Survival Of Solid Organ Transplant Recipients Research Articles

Immune-Suppression Modulation in Solid Organ Transplant Recipients Admitted for COVID-19

SARS-CoV-2 infection has significantly impacted solid organ transplant (SOT) recipients, who are at high risk of disease and worse outcomes. Moreover, therapeutic management in this population is not precise yet. Our study aimed to evaluate the overall survival of SOT recipients and predictive factors for mortality. We also aimed to assess the impact of antiviral treatments and immunosuppressant changes on overall mortality and to evaluate the length of hospital stay of SOT compared to the general population. This is a retrospective monocenter study. We included all SOT recipients with laboratory-confirmed SARS-CoV2 infection admitted at Niguarda Hospital in Milan from February 2020 through January 2022. We enrolled 74 solid organ transplant recipients with a median age of 59. The overall mortality rate was 19%. Older age, male sex, diabetes, and high LDH values were associated with an increasing fatality rate. The median length of stay (LoS) was 17 days. Low white blood count and lymphocyte levels were associated with 19 days LoS. Changes in immunosuppression and SARS-CoV-2 antiviral therapies had no impact on mortality and LoS. In this study, we confirm previously described risk factors for worse outcomes. We did not observe beneficial therapies in terms of mortality rate and LoS. Seven patients received antiviral treatment. More studies are needed to assess the best therapeutical options, including immunosuppressant modulation, in SOTs.

Mammalian target of rapamycin inhibitors for prolonged secondary prevention of nonmelanoma skin cancer in solid organ transplant recipients

Immunosuppressive agents are essential for graft survival in solid-organ transplant recipients (SOTRs), but they have substantial durable side effects, including a higher incidence of aggressive nonmelanoma skin cancers (NMSCs). Hitherto, only one class of immunosuppressants, mammalian target of rapamycin inhibitors (mTORi), may inhibit skin tumor formation, however their durable effectiveness is controversial. To evaluate the sustained effectiveness of mTORi in reducing NMSCs' incidence in SOTRs, a retrospective study was conducted in a specialized dermatology clinic for SOTRs of a tertiary university-affiliated medical center. SOTRs with a history of at least one histologically proven NMSC were followed for 6 years: 3 years after transplantation, before initiation of mTORi, and 3 years under mTORi treatment. The cohort consisted of 44 SOTRs. Treatment with mTORi was initiated on average 6.27 (3.34-6.34) years following transplantation. In the 3 years before mTORi treatment initiation, the mean number of new NMSCs per patient was 2.11 (1-14). This value decreased to 1.2 (0-19) in the 3 years under mTORi treatment (p= 0.0007). Analysis by NMSC type yielded a significant decrease in both SCCs and BCCs. This study found that mTORi are effective for prolonged secondary prevention of NMSCs in SOTRs.

MP36-06 CHARACTERISTICS AND OUTCOMES OF DE NOVO PROSTATE CANCER IN THE SOLID ORGAN TRANSPLANT POPULATION AT THE UNIVERSITY OF MINNESOTA

You have accessJournal of UrologyCME1 May 2022MP36-06 CHARACTERISTICS AND OUTCOMES OF DE NOVO PROSTATE CANCER IN THE SOLID ORGAN TRANSPLANT POPULATION AT THE UNIVERSITY OF MINNESOTA Brent Cleveland, Andrew Gardeck, Matthew Holten, Scott Jackson, Timothy Pruett, and Christopher Warlick Brent ClevelandBrent Cleveland More articles by this author , Andrew GardeckAndrew Gardeck More articles by this author , Matthew HoltenMatthew Holten More articles by this author , Scott JacksonScott Jackson More articles by this author , Timothy PruettTimothy Pruett More articles by this author , and Christopher WarlickChristopher Warlick More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002590.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior research suggests genitourinary malignancies occur at a higher incidence in solid organ transplant (SOT) population compared to the general population but the incidence of prostate cancer is not increased. Most studies examining prostate cancer in the transplant population consist of small cohorts and are limited to renal transplant recipients. We aim to expand our knowledge of the characteristics and outcomes of de novo prostate cancer diagnosed in a large single-center SOT cohort. METHODS: The University of Minnesota SOT database was queried for recipients who subsequently developed prostate cancer from 1984–2019. Available records were reviewed for clinical characteristics and outcomes. Descriptive statistics, frequencies, and Kaplan Meier survival estimates were calculated. RESULTS: Approximately 10,888 SOTs were performed during this timeframe. Of these, 139 had diagnosis code of prostate malignancy, of which 71 had confirmed diagnosis and available records. These men were predominantly Caucasian (94.4%) with a mean age at first transplant of 54.4 (±10.3) years and mean age at cancer diagnosis of 64.5 (±7.2) years. The most common transplant types were kidney (43.7%), heart (28.2%), and liver (14.1%). Median PSA at diagnosis was 7.2 ng/mL (range 1.1–91.3). Grade group 1 disease (32.4%) was most common at initial diagnosis, followed by groups 2 (23.9%) and 5 (14.1%). The distribution of initial treatments were: prostatectomy (38%), hormonal therapy (22.5%), surveillance (14.1%), radiation (8.5%), brachytherapy (4.2%), and cryotherapy (4.2%). At last known follow up, 25 patients had died (35.2%) with mean age of death of 72.4 (±7.1) years, mean time from transplant to death of 12.5 (±6.5) years, and mean overall survival after initial cancer diagnosis of 11.0 (±23.1) years. Two (2.8%) patients died from prostate cancer. Overall survival estimates at 5 and 10 years from initial cancer diagnosis were 82.4% and 56.5%, respectively. Prostate cancer specific survival was 96.2% at 5 and 10 years. CONCLUSIONS: This investigation of de novo prostate cancer in the largest single-center SOT cohort to date revealed clinical characteristics and survival in SOT recipients were similar to the non-transplant population for men diagnosed with localized disease. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e598 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brent Cleveland More articles by this author Andrew Gardeck More articles by this author Matthew Holten More articles by this author Scott Jackson More articles by this author Timothy Pruett More articles by this author Christopher Warlick More articles by this author Expand All Advertisement PDF DownloadLoading ...

Pneumocystis jirovecii Pneumonia in Solid-Organ Transplant Recipients: A National Center Experience.

Immunosuppressive therapies have impro-ved survival in solid-organ transplant recipients at the expense of increased prevalence of opportunistic infections. We investigated the prevalence, risk factors, and prognosis of Pneumocystis jirovecii pneumonia in solid-organ transplant recipients who were followed by our transplant unit. We conducted a retrospective observational study using medical record reviews to identify all adult solid-organ transplant recipients who underwent bronchoscopy and bronchoalveolar lavage between January 2011 and 2018. We collected clinical characteristics, including risk factors and prognosis. Pneumocystis jirovecii pneumonia symptoms com-patible with microscopy and/or positive nucleic acid amplification assays were defined as proven infection by P. jirovecii pneumonia. We identified 312 adult solid-organ transplants (114 renal, 1 kidney and pancreas, 197 liver) in this period. Overall, 113 (36.2%) pulmonary disease consultations were performed in the posttransplant stage, and 46 (40.7%) patients underwent bronchoalveolar lavage with P. jirovecii screening. We identified 18 patients who tested positive for P. jirovecii infection according to nucleic acid amplification assay; 3 were not proven, and 7 had a transplant date before 2011. The prevalence was 8/312 (2.6%); of these 8 patients, 5 had the same genotype cluster. Median P. jirovecii pneumonia development time was longer in renal transplant recipients (P = .016). Only renal transplant recipients were offered Pneumocystis prophylaxis for 6 months. Concomitant viral infection including cytomegalovirus was the only significant factor for P. jirovecii pneumonia development (P = .028). Intensive care admission was 40% (n = 6), and disease-related mortality was 33% (n = 5). The overall prevalence of P. jirovecii pneumonia in solid-organ transplant recipients was similar to other single-center reports. Prophylaxis prevented early posttransplant P. jirovecii pneumonia. However, P. jirovecii pneumonia may develop at any posttransplant stage, and viral infections other than cytomegalovirus should also be considered as a predictor.

Anti-HBc impacts on the risk of hepatitis B reactivation but not on survival of solid-organ transplant recipients.

Immunosuppression can lead to hepatitis B virus (HBV) reactivation in hepatitis B core antigen antibodies (anti-HBc) positive patients, especially those undergoing chemotherapy, although there is limited data on solid organ recipients, especially lung transplantation. Our aim was to analyze the risk of HBV reactivation and the potential impact of anti-HBc-positive status (both donors and recipients) on prognosis in a lung, kidney, and liver transplantation cohort.Retrospective analysis including data from all transplants in adults (2011–2012) in a tertiary hospital, with prospective HBV serology study to assess the risk of reactivation and its possible impact on survival.In total, 392 transplant recipients were included (196 kidney, 113 lung, 83 liver). Pre-transplantation anti-HBc screening was more frequent in liver recipients (P < .001) and donors (P < .001) than in kidney or lung. Fifty-five (14%) recipients were anti-HBc-positive and were not undergoing antiviral prophylaxis. Three (5.4%) cases of HBV reactivation occurred: 2 in pre-transplant anti-HBc-positive recipients and 1 with prior unknown anti-HBc status. All were HBeAg+ with HBV deoxyribonucleic acid (DNA) >10E8 IU/mL and only mild fibrosis. Baseline recipient anti-HBc positive status was the only factor associated with HBV reactivation. No reactivation cases occurred in lung or kidney recipients of anti-HBc positive grafts. Survival was lower in lung transplants, especially in human immunodeficiency virus-infected patients and those with prior immunosuppression.Anti-HBc positive status is a risk factor for HBV reactivation in solid organ recipients. Anti-HBc testing is highly recommended in solid-organ transplant recipients in order to identify those anti-HBc positive and therefore candidates for periodical hepatitis B surface antigen (HBsAg) and HBV DNA screening after transplant.

2664. Impact of Multidrug-Resistant Bacterial Infections in Solid-Organ Transplantation: The Value of Electronic Health Records-Based Registries and Data Extraction Tools

BackgroundAntimicrobial usage is the most important driver of antimicrobial resistance. Despite compelling reasons to use antimicrobials judiciously, it has been challenging to implement antimicrobial stewardship programs (ASP) in the solid-organ transplant (SOT) population. The objective of our study is to assess the impact of multidrug-resistant bacterial infections (MDRBI) on the 1-year post-transplant survival in SOT recipients.MethodsIn this retrospective cohort study, we included all patients with a first SOT from January 1, 2010–December 31, 2016 at our institution. Patients were followed for a year. Data extraction tools retrieved information from the electronic health record (EHR) and merged it with data from the Social Security Death Index (SSDI) and Standard Transplant Analysis and Research (STAR) files. Charts of subjects with positive cultures were manually reviewed and adjudicated using CDC/ECDC and CDC/NHSN criteria. The 1-year MDRBI cumulative incidence and survival were estimated using the Kaplan–Meier method and compared using the Log-rank test. A Cox proportional hazards model was used to identify predictors of 1-year mortality. Cytomegalovirus (CMV) Infection, renal replacement therapy (RRT), and post-transplant extra-corporeal membrane oxygenation (ECMO) were analyzed as a time-dependent covariate.Results1,112 SOT recipients met inclusion criteria. Patient characteristics are shown in Table 1. 105 patients had at least one MDRBI. The cumulative incidence of MDRBI was 9.7% (95% CI 14.6–5.9) (Figure 1). The most common MDR pathogens were Vancomycin-resistant Enterococci and E. coli (Figure 2A), and the most common sites of infection were urinary tract infection and pneumonia (Figure 2B). The 1-year post-SOT survival in patients with MDR infection was 75.3% (95% CI 82.8–65.2) (Figure 2C). In multivariable analysis, MDRBI (HR = 6.2 [3.5–10.9]) and post-SOT RRT (HR = 17.8 [10.3–30.6]) were associated with an increased risk of 1-year mortality (Table 2).ConclusionMDRBI significantly impacts the 1-year survival of SOT recipients. Our results highlight the need to strengthen ASP measures in SOT. Additionally, this study illustrates the versatility of EHR-based registries and data extraction tools in the field of transplantation. Disclosures All authors: No reported disclosures.

Outcome Analysis of Donor Gender in Heart Transplantation

Several studies have shown a detrimental effect of female donor gender on the survival of solid-organ transplant recipients, including heart, kidney and liver. We evaluated our own experience in heart transplantation in the cyclosporine era, since 1980, to determine the effect of donor gender on survival. We retrospectively reviewed 869 consecutive patients who underwent primary heart transplantation at Stanford University Medical Center between December 1980 and March 2004. Actuarial life-table data were calculated for survival and freedom from rejection and compared between groups. Multivariate Cox proportional hazard analysis was used to identify predictors of reduced long-term survival. One-year mortality in male recipients who received a female donor heart (24%) was higher than in male recipients who received male donor heart (13%) (p = 0.009). Actuarial survival rates for male recipients at 1, 5 and 10 years were 86%, 69% and 50% (with male donor), and 76%, 59% and 45% (with female donor) (p = 0.01), respectively. Donor gender had no effect on long-term survival in male recipients < 45 years of age and female recipients. Female donor gender was identified as an independent risk factor for death by multivariate analysis, with an odds ratio of 2.3 (95% confidence interval 1.5 to 3.4, p < 0.001). In heart transplantation the detrimental effect of female donor gender on recipient survival is significant but limited to male recipients > 45 years of age. These findings should be considered in the process of donor-recipient matching.