Post-transplant Patients Research Articles

#665 Comparison of outcomes between kidney transplant-naïve and post-transplant graft failure peritoneal dialysis patients

Abstract Background and Aims Despite progress in kidney transplant medicine, there are still patients experiencing graft failure and returning to dialysis therapy. Data regarding the prognosis of these patients remain conflicting. This study was conducted to compare clinical outcomes between transplant-naïve peritoneal dialysis (PD) patients and those returning to PD after a failed allograft. Method In this retrospective cohort study during 2006 and 2016, we included a total of 786 patients on chronic PD. Of them 679 were transplant-naïve, 76 patients underwent a successful transplantation, and 32 patients returned to PD after a failed kidney allograft. Baseline demographics and clinical characteristics were analyzed in relation to the outcomes of all-cause mortality and peritonitis rate. We employed the Kaplan-Meier method and Cox proportional hazards model to evaluate survival, while Poisson regression was utilized to estimate rate ratios for peritonitis. Results During a median follow-up of 6.37 years, 56.68 % death and 146.62 episodes of peritonitis/patient-year were observed. Compared with patients who received a kidney graft, transplant-naïve patients were older, more with diabetes and having higher mortality (58.6 ± 15.8, 40.5% and 57.73%, p < 0.0001). After accounting for age, gender, and comorbidities, the adjusted hazards ratios were 0.26 (95% CI 0.13-0.53) in patients with a functioning graft and 1.12 (95% CI 0.61-2.06) in patients returning to PD after graft failure, compared respectively with concurrent PD patients without kidney transplant. The adjusted relative risk of peritonitis in patients resuming PD after graft failure was comparable to those without kidney transplant (95% CI 0.22-1.14). Conclusion Successful kidney transplant reduced the risk of overall mortality among patients on long-term PD. Patients returning to PD after graft loss showed outcomes similar to transplant-naïve counterparts. These data support reactivation of PD as a viable option for patients with a failed kidney transplant.

Hepatitis B reactivation after solid organ transplantation: A single-center experience

BackgroundThe risk of HBV reactivation after solid organ transplantation and the strategies to prevent it are not well defined. MethodsWe reviewed patients who received liver, kidney, pancreas, or heart transplants at our center between September 2015 and November 2020. We collected recipient and donor data on HBV serologies, prophylactic strategies, and known risk factors that associate with HBV reactivation in post-transplant patients. ResultsIn the study period, 2126 solid organs were transplanted into 1951 patients. The recipient (R), donor (D), or both were HBcAb(+)/HBsAg(-) in 360 transplants. Post-transplant HBV DNA developed in 0/10 heart, 0/3 pancreas-kidney, 2/1517 (0.1 %) kidney, and 10/430 (2.3 %) liver recipients. Both kidney recipients with HBV DNA tested negative on re-testing without treatment. HBV DNA developed in 17.5 % of liver recipients who were D+/R- for HBcAb (10/57). All 10 liver recipients developing HBV DNA received prophylaxis. 5 patients developed detectable HBV DNA while on prophylaxis at a median 886 days (range 139 to 2287) after transplant. 5 patients developed HBV DNA after prophylaxis was discontinued at a median 955 days (range 756 to 2003) after transplant and 596 days (395 to 1638) after discontinuation. ConclusionHBcAb is found in a significant portion of our solid organ transplant donors and recipients, and HBcAb(+)/HBsAg(-) liver allografts represent the primary risk factor for HBV post-transplant. HBV infection in non-liver solid organ transplant is minimal risk using current monitoring strategies. Infection can occur long after the transplant event. Monitoring and prophylaxis strategies in this group should be reassessed.

Systematic review of the impact of protease-inhibitor-based combination antiretroviral therapy on renal transplant outcomes in recipients living with HIV infection.

Advances in human immunodeficiency virus (HIV) treatment, including combination antiretroviral therapy (cART), have transformed HIV into a chronic condition. Kidney diseases cause morbidity and mortality in patients living with HIV (PLWH), though cART has permitted kidney transplants with acceptable post-transplant graft and patient survival. Risk of allograft rejection remains high, which may be related to interactions between cART, specifically protease inhibitors (PI), and immunosuppressants prescribed post-transplant. This systematic review evaluates renal transplant outcomes in PLWH treated with PI- vs non-PI-based cART. A search strategy was generated with terms related to renal transplant, HIV, and cART and run on PubMed, Embase, Scopus, and Cochrane. Studies were evaluated using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on Covidence by two reviewers and then evaluated for bias. Of 803 studies, 9 were included. Included papers were prospective or retrospective cohort studies or chart reviews of adult patients. Outcome measures included acute graft rejection, graft survival, and patient survival. One study had significant results demonstrating that PI-based therapy was correlated with increased graft rejection rates. Two studies demonstrated significant graft survival benefit to non-PI-based therapy, while one demonstrated significant benefit to PI-based therapy. Two studies found significant patient survival benefit to non-PI-based therapy. For each outcome measure, remaining data suggested improved outcomes with non-PI-based therapies without achieving statistical significance. The results demonstrate superior outcomes in PLWH taking non-PI-based cART, though the paucity of significant results suggests that PLWH who require PI-based cART for virological control may continue their regimen safely post-kidney transplant.

Kidney transplantation in patients with tuberous sclerosis complex.

Tuberous sclerosis complex (TSC) is a disorder of the mammalian target of the rapamycin (mTOR) pathway associated with the development of multisystem tumors, including renal angiomyolipoma (AML). These renal tumors are benign by nature but locally invasive and carry a risk for the progression of chronic kidney disease (CKD) to end stage kidney disease (ESKD). The frequency of subsequent renal transplantation in this population is largely uncharacterized, although single-center data suggests that 5%-15% of adult TSC patients are kidney transplant recipients. This retrospective cohort study utilized United Network for Organ Sharing (UNOS) data. We included candidates waitlisted between 1987 and 2020 for a first kidney transplant with TSC-associated kidney failure. We utilized descriptive statistics to characterize the frequency of first-time kidney transplant waitlisting and transplantation among persons with TSC and the Fine-Gray subdistribution hazard model to evaluate characteristics associated with progression from waitlist. We identified 200 TSC-associated kidney failure patients within the waitlist cohort. Of these, 12 were pediatric patients. Two-thirds (N = 134) of waitlisted persons were female. One hundred forty patients received a transplant with a median waitlist time of 2 years. Younger age at waitlisting was associated with a greater probability of progressing to transplant (HR 0.98 [95% CI: 0.96-0.99]). 91.8% of kidney transplant recipients survived 1-year post-transplant with a functioning allograft. The majority of patients with TSC who are waitlisted for a kidney transplant progress onto transplantation with excellent 1-year post transplant patient and allograft survival.

Impact of donor-specific antibody with low mean fluorescence intensity on allograft outcomes in kidney transplant

BackgroundImmune-mediated rejection is the most common cause of allograft failure in kidney transplant (KT) patients. Exposure to alloantigen, including human leukocyte antigen (HLA), results in the production of donor-specific antibodies (DSA). There are limited data about low levels of mean fluorescence intensity (MFI) DSA, especially post-transplantation. This study evaluated allograft outcomes in KT patients with low MFI DSA. MethodsFrom January 2007 to December 2021, KT patients who were tested for post-transplant DSA at Ramathibodi Hospital, Bangkok, Thailand, with the DSA MFI ≤ 1000 were evaluated. These KT patients were categorized into two groups: very low DSA (VLL; MFI = 1–500) and low DSA (LL; MFI = 501–1000). All KT patients were evaluated for the primary outcomes, such as the incidence of acute rejection, serum creatinine levels at one and five years after transplantation as well as allograft and patient survivals. ResultsAmong 36 KT patients 25 were included as those with VLL and 11 as those with LL. The LL group had significantly higher T-cell mediated allograft rejection (TCMR) than the VLL group (45% vs. 12%, P = 0.04). In addition, 10 patients, 5 in the VLL group and 5 in the LL group developed antibody-mediated allograft rejection (ABMR). Both TCMR and ABMR were confirmed by biopsy results. There was a trend toward higher MFI in KT patients with ABMR than without ABMR (P = 0.22). At 5 post-transplant years, serum creatinine, allograft and patient survivals were comparable between these two groups. Furthermore, the univariate and multivariate analyzes revealed that the LL group was a high risk for rejection. ConclusionLow MFI DSA values after transplantation may be associated with a higher incidence of rejection, but this finding did not show differences in allograft and patient survival in this study's analysis.

Focus on Pneumonia After Organ Transplantation: Is There a Need for Specific Medical Care in the Emergency Department?

Pneumonia is a major cause of hospitalization and has a substantial impact on health care costs. Diagnosis and treatment of pneumonia in solid organ transplant (SOT) patients remain a challenge for clinicians in the emergency department. This study aimed to evaluate demographic features, clinical patterns, history of hospitalization, and diagnosis of adult patients after organ(s) transplantation (liver, kidney, pancreas) with severe pneumonia requiring hospitalization. The aim is to determine whether patients undergoing SOT receive or require specific care and whether they need to be prioritized. This was a single-center observational study of adult patients after SOT with severe pneumonia requiring hospitalization. The data set for the analysis included only patients with pneumonia as the main reason for hospitalization. The diagnosis of pneumonia was suspected based on the American Thoracic Society criteria. The study revealed that the standard of care for patients with a history of SOT did not significantly differ from care provided to the non-SOT patients with pneumonia admitted to the same hospital during a 94-week period. There were notable differences, such as post-transplant patients being transferred more quickly to the hospital ward, having longer hospital stays, and receiving antibiotics earlier than the non-SOT group.

Clinical analysis of air-leak syndrome following allogeneic hematopoietic stem cell transplantation in pediatric patients.

Air-leak syndrome (ALS) is considered as an independent risk factor for poor prognosis in adult patients who had received hematopoietic stem cell transplantation (HSCT), and the 5-year overall survival (OS) of ALS is less than 30%. However, the clinical features of ALS among post-transplant pediatric patients have rarely been explored. We retrospectively reviewed 2206 pediatric patients who had received an allo-HSCT between January 2013 and December 2019 at the Hebei Yanda Lu Daopei Hospital, and analyzed the role of ALS in prognosis following HSCT. In our research, ALS was divided into two categories: 15 cases of bronchiolitis obliterans syndrome (BOS) and 13 cases of idiopathic pneumonia syndrome (IPS). Following treatment of the ALS, 18 patients survived (18/28, 64.3%), and 10 patients died of respiratory failure or infection (10/28, 35.7%). The OS of ALS in Hebei Yanda Lu Daopei Hospital is significantly higher than others, and they were cited to be related to early diagnosis and timely FAM treatment in previous reports.

Editor’s Pick: Correlation of Cutaneous Manifestations with the Severity of Disease in Patients with Chronic Kidney Disease and Effect of Hemodialysis: An Observational Study

Aim: Chronic kidney disease is a non-communicable disease, and is the sixth fastest growing contributor of morbidity and mortality. Hemodialysis is one of the important therapeutic modalities that can improve survival in these patients, and can increase their life expectancy, but the cutaneous disorder can precede or follow the initiation of hemodialysis. Methods: This is a retrospective, observational study with a sample size of 250 patients, with a glomerular filtration rate <60 mL/min/1.73 m2 for a minimum duration of 3 months or more, undergoing hemodialysis. Patients post-renal transplant, HIV-positive cases, and pregnant patients were excluded from the study. Studied cases were recruited equally into two groups: the dialytic group (Group A) and non-dialytic group (Group B). Results: In the authors’ study, the prevalence of dermatological manifestations was 79% in the dialytic group and 75% in the non-dialytic group. The most common finding overall was xerosis (58%), which was more common in the dialytic (66%) group, both in number of patients and severity. The second most common finding was pallor (55%), which was seen more in the dialytic group (60%). Other major findings were pruritus (49%) and hyperpigmentation (37%). The intensity of pruritus was higher in non-dialytic patients. Specific cutaneous manifestations, such as Kyrle’s disease, were seen only in eight patients. Skin infections were seen in 17% of patients overall, and there was no major difference seen in both groups. The prevalence of nail findings, mucosal changes, and hair changes was also high in the dialytic group. Other specific cutaneous manifestations, like calciphylaxis, uremic frost, and nephrogenic fibrosing dermopathy, were not seen in the authors’ study. Hemodialysis has increased the life expectancy of patients with end-stage renal disease and has also brought about a rise in the number of manifestations, by giving time for these changes to occur. The severity of symptoms was also higher in patients on dialysis. This could be because of the higher mean duration of disease in the dialytic group compared to the non-dialytic group. Conclusion: Dermatological manifestations of chronic kidney disease were significantly associated with the mean duration of disease, which was higher in patients on dialysis. There was a higher prevalence of non-specific dermatological findings, such as xerosis, hyperpigmentation, nail findings, hair, and mucosal changes in the dialytic group, except pruritus. Any such cutaneous marker in the absence of a primary dermatological problem warrants a thorough search, including blood, urine, and radiological investigations, to rule out kidney disease.

The association of socioeconomic status on kidney transplant access and outcomes: a nationwide cohort study in Taiwan

BackgroundConflicting evidence exists regarding the relationship between socioeconomic status and access to or outcomes after kidney transplantation. This study analyzed the effects of individual and neighborhood socioeconomic status on kidney transplant access and outcomes in Taiwan.MethodsWe used a retrospective cohort study design and performed comparisons using the Cox proportional hazards model after adjusting for risk factors. Data were collected from the National Health Insurance Bureau of Taiwan data (2003–2012).ResultsPatients with high individual and neighborhood socioeconomic status had higher chances of receiving kidney transplants than those with low individual and neighborhood socioeconomic status [adjusted hazard ratio (aHR) = 2.04; 95% CI: (1.81–2.31), p < 0.001]. However, there were no significant differences in post-transplant graft failure or patient mortality in Taiwan between individuals of varying socioeconomic status after five years. When we stratified kidney transplants by domestic and overseas transplantation, there were no significant differences in post-transplant mortality and graft failure, but individuals who received a kidney graft in Taiwan with high individual and neighborhood socioeconomic status experienced lower risks of graft failure (aHR = 0.55; [95% CI 0.33–0.89], p = 0.017).ConclusionA relevant disparity exists in accessing kidney transplantation in Taiwan, depending on individual and neighborhood socioeconomic status. However, results post transplantation were not different after five years. Improved access to waitlisting, education, and welfare support may reduce disparities.Graphical

Safety and efficacy of semaglutide in post kidney transplant patients with type 2 diabetes or Post-Transplant diabetes

ObjectiveType 2 diabetes mellitus (T2DM) and post-transplant diabetes mellitus (PTDM) are common in renal transplant recipients. Semaglutide has demonstrated efficacy and safety in patients with T2DM. To date, only a limited number of studies have investigated its use in renal transplant patients. This study assessed the safety and efficacy of semaglutide in post-renal transplant patients. MethodsA retrospective study was conducted at king Abdulaziz Medical City-Riyadh, Saudi Arabia. The subjects of the study were adults and adolescents (>14 years) who had undergone a kidney transplant and had pre-existing T2DM or PTDM. The study subjects were given semaglutide during the study period, from January 2018 to July 2022. The data were collected over a period of 18 months. ResultsA total of 39 patients were included, 29 (74 %) of whom were male. A significant decrease in hemoglobin A1c (HbA1c) was observed during the follow-up period when compared to baseline (8.4 %±1.3 % at baseline vs. 7.4 %±1.0 % at 13–18 months (p < 0.001). A significant reduction in weight was also noted at follow-up as compared to baseline (99.5 kg ± 17.7 vs 90.7 kg ± 16.8 at 13–18 months (p < 0.001). No significant changes were found in renal graft function markers. ConclusionSemaglutide was found to significantly reduce HbA1c levels and weight in post renal transplant patients with diabetes. No significant changes in markers of renal graft function were observed.

Abstract CT180: Phase I clinical trial of CD19CAR -T cells secreting PD-1-targeting IL-21 in advanced relapsed/refractory acute lymphoblastic leukemia

Abstract Background/Purpose: Chimeric antigen receptor (CAR) T cell therapy has shown remarkable responses in hematologic malignancies. However, suboptimal clinical outcomes have been associated with decreased expansion and persistence of adoptive transferred CAR-T cells, antigen-negative relapses, and impairment by an immunosuppressive tumor microenvironment. We previously developed CD19CAR-T cells secreting PD-1Ab21 fusion protein composed of anti-PD-1 single chain antibody and IL-21(PD-1Ab21-CD19CAR-T). This investigator-initiated clinical trial is designed to assess the safety and efficacy of the novel CAR-T cells in advanced relapsed/refractory acute Lymphoblastic leukemia (ALL). Methods: This study recruited 10 patients with advanced relapsed/refractory B-ALL and half of them relapsed after allogeneic hematopoietic stem cell transplantation (allo-HSCT). All patients received fludarabine and cyclophosphamide before a single infusion of PD-1Ab21-CD19CAR-T cells at dose of 0.3, 1 or 3 x 106 cells/kg of body weight. The patients were monitored for adverse events, clinical response, as well as expansion of CAR-T and lymphocytes. Results: All five non-post-transplant patients achieved complete remission (CR), including two active CNS diseases, and three of them pursued consolidative allo-HSCT. Among the five post-transplant patients, one patient, who had undergone autologous, allogeneic CAR-T cell therapies and allo-HSCT, achieved CR and remained leukemia-free for 5 months, which was longer than the duration of remission (&amp;lt; 4 monthes) after allo-HSCT. The last treated patient achieved CR. Three other post-transplant patients, including two active CNS diseases, eventually died of the infection. One of the patients achieved minimal residual disease negative CR. The other two patients did not undergo laboratory evaluation, but their CNS symptoms disappeared. Once the expansion of CAR-T cells was detected, the proportion of CD8+T cell in CD3+T cells increased dramatically, rapidly reaching 77.8~91.2% and maintaining above 50% for a long time in all treated patients. Except for the three patients who died from infection, other patients experienced no or mild cytokine release syndrome (CRS) (grade ≤2). None of the patients had neurotoxic side effects. Conclusion: This study demonstrates that PD-1Ab21-secreting CAR-T cells are safe and effective therapeutic platform, even in cancer patients with CNS invasion. Our data also suggest that PD-1Ab21-secreting CAR-T therapy can activate endogenous anti-tumor CD8+ T cell responses. Citation Format: Yu Jing, Ying Li, Liping Dou, Shengjuan Zhang, Ran Tian, Guojing Wang, Xiangrui Cheng, Jitao Zhao, Hang Li, Yueyi An, Naibo Yang, Shengdian Wang. Phase I clinical trial of CD19CAR -T cells secreting PD-1-targeting IL-21 in advanced relapsed/refractory acute lymphoblastic leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT180.

Is Lack of Consensus on the Management of Chronic Active Antibody-Mediated Rejection Harming Renal Transplant Recipients?

In 2022, over 92,000 kidney transplants were performed globally. With advancements in transplant science, 1-year graft survival rates have reached 94.3% for deceased donor kidney transplant recipients, and 97.8% for living recipients. However, 5-year graft survival remains at 76.3% and 86.5%. Antibody-mediated rejection (AMR) is one of the most common causes of immune-related allograft rejection. Chronic active AMR (CABMR) typically develops 6–12 months post-transplant; 76% of kidney transplant recipients with CABMR experience graft loss 1.9 years after diagnosis. Despite these alarming figures, consensus guidelines on the management of post-transplant patients have not been updated with advancements in testing and protocol biopsies, and there is currently no consensus in Europe on CABMR management.

A 6-year Retrospective Study on the Clinical Profile and Outcomes of Postrenal Transplant Patients in the Emergency Department

Abstract Background: Kidney transplantation is widely recognized as the primary treatment for those with end-stage renal disease. Our goal was to provide an overview of the clinical characteristics of postrenal transplant patients (commercial vs. noncommercial) seeking care in the emergency department (ED). Methodology: The study was conducted at a leading Omani ED from 2015 to 2021; this study included all postrenal transplant patients. Various variables were categorized, coded, and analyzed. Results: A total of 55 postrenal transplant patients were included in our study. Of these, 60.0% were male (n = 33). Among the participants, 14.5% (n = 8) had undergone noncommercial renal transplants, whereas the remaining 85.5% (n = 47) had undergone commercial renal transplants. Among noncommercial postrenal transplant patients, the most common reasons for ED visits were fever (5), gastrointestinal symptoms (4), and cardiac symptoms (3). They also presented with pain at the surgical site (2) and urological symptoms such as dysuria and hematuria (2). In contrast, the most frequent clinical presentations among commercial postrenal transplant patients were cardiac symptoms (13) and pain at the surgical site (13), followed by fever (12). Noncommercial renal transplant patients had a high discharge rate of 62.5% (5) and a low admission rate of 37.5% (3). On the other hand, commercial renal transplant patients necessitated a high admission rate of 59.6% (28) and a low discharge rate of 40.4% (19). Conclusion: The majority of patients had received commercial kidney transplants, and the most common complaints upon their presentation to the ED were cardiac symptoms and pain at the surgical site. Patients undergoing commercial transplants had higher rates of admission.

Rhabdomyolysis and Neuroleptic Malignant Syndrome in a Postrenal Transplant Patient: Is Desidustat a Culprit?

We report a case of a 46-year-old female – a postrenal transplant patient, having developed rhabdomyolysis and neuroleptic malignant syndrome (NMS), after 2.5 months of desidustat initiation – for anemia. Post renal transplant anemia (PTA) is common among renal transplant recipients. Apart from treating it with iron supplements, folic acid, andrecombinant human erythropoietin (EPO), novel agents like hypoxia-inducible factor–prolyl hydroxylase domain (HIF–PHI) are also used, with a very few studies available on its efficacy and safety in PTA patients. Anemia occurring in the first 6 months is called early PTA – occurring most commonly due to iron deficiency, while anemia occurring after 6 months is called late PTA – associated with impaired graft function. The optimal target of hemoglobin in transplant recipients is 12.5–13 gm/dl, which is higher than targets in chronic kidney disease patients. NMS is a life-threatening emergency – mainly seen in patients on antipsychotic medications. It needs to be differentiated from other closely related conditions such as central nervous system infections (meningitis and encephalitis), tetanus, heatstroke, serotonin syndrome, and thyrotoxicosis. Desidustat is an oral HIF–PHI that stimulates erythropoiesis by preventing EPO degradation. Its adverse effects include high blood pressure, myocardial infarction, heart failure, high potassium, and dizziness; however, there is only one case report of rhabdomyolysis associated with desidustat, and none of NMS. It is, therefore, important to be aware of this potential severe side effect of the drug that was not known earlier so that practicing physicians can be vigilant of the same.

SUV max as Predictor of Metastatic Disease on 18 F-FDG PET-CT in Hepatocellular Carcinoma.

To ascertain the utility ofmaximum standardised uptake value (SUVmax) in 18F-FDG PET-CT in predicting metastatic disease burden in hepatocellular carcinoma (HCC) patients. Descriptive study. Place and Duration of the Study: Department of Nuclear Medicine and PET-CT Imaging, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan, from April to October 2022. 18F-FDG PET-CT data of 87 patients were analysed prospectively. Patients were considered regardless of resection status. The SUVmax measurements were performed, and their association with metastases was determined. Molecular docking studies were conducted to determine a mechanism behind the higher SUVmax at the metastatic sites. A higher number of patients (49) was found to have metastasis (1 to 5 in numbers) and demonstrated higher SUVmax, especially in cases of pre-surgery and post-transplant state. A positive correlation existed between SUVmax of pre-surgery (r = 0.419, p = 0.001) and post-transplant patients (r = 0.779, p = 0.001). Molecular docking studies revealed a strong binding affinity (-5.18± 0.25 kcal/mol) between the hexokinase (HK-II) and 18F-FDG. SUVmax positively correlated with metastatic tumour burden. The strong binding affinity between the HK-II and 18F-FDG may be the reason. 18F-FDG PET-CT appeared beneficial in providing prognostic information for HCC in a selected group. Hepatocellular carcinoma, 18F-FDG, Positron emission tomography, Maximum standardised uptake value, SUVmax, HK-II binding, PET-CT, Metastases.

Live-Attenuated Vaccines in Pediatric Solid Organ Transplant.

Measles, mumps, rubella (MMR), and varicella incidence rates have increased due to the delayed vaccination schedules of children secondary to the COVID-19 pandemic. Decreased herd immunity creates a risk for immunocompetent children and immunocompromised individuals in the community. Historically, live-attenuated vaccines (MMR and varicella) were recommended before solid organ transplants. The amount of time before transplant when this is appropriate is often debated, as is the utility of vaccine titers. MMR and varicella vaccines previously were not recommended in immunocompromised patients post-solid organ transplant due to the undue risk of transmission and posed infection risk. The new literature on live-attenuated vaccines in post-transplant pediatric patients provides more insight into the vaccines' safety and efficacy. The present article aims to provide guidance on live-attenuated vaccines (MMR and varicella) in the pre-transplant and post-operative solid organ transplant phases of care in pediatric patients.

Successful management of Aspergillosis in post renal transplant patient: A case report

This case describes a 60-year-old man with a history of diabetes and hypertension who underwent a kidney transplant in September 2023. The patient presented with fever, cough for 5 days, empirical antibiotics were started but complaints were not resolved so fungal markers were sent, which showed elevated galactomannan levels, necessitating the initiation of voriconazole therapy. X Ray chest showed patch along with cavitatory lesion which was further confirmed by CT Scan Chest which confirmed a cavitatory lesion. This case report emphasizes the importance of considering fungal infection as a differential diagnosis in immunocompromised patients and achieving good results with appropriate treatment.

A Case Report of Kidney Transplantation in a Patient With Pre-existing Chronic Myeloid Leukemia: The Role of Achieving Molecular Response and Treatment-Free Remission

Treatment-free remission (TFR) in chronic myeloid leukemia (CML) is achieved when a patient who has discontinued tyrosine-kinase inhibitor treatment sustains major molecular response (MMR) and does not require restarting therapy. The feasibility of kidney transplantation (KT), and achieving TFR post-transplantation in patients with a pre-existing CML, are currently not well-studied. We describe the clinical course of a 39-year-old Filipino woman with IgA nephropathy who developed CML during treatment. She received nilotinib 600 mg daily and was able to achieve MMR after 5 months. Eight years later, the patient sustained MMR; however, she ultimately underwent KT due to advancing kidney disease. Before the transplant, she was able to achieve deep molecular response. In anticipation of possible drug-to-drug interaction of nilotinib with tacrolimus and everolimus, a shared decision was made to discontinue nilotinib despite not fulfilling the criteria for TFR. Twelve months post-transplant, the patient remains in MMR without nilotinib. Good renal allograft function was maintained, and there were no signs of allograft rejection. Attempting TFR may be feasible after KT in patients with low-risk chronic phase CML especially if good molecular response is obtained before the transplant. Data regarding the length at which TFR can be maintained after KT is still yet to be determined. In this regard, low-risk chronic phase CML in good disease control may not be considered a contraindication to KT.

Performance evaluation of the high-throughput quantitative Alinity m BK virus assay.

BK virus (BKV) in transplant patients can lead to adverse health consequences. Viral load monitoring is important in post-transplant patient care. This study evaluates the Alinity m BKV assay with currently available assays.

Early hematopoietic cell transplantation for familial hemophagocytic lymphohistiocytosis in a regional treatment network in Japan.

Familial hemophagocytic lymphohistiocytosis (FHLH) is a fatal hyperinflammation syndrome arising from the genetic defect of perforin-mediated cytolysis. Curative hematopoietic cell transplantation (HCT) is needed before development of central nervous system (CNS) disease. We studied treatment outcomes of 13 patients (FHLH2 n = 11, FHLH3 n = 2) consecutively diagnosed from 2011 to 2022 by flow cytometric screening for non-myeloablative HCT in a regional treatment network in Kyushu, Japan. One patient with a novel PRF1 variant escaped screening, but all patients with FHLH2 reached diagnosis and 8 of them received HCT until 3 and 9months of age, respectively. The earliest HCT was conducted 65days after birth. Three pretransplant deaths occurred in newborns with liver failure at diagnosis. Ten posttransplant patients have remained disease-free, 7 of whom had no neurological involvement. Time from first etoposide infusion to HCT was shorter in patients without CNS disease or bleeding than in patients with those factors (median [range] days: 62 [50-81] vs. 122 [89-209], p = 0.016). Six of 9 unrelated patients had a PRF1 c.1090_1091delCT variant. These results suggest that the critical times to start etoposide and HCT are within 3months after birth and during etoposide control, respectively. Newbornscreening may increase the percentage of disease-free survivors without complications.