes were also compared. There were 19 BSI patients and 66 NBSI patients. One BSI case was detected on the day of LT. This patient had no changes in vital signs and general condition. After evaluation and therapeutic intervention by pediatric infectious disease specialists, LT was performed on the same day. Five cases developed septic shock at the time of detection of BSI. All BSI patients were in stable condition on the operation day with proper interventions. There were no significant differences in mortality and hospital stay between both groups. LT might be able to be performed for pediatric ALF even with positive blood cultures. In addition, appropriate therapeutic intervention by specialists and patient's stable condition before LT are essential.

2732. Peri-Operative Antibiotic Management for Lung Transplant Recipients with Cystic Fibrosis

Abstract Background Lung transplant (LTx) recipients universally receive peri- and post-transplant antibiotics. Approaches to antibiotics for candidates with cystic fibrosis (CF) are institution specific. Little has been published about these practices. Routine LTx perioperative prophylaxis at our institution is 96 hours of vancomycin and cefepime with antibiotics then adjusted for positive intraoperative donor and recipient cultures. In recipients with CF, perioperative prophylaxis is determined pre-LTx to cover colonizing organisms isolated in culture from the 2 years before LTx, adjusted for intraoperative cultures, and administered for 14-21 days post-LTx. Our study aims to add to the current literature by describing our center’s experience with antibiotic management and outcomes in lung transplant recipients with CF to help guide best practices for prophylaxis strategies for this patient population. Methods We performed a retrospective chart review of patients with CF who underwent LTx from 3/1/2015-11/18/21 at our center and were colonized pre-LTx with MRSA, Pseudomonas aeruginosa, or Burkholderia cepacia complex. Peri- and post-operative antibiotic regimens, donor and recipient culture results, changes in antibiotic therapy post-LTx, and duration of antibiotic therapy were documented. Outcomes included rehospitalization, isolation in culture of the prophylaxis-targeted organisms post-LTx, and mortality, within 6 months of LTx. Results Nineteen incidents of LTx were included in this study. Pre-LTx colonizing organisms and antibiotics administered are outlined in table 1. Prophylaxis-targeted organisms were infrequently isolated in culture after LTx (table 2), with 7/19 (36.8%) developing post-transplant infection with prior colonizing organisms. Four (21.1%) recipients developed post-LTx Clostridioides difficile infection. One (5.3%) recipient died within 6 months post-LTx. Conclusion LTx recipients with CF who received targeted perioperative prophylaxis for pre-LTx colonizing organisms infrequently developed post-LTx culture positivity with the same bacteria including none during the antimicrobial prophylaxis period. Future prospective studies are needed to determine optimal antibiotic duration of peri-LTx antibiotics in this patient population. Disclosures All Authors: No reported disclosures

2733. Evusheld (AZD7442) Uptake and COVID-19 Outcomes in Solid Organ Transplant Recipients: A Secondary Analysis

Abstract Background Evusheld is a pre-exposure prophylaxis for COVID-19. It was recommended for high-risk populations, including solid organ transplant (SOT) recipients, due to their increased risk of severe COVID-19 and suboptimal vaccine response. Evusheld received emergency use authorization (EUA) in 12/2021, which was withdrawn on 1/27/2023 due to limited strain efficacy. This study examines Evusheld uptake among SOT recipients and evaluates the frequency and outcomes of COVID-19 infections in those receiving at least one dose. Methods We performed a secondary analysis using data from adult SOT recipients (heart, kidney, liver) enrolled in a phase II, multicenter, randomized controlled, double-blind immunogenicity and safety clinical trial for influenza vaccines. Our study included patients enrolled at Vanderbilt University Medical Center between 1/11/2021 and 2/28/2023 who had undergone transplantation before 1/27/2023. Demographic characteristics, transplant history, and COVID-19 vaccine information were obtained from the study database. We conducted chart abstractions until 4/27/2023 to collect data on COVID-19 infections, outcomes, and Evusheld receipt and dosage. Results Our study included 62 heart, 93 kidney, 14 liver, and 12 multiple-organ transplant recipients, for a total sample size of 181. Overall, 99 patients (54.7%) received Evusheld. We did not find sufficient evidence of differences in demographic characteristics or frequency of symptomatic COVID-19 infections between those who received Evusheld vs. those who did not. None of the 14 liver transplant recipients received Evusheld, and patients who received Evusheld were more likely to have been transplanted during the EUA period (Table 1). The number of posttransplant COVID-19 infections was 0.09 per person-years in those who did not receive Evusheld. Among those who received Evusheld, the number of posttransplant COVID-19 infections was 0.14 per person-years pre-Evusheld and 0.08 post-Evusheld (Table 2; Figure). Demographics, clinical characteristics, and COVID-19 outcomes of adult solid organ transplant recipients who received a transplant between 08/09/2020 and 01/22/2023, stratified by Evusheld receipt (N=181). Timing and characteristics of COVID-19 infections in 181 adult solid organ transplant recipients. Figure Timeline of COVID-19–related events in those who tested positive for COVID-19 at least once and (a) did not receive Evusheld or (b) received at least one dose of Evusheld. Conclusion Despite recommendations, Evusheld uptake among SOT recipients in our cohort was suboptimal. Additional research is needed to understand factors associated with suboptimal Evusheld uptake and to evaluate the effectiveness of monoclonal antibodies against COVID-19. Disclosures Daniel Dulek, MD, Eurofins Viracor: Research supplies Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support|Quidell: Grant/Research Support|Quidell: donation of kits|Sanofi: Grant/Research Support|Sanofi: vaccine support

2728. Bronchial Cultures at Time of Transplant Affect Anastomotic Outcomes in Lung Transplant Recipients

Abstract Background Anastomotic complications after lung transplant cause significant morbidity and mortality. Estimates of complication prevalence in lung transplant recipients range from 5-20%. Many factors are hypothesized to contribute to airway complications, including the presence of bacteria and fungi at time of transplant. Our aim was to examine the contribution of airway cultures at the time of transplant to airway complications. Methods We performed a retrospective analysis of lung transplant recipients who developed bronchial complications at a single, tertiary care center between January 1, 2016 and March 31, 2020. We identified 68 cases with anastomotic complications during this time period, then compared this cohort to 131 cases without bronchial complications. Primary outcomes were airway complications at 30 and 90 days. Please refer to the attached tables for variables of interest. Results Of 199 total study participants, 68 (34%) were found to have airway complications. Overall, the most common bacterial isolate was Staphylococcus aureus (72 MSSA and 17 MRSA). The most common fungal isolate was Candida albicans (87). When examining the patients with airway complications, MRSA isolates at time of transplant showed a statistically significant increase in airway complications (p=0.03, OR=3). An increase in airway complications was not seen for patients with other positive bacterial or fungal cultures at 30 days or 90 days. Microbiological Risk Factors for Airway Complications Patient Demographics and Characteristics Conclusion MRSA isolates at time of transplant correlated to increased 30 day and 90 day bronchial complications. This study helps confirm the importance of monitoring airway cultures at the time of transplant. A multi-center study with a larger sample size may be needed to further delineate contributions of specific microorganisms, surgical techniques, as well as perioperative and prophylactic antimicrobials on bronchial complications. Disclosures Aaron D. Mishkin, MD, Pfizer: Grant/Research Support|Takeda: Advisor/Consultant

Acute Rejection of the Lung Allograft: Phenotypes and Management

Treatment options for end stage lung diseases are limited to stabilizing lung failure, decreasing disease progression, and symptom management, but significant reversal of lost lung function is often not possible. For well selected patients, lung transplantation may be a viable option to improve both longevity and quality of life. Though outcomes for lung transplant recipients have improved over several decades, long term survival still lags behind that of other solid organ transplant recipients. Longevity after lung transplantation is limited by chronic lung allograft dysfunction. Numerous insults to the allograft contribute to chronic rejection, alloimmune injuries including acute T-cell mediated and antibody mediated rejection are chief among them. Therefore, monitoring for and management of acute cellular and antibody mediated rejection are of paramount importance to those caring for lung transplant recipients. We provide an up to date and comprehensive review of acute rejection affecting lung allografts and attempt to highlight pathophysiology, risk factors, clinical presentation, rejection phenotypes, management strategies, as well as related from of acute allograft injury.

Impact of everolimus plus calcineurin inhibitor on formation of non-HLA antibodies and graft outcomes in kidney transplant recipients: 12-month results from the ATHENA substudy.

Non-human leukocyte antigen (non-HLA) antibodies including antibodies targeting Angiotensin II type 1 (AT1R) and Endothelin-1 type A (ETAR) receptors represent a topic of interest in kidney transplantation (KTx). This exploratory substudy evaluated the impact of everolimus (EVR) or mycophenolic acid (MPA) in combination with tacrolimus (TAC) or cyclosporine A (CsA) in patients with preformed non-HLA antibodies, potentially associated rejections and/or their impact on renal function over 1 year. All eligible patients were randomized (1:1:1) before transplantation to receive either EVR/TAC, EVR/CsA, or MPA/TAC regimen. The effect of these regimens on the formation of non-HLA antibodies within one year post de novo KTx and the association with clinical events was evaluated descriptively in randomized (n = 268) population. At Month 12, in EVR/TAC group, higher incidence of patients negative for AT1R- and ETAR-antibodies (82.2% and 76.7%, respectively) was noted, whereas the incidence of AT1R- and ETAR-antibodies positivity (28.1% and 34.7%, respectively) was higher in the MPA/TAC group. Non-HLA antibodies had no influence on clinical outcomes in any treatment group and no graft loss or death was reported. The studied combinations of immunosuppressants were safe with no influence on clinical outcomes and suggested minimal exposure of calcineurin inhibitors for better patient management. https://clinicaltrials.gov/ (NCT01843348; EudraCT number: 2011-005238-21).

Optimal tacrolimus trough levels and allograft outcomes in kidney transplant recipients: insights from a multicenter real-world study in South Korea

Optimal tacrolimus trough levels and allograft outcomes in kidney transplant recipients: insights from a multicenter real-world study in South Korea

Effects of personalized nutrition counseling on dietary intake and health outcomes in Vietnamese kidney transplant recipients

Effects of personalized nutrition counseling on dietary intake and health outcomes in Vietnamese kidney transplant recipients

Urinary tract infection incidence, risk factors and impact on short term outcome in kidney transplant recipients in Mongolia

Urinary tract infection incidence, risk factors and impact on short term outcome in kidney transplant recipients in Mongolia

The impact of sarcopenic obesity on survival outcomes in kidney transplant recipients: a retrospective study

The impact of sarcopenic obesity on survival outcomes in kidney transplant recipients: a retrospective study

Differential in Kidney Graft Years on the Basis of Solitary Kidney, Simultaneous Liver-Kidney, and Kidney-after-Liver Transplants.

The number of simultaneous liver-kidney (SLK) transplants has significantly increased in the United States. There has also been an increase in kidney-after-liver transplants associated with 2017 policy revisions aimed to fairly allocate kidneys after livers. SLK and kidney-after-liver candidates are prioritized in allocation policy for kidney offers ahead of kidney-alone candidates. We compared kidney graft outcomes of kidney-alone transplant recipients with SLK and kidney-after-liver transplants using paired kidney models to mitigate differences among donor risk factors. We evaluated recipient characteristics between transplant types and calculated differential graft years using restricted mean survival estimates. We evaluated 3053 paired donors to kidney-alone and SLK recipients and 516 paired donors to kidney-alone and kidney-after-liver recipients from August 2017 to August 2022. Kidney-alone recipients were younger, more likely on dialysis, and Black race. One-year and 3-year post-transplant kidney graft survival for kidney-alone recipients was 94% and 86% versus SLK recipients 89% and 80%, respectively, P < 0.001. One-year and 3-year kidney graft survival for kidney-alone recipients was 94% and 84% versus kidney-after-liver recipients 93% and 87%, respectively, P = 0.53. The additional kidney graft years for kidney-alone versus SLK transplants was 21 graft years/100 transplants (SEM=5.0) within 4 years post-transplantation, with no significant difference between kidney-after-liver and kidney-alone transplants. Over a 5-year period in the United States, SLK transplantation was associated with significantly lower kidney graft survival compared with paired kidney-alone transplants. Most differences in graft survival between SLK and kidney-alone transplants occurred within the first year post-transplantation. By contrast, kidney-after-liver transplants had comparable graft survival with paired kidney-alone transplants.

Clinical outcomes of renal transplant recipients undergoing percutaneous coronary intervention

Abstract Background Cardiovascular disease is the leading cause of mortality among renal transplant (RT) recipients. Despite this, the clinical outcomes of patients with RT undergoing percutaneous coronary intervention (PCI) remain poorly elucidated. Purpose This study compared characteristics and outcomes among three groups of patients undergoing PCI: (1) RT recipients, (2) patients receiving dialysis and (3) patients with stage 3 chronic kidney disease (CKD) (estimated glomerular filtration rate 30–59 ml/min/1.73m²) without previous RT. Methods Data were analyzed for consecutive patients undergoing PCI enrolled in a large, multicenter Australian registry between 2014 and 2021 stratified into RT (n=226), dialysis (n=992) and CKD (n=15,534) groups. The primary outcome was 30-day major adverse cardiac and cerebrovascular events (MACCE) (composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularization and stroke). Long-term mortality was derived from linkage with the Australian National Death Index. Multivariable logistic and Cox regression were performed to assess the risk of 30-day MACCE and long-term mortality, respectively. Results RT recipients were younger compared to dialysis and CKD patients (61±10 vs 68±12 vs 78±8.2 years, p&amp;lt;0.001). The majority of patients were male: 72%, 76% and 61% in RT, dialysis, and CKD groups, respectively (p&amp;lt;0.001). RT patients had fewer comorbidities (diabetes mellitus, peripheral vascular disease and previous cerebrovascular events) than dialysis patients, however more than the CKD group (all p&amp;lt;0.001). Compared to dialysis and CKD groups, RT patients less frequently had severe left ventricular dysfunction (14% and 8.5% vs 6.7%), however more often presented with acute coronary syndrome (52% and 48% vs 58%), especially ST-elevation myocardial infarction (12% and 17% vs 20%) (all p&amp;lt;0.001). RT and CKD patients had lower rates of in-hospital mortality (2.7% and 3.8% vs 6.4%), target vessel revascularization (0.4% and 0.7% vs 1.7%) and 30-day MACCE (4.4% and 6.8% vs 11.6%) compared to the dialysis group (all p&amp;lt;0.001). Three-year survival was similar between RT and CKD groups, however lower in the dialysis group (80% and 83% vs 60%) (p&amp;lt;0.001) (Figure 1). After adjustment, dialysis at baseline was an independent predictor of 30-day MACCE (OR 1.90, 95% CI 1.44–2.50, p&amp;lt;0.001), however RT status was not (0.91, 0.42–1.96, p=0.802). In contrast, both RT status (HR 2.07, 95% CI 1.46–2.95, p&amp;lt;0.001) and dialysis at baseline (1.35, 1.02–1.80, p=0.036) conferred a heightened long-term hazard for mortality (Figure 2). Conclusions RT recipients have more favorable clinical outcomes following PCI compared to patients receiving dialysis. Nevertheless, despite having similar short-term outcomes to those with CKD, the hazard of long-term mortality is significantly greater for RT recipients. Close follow-up is warranted in this high-risk population.Figure 1Figure 2

Slaying the "Troll of Transplantation"-new frontiers in cytomegalovirus management: A report from the CMV International Symposium 2023.

The 2023 International CMV Symposium took place in Barcelona in May 2023. During the 2-day meeting, delegates and faculty discussed the ongoing challenge of managing the risk of cytomegalovirus infection (the Troll of Transplantation) after solid organ or hematopoietic cell transplantation. Opportunities to improve outcomes of transplant recipients by applying advances in antiviral prophylaxis or pre-emptive therapy, immunotherapy, and monitoring of cell-mediated immunity to routine clinical practice were debated and relevant educational clinical cases presented. This review summarizes the presentations, cases, and discussions from the meeting and describes how further advances are needed before the Troll of Transplantation is slain.

Viral specific T cell therapy in kidney transplant recipients - A single-center experience.

Viral infections such as adenovirus (ADV), BK virus (BKV), and cytomegalovirus (CMV) after kidney transplantation negatively impact outcomes in transplant recipients despite advancements in screening and antiviral therapy. We describe our experience of using the virus-specific T cell therapy (VSTs) in kidney transplant recipients (KTR) at our transplant center. This is a retrospective, single center review of KTR with ADV, BKV and CMV infections between June 2021 and December 2022. These patients received third party VSTs as part of the management of infections. The immunosuppression, details of infection and outcome data were obtained from electronic medical records. Two cases of ADV infection resolved after one infusion of VSTs. The response rate of BKV and CMV infection was not as robust with close to 50% reduction in median viral load after VSTs. Out of 23 patients, two patients developed chronic allograft nephropathy from membranoproliferative glomerulonephritis and acute rejection. Patients that are resistant to antivirals or who have worsening viremia despite conventional management may benefit from VSTs therapy to treat underlying viral infection. Additional studies are needed to ascertain efficacy and short- and long-term risks secondary to VSTs.

Feasibility of a mindfulness intervention on sleep disturbance, immune function, and clinical outcomes in hematopoietic stem cell transplant recipients

Feasibility of a mindfulness intervention on sleep disturbance, immune function, and clinical outcomes in hematopoietic stem cell transplant recipients

Prolonged travel time to transplantation center is associated with poor outcomes following heart transplantation

BackgroundThis study aims to examine the impact of home-to-transplantation center travel time as a potential barrier to healthcare accessibility. MethodsObservational study examined adult heart transplant recipients who received a graft between 2012 and 2022 in the United States. Travel time was calculated using the Google Distance Matrix API between the recipient's residence and transplantation center. A multivariable parametric survival model was fitted to minimize confounding bias. ResultsAmong the 25,923 recipients that met the selection criteria, the median travel time was 51 ​min and 95 ​% of recipients lived within a 5-h radius of their center. White recipients experienced longer median travel times (62 ​min, p ​< ​0.001) compared to Black (36 ​min) or Hispanic (40 ​min) recipients. A travel time of 1–2 ​h (survival time ratio [STR] 0.867, p ​= ​0.035) or >2 ​h (STR 0.873, p ​= ​0.026) away from the transplantation center was independently associated with lower long-term survival rates. ConclusionExtended travel times to transplantation centers may negatively impact long-term survival outcomes for heart transplant recipients, suggesting the need to address this potential barrier to healthcare accessibility.

Implementing a Structured Transition from Pediatric to Adult Care Can Impact Clinical Outcomes in Young Adult Kidney Transplant Recipients

Implementing a Structured Transition from Pediatric to Adult Care Can Impact Clinical Outcomes in Young Adult Kidney Transplant Recipients

Exploring the Diversity of Clinical Profiles and Outcomes in Kidney Transplant Recipients with Limited Education Using Clustering Analysis

Exploring the Diversity of Clinical Profiles and Outcomes in Kidney Transplant Recipients with Limited Education Using Clustering Analysis

Role of Angiopoietins in Cardiovascular Disease (CVD) Outcomes of Kidney Transplant Recipients

Role of Angiopoietins in Cardiovascular Disease (CVD) Outcomes of Kidney Transplant Recipients

Prevalence of Polypharmacy and Associated Adverse Outcomes in Kidney Transplant Recipients

Prevalence of Polypharmacy and Associated Adverse Outcomes in Kidney Transplant Recipients