Thoracic Transplant Recipients Research Articles

(734) - Associations of Outpatient Administration of Monoclonal Antibody Therapy for COVID-19 Infection in Orthotropic Thoracic Organ Transplant Recipients

(734) - Associations of Outpatient Administration of Monoclonal Antibody Therapy for COVID-19 Infection in Orthotropic Thoracic Organ Transplant Recipients

(102) - Efficacy of Short Course Direct Acting Antivirals and Ezetimibe vs Longer Course of Direct Acting Antivirals to Prevent Hepatitis C Infection in Thoracic Transplant Recipients of Hepatitis C Viremic Donors

(102) - Efficacy of Short Course Direct Acting Antivirals and Ezetimibe vs Longer Course of Direct Acting Antivirals to Prevent Hepatitis C Infection in Thoracic Transplant Recipients of Hepatitis C Viremic Donors

Management of infectious disease syndromes in thoracic organ transplants and mechanical circulatory device recipients: a Delphi panel.

Antimicrobial misuse contributes to antimicrobial resistance in thoracic transplant (TTx) and mechanical circulatory support (MCS) recipients. This study uses a modified Delphi method to define the expected appropriate antimicrobial prescribing for the common clinical scenarios encountered in TTx and MCS recipients. An online questionnaire on managing 10 common infectious disease syndromes was submitted to a multidisciplinary Delphi panel of 25 experts from various disciplines. Consensus was predefined as 80% agreement for each question. Questions where consensus was not achieved were discussed during live virtual live sessions adapted by an independent process expert. An online survey of 62 questions related to 10 infectious disease syndromes was submitted to the Delphi panel. In the first round of the online questionnaire, consensus on antimicrobial management was reached by 6.5% (4/62). In Round 2 online live discussion, the remaining 58 questions were discussed among the Delphi Panel members using a virtual meeting platform. Consensus was reached among 62% (36/58) of questions. Agreement was not reached regarding the antimicrobial management of the following six clinical syndromes: (1) Burkholderia cepacia pneumonia (duration of therapy); (2) Mycobacterium abscessus (intra-operative antimicrobials); (3) invasive aspergillosis (treatment of culture-negative but positive BAL galactomannan) (duration of therapy); (4) respiratory syncytial virus (duration of antiviral therapy); (5) left ventricular assist device deep infection (initial empirical antimicrobial coverage) and (6) CMV (duration of secondary prophylaxis). This Delphi panel developed consensus-based recommendations for 10 infectious clinical syndromes seen in TTx and MCS recipients.

Difference in immunosuppressant dose requirement when transitioning to isavuconazole from other azoles in thoracic transplant recipients.

The triazole antifungal isavuconazole (ISAVU) is used for prevention and treatment of fungal infections in solid organ transplant (SOT). SOT recipients commonly need to transition from one azole to another due to breakthrough infection, toxicity, or other reasons. The purpose of our study was to evaluate the effect of ISAVU on immunosuppressant concentrations in thoracic transplant recipients when ISAVU was started de novo or transitioned from another azole. We conducted a single-center retrospective cohort study including 68 patients (51 lung, 14 heart, and 3 heart/lung transplant). Concentration to dosage ratios (C/D) of immunosuppressants were assessed at baseline, day 3, and weekly for 9 weeks. When starting ISAVU de novo, we observed a temporary doubling of tacrolimus exposure. Cyclosporine and sirolimus required dose decreases. Tacrolimus C/D increased by 110% at day 3 in patients started on ISAVU de novo then returned to baseline C/D ± 17% weeks 2-9 (n = 8). One cyclosporine patient started on ISAVU de novo had variable C/D, and C/D increased by 219% ± 72% in 2 sirolimus patients. When transitioning from other azoles, tacrolimus and cyclosporine required about twice the initial dose. After week 1, tacrolimus C/D decreased by 53% ± 6% in patients transitioned from posaconazole (n = 33), voriconazole (n = 14), or fluconazole (n = 2). Cyclosporine C/D decreased by 45% ± 16% in patients transitioning from other azoles (posaconazole [n = 2], voriconazole [n = 2], fluconazole [n = 1]). Sirolimus C/D decreased by 73% ± 13% in patients transitioned from posaconazole (n = 7). Aside from the initial loading phase, ISAVU had a lesser degree of interaction with immunosuppressants than other azoles in loading phase, ISAVU had a lesser degree of interaction with immunosuppressants than other azoles in adjustments for the 4-week period after initiating antifungal therapy with ISAVU or switching from another agent.

Successful treatment of Rhodococcus lung abscess and empyema thoracis in a heart transplant recipient.

Rhodococcosis is an uncommon cause of pulmonary infection in thoracic organ transplant recipients. We describe a heart transplant recipient diagnosed withRhodococcus equileft upper lung abscess with empyema thoracis complicated by bacteremia. The patient was successfully treated with appropriate antibiotics, adequate surgical resection, and optimization of immunosuppressants.

Assessing the Skin and UV Neoplasia Transplant Risk Assessment Calculator in an Irish cohort of thoracic organ transplant recipients.

The Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) is a tool that can be used to decide when to first screen for skin cancer in organ transplant recipients (OTRs). The objective of this study was to assess the applicability of this tool in thoracic OTRs. Based on data from patient files, the OTRs were categorized into four risk groups according to the SUNTRAC tool. The time of the first post-transplant skin cancer in each OTR was recorded. The proportion of OTRs with post-transplant skin cancer in the low-, medium-, high- and very high-risk groups was 0%, 28.3%, 58.3% and 100%, respectively. This positive correlation suggests that SUNTRAC can be used to determine when to first screen for skin cancer in heart and lung OTRs.

Graft survival in primary thoracic organ transplant recipients: A special report from the International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation

Graft survival in primary thoracic organ transplant recipients: A special report from the International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation

Candidemia in thoracic solid organ transplant recipients: Characteristics and outcomes relative to matched uninfected and bacteremic thoracic organ transplant recipients.

Little is understood about the risk factors and outcomes from candidemia in thoracic solid organ transplant recipients. This is a single-center retrospective cohort study of patients undergoing heart or lung transplant between January 1, 2013 and December 31, 2022. We performed two comparisons among heart and lung transplant recipients: (1) recipients with candidemia versus matched, uninfected recipients, and (2) recipients with candidemia versus recipients with bacteremia. During the study 384 heart and 194 lung transplants were performed. Twenty-one (5.5%) heart and six (3.1%) lung recipients developed candidemia. Heart recipients with candidemia were more likely to have had delayed chest closure (38.1%vs. 0%, p<.0001), temporary mechanical circulatory support (57.1%vs. 11.9%, p=.0003), and repeat surgical chest exploration 76.2%vs. 16.7%, p<.0001) than uninfected controls. Heart and lung recipients who developed candidemia were more likely to have been on renal replacement therapy prior to infection relative to uninfected controls (57.1%vs. 11.9%, p=.0003 and 66.7%vs. 0%, p=.0041, respectively). Heart recipients with candidemia had significantly lower post-transplant survival and lower post-infection survival relative to matched uninfected controls and heart recipients with bacteremia, respectively (p<.0001 and p=.0002, respectively). Candidemia following heart and lung transplantation is associated with significant morbidity and mortality. Further research is needed to understand if heart recipients with delayed chest closure, temporary mechanical circulatory support, renal replacement therapy, and repeat surgical chest exploration may benefit from targeted antifungal prophylaxis.

(626) Bariatric Surgery is Safe and Effective in Thoracic Organ Transplant Recipients

(626) Bariatric Surgery is Safe and Effective in Thoracic Organ Transplant Recipients

'My Transplanted Self': Adolescent recipients' experience of post-traumatic growth following thoracic transplantation.

Despite heart and lung transplantation being life-saving therapies for children and adolescents, little research has focused on recipients' lived experience post-transplant. This study captures the subjective experiences of adolescent thoracic transplant recipients, providing insight into the impact of life changes following transplantation in this population. A grounded theory approach guided an iterative process of data collection and data analysis. Adolescent heart and lung transplant recipients were recruited from a large Canadian pediatric teaching hospital to participate in one-on-one semi-structured interviews. Analysis using line-by-line coding and constant comparison methods facilitated reflection and agreement on categories and emergent themes. A total of 27 heart and 5 lung transplant recipients (66% female) participated at a median age of 15.9 years and a median time post-transplant of 2.7 years. Participant narratives illuminated three themes describing (1) personal growth - an awareness of personal strengths and coping abilities, (2) relationship growth - a greater appreciation for family and friends, and (3) introspective growth - a developing life philosophy. Findings suggest that adolescents experience an emergent 'transplanted self', positioning thoracic transplantation as a potential catalyst for positive growth and personal change. The study findings describe pediatric thoracic transplantation as potentially transformative in nature and sheds light on the application of post-traumatic growth theory. Practitioners and researchers are encouraged to acknowledge the possibility of growth, transformation, and positive change that may be possible within the adolescent thoracic transplant experience and leverage such strengths in clinical care.

Cytomegalovirus seroprevalence, infection, and disease in Chinese thoracic organ transplant recipients: a retrospective cohort study

BackgroundCytomegalovirus (CMV) infection is a leading cause of morbidity and mortality after transplantation. This study aimed to investigate CMV seroprevalence, infection, and disease in Chinese thoracic organ transplant recipients.MethodsThe clinical data of the patients who underwent lung and/or heart transplantation between January 2015 and October 2020 were retrospectively collected from four transplantation centers in China.ResultsA total of 308 patients were analyzed. The CMV serostatus was donor positive (D+) recipient negative (R−) in 19 (6.17%) patients, D+/R+ in 233 (75.65%), D−/R+ in 36 (11.69%), and D−/R− in 20 (6.50%). CMV DNAemia was detected in 52.3% of the patients and tissue-invasive CMV disease was diagnosed in 16.2% of the patients. Only 31.8% of the patients adhered to the postdischarge valganciclovir therapy. The D+/R− serostatus (odds ratio [OR]: 18.32; 95% confidence interval [CI]:1.80-188.68), no valganciclovir prophylaxis (OR: 2.64; 95% CI: 1.05–6.64), and higher doses of rabbit anti-human thymocyte globulin (> 2 mg/kg) (OR: 4.25; 95% CI: 1.92–9.42) were risk factors of CMV disease.ConclusionCMV seroprevalence was high in Chinese thoracic organ transplant donors and recipients. The low adherence rate to the postdischarge CMV prophylaxis therapy in Chinese patients is still an unresolved issue.

Cytomegalovirus Infection Following Vaccination for COVID-19 in Thoracic Organ Transplant Recipients

PurposeCytomegalovirus (CMV) is one of the main causes of infection after solid organ transplantation but CMV infection after vaccination for COVID has not been previously reported. The purpose of our study was to study cases of CMV DNAemia noted after COVID-19 mRNA vaccination in our thoracic organ transplant recipients.MethodsBetween March 1, 2021, and June 30, 2021, we identified 7 cases of CMV infection in thoracic organ transplant recipients within 30 days of COVID-19 mRNA vaccination. Descriptive statistics was used to study these cases.ResultsOur findings are summarized in the table. Of our patients, 3 were lung recipients, 3 were heart recipients while one was a dual heart-kidney recipient. Three patients received the mRNA-1273 (Moderna) vaccine while others received the BNT162b2 (Pfizer) vaccine. Age ranged from 42 to 73 years. Two of the lung transplant recipients and one heart recipient were CMV high-risk status (Donor+/Recipient-), while the others were recipient-seropositive for CMV. The median time to PCR detection of CMV DNAemia from the second dose of mRNA vaccine was 16 days with a range of 4 days to 30 days. None of these recipients had post-transplant CMV infection detected previously. All patients were off antiviral prophylaxis and on their standard immunosuppressive regimen at the time of vaccination. Symptoms were variable but ranged from asymptomatic to acute respiratory failure. However, all patients had resolution of CMV DNAemia by the censor date with a range of 7 days to 45 days. Therapy included reduction of immunosuppression, intravenous ganciclovir, and oral valganciclovir. The median peak CMV DNA PCR in the cohort was 15,900 IU/ml with a range of 272 IU/ml to 175,973 IU/ml. None of the recipients developed IgG antibodies to SARS-CoV-2 in response to vaccination. There were no documented cases of COVID-19 in these transplant recipients.ConclusionCMV DNAemia after COVID-19 mRNA vaccination in solid organ transplant recipients may be an under-recognized phenomenon. Although the risk-benefit assessment strongly favors COVID-19 vaccination, due to the greater risk of adverse events with COVID-19 infection care teams should consider active monitoring for CMV disease activity in these patients. In some cases, CMV prophylaxis may be warranted depending on patients’ risk profile. Our findings warrant study in a larger prospective study.

A Cost Effective Liquid Biopsy Technology Using Donor Derived Cell Free Dnato Diagnose Rejection in Thoracic Organ Transplant Recipients

<h3>Purpose</h3> Solid organ transplant recipients are periodically reviewed to assess the health of transplanted organ. Surgical biopsy is considered as gold standard to monitor rejections as histological changes associated with rejection can be identified by direct microscopy or after immunohistochemical staining with rejection specific biomarker, C4d. However, a number of inconsistencies exist while interpreting the sections as criteria for quantitative scoring of endothelial enlargement and C4d-positivity in patients without clinical evidence of rejection and C4d-negativity in patients with clinical evidence of rejection is not established. Besides the above repeated biopsies can expose the organs to risk of scarring, which in turn can affect its optimal function. <h3>Methods</h3> To mitigate these inconsistencies and risks we have developed a cost effective liquid biopsy technology to diagnose allograft rejection. We first screen an array of single-nucleotide polymorphisms (SNPs) in donor and recipient genomic DNA to discriminate and identify donor specific SNPs. As these SNPs are representative of donor derived cell free DNA (dd-cfDNA), quantification of them by real time PCR in total cell free DNA (total cfDNA) fraction of recipients can be considered as indicator for allograft health. By using this technology we performed a pilot study on 12 heart or lung allograft recipients. 9ml of whole blood collected in PAXGENE tubes from the patients before biopsy were processed to extract total cfDNA and quantify the abundance of dd-cfDNA in the total cfDNA fraction by real time qPCR. <h3>Results</h3> Data analysis indicated presence of dd-cfDNA in 2/12 samples, which correlated with histopathological investigations that identified minimal acute rejection in one patient and cell mediated rejection in the other. One more patient was identified to be undergoing minimal cellular rejection one month post transplant. However, we could not detect dd-cfDNA signal in the plasma. Based on these data, our liquid biopsy technology is able to diagnose rejection in 66.6% (2/3) of patients with a negative prediction at 100% (9/9). <h3>Conclusion</h3> A cost effective Liquid Biopsy Technology using dd-cfDNA quantification by real time qPCR which has excellent correlation with conventional biopsies. Large randomised control studies need to be conducted to further validate this.

Cytomegalovirus prevention in thoracic organ transplantation: A single-center evaluation of letermovir prophylaxis

Cytomegalovirus (CMV) infection is common following thoracic organ transplantation and causes substantial morbidity and mortality. Letermovir is a novel antiviral agent used off-label in this population for CMV prevention. Our goal was to understand patterns of letermovir use and effectiveness when applied for CMV prophylaxis after thoracic transplantation. We retrospectively evaluated letermovir use among thoracic transplant recipients at an academic transplant center who initiated letermovir from January 2018 to October2019 for CMV prophylaxis. We analyzed indication, timing, and duration of prophylaxis; tolerability; and occurrence of breakthrough CMV DNAemia and disease. Forty-two episodes of letermovir prophylaxis occurred in 41 patients, including 37 lung and 4 heart transplant recipients. Primary prophylaxis (26/42, 61.9%) was utilized mainly due to myelosuppression (25/26, 96.2%) and was initiated a median of 315 days post-transplant (interquartile range [IQR] 125-1139 days). Sixteen episodes of secondary prophylaxis (16/42, 38.1%) were initiated a median of 695 days post-transplant (IQR 537-1156 days) due to myelosuppression (10/16, 62.5%) or prior CMV resistance (6/16, 37.5%). Median duration of letermovir prophylaxis was 282 days (IQR 131-433 days). Adverse effects required letermovir cessation in 5/42 (11.9%) episodes. Only one episode (2.4%) was complicated by clinically significant breakthrough CMV infection. Transient low-level CMV DNAemia (<450 IU/ml) occurred in 15 episodes (35.7%) but did not require letermovir cessation. Letermovir was well tolerated and effective during extended prophylactic courses with only one case of breakthrough CMV infection in this cohort of thoracic transplant recipients. Further prospective trials of letermovir prophylaxis in this population are warranted.

Incidence and Outcomes of Tuberculosis among Thoracic Organ Transplant Recipients in an Endemic Country - 15 Years of Evaluation

Purpose Tuberculosis (TB) is an endemic disease in Brazil. Therefore, it demands a higher surveillance regarding donors and receptors. Reactivation of latent TB infection (LTBi), new cases of TB and “de novo” TB may occur. For this reason, we revised all cases of post-transplant tuberculosis, and their outcomes, reported in the last 15 years in our heart and lung transplant center. Methods We conducted a retrospective review of medical records between January/2005 - June/2020 of all TB infection and LTBi in thoracic organ transplant recipients in our center at Sao Paulo, Brazil. Diagnosis was done after biopsy, culture or positive smear microscopy at affected sites, except for pleural tuberculosis, when diagnosis was given by the analysis of pleural effusion. Results In this period, 872 thoracic organ transplants were performed: 484 heart transplant (HTx) and 388 lung transplants (LTx). Eighteen recipients had LTBi and received treatment with isoniazid for 6 months: 1 HTx and 17 LTx recipients. Among those, 11 had confirmed previous pulmonary TB and 8 of them had LTx indication for bronchiolitis due to TB sequela. The other patients, received LTBi treatment because: 4 cases of positive Manteaux test, 1 post-exposure and 2 with donor previous treated Pulmonary TB.Post-transplant TB infection was diagnosed in 21 patients (2,4%): 14 LTx and 7 HTx. There sites were 11 pulmonary, 3 donor-derived pulmonary, 3 pleural, 3 ganglionary and, 1pericardium. All patients, until 2013, were initially treated with regular 4-drugs treatment (rifampin+isoniazid+pyrazinamide+ethambutol) however due to great interaction with calcineurin inhibitors, treatment was changed to rifampin-free scheme for 12 months. There were no changes in the immunosuppression. One patient had elevation of liver enzymes and other 2 patients reported nausea and vomiting. Crude mortality was 19% (4 patients). Conclusion We observed higher risk (almost 3 times) for TB infection among LTx recipients compared to HTx patients. Extra-pulmonary TB infection was frequent among HTx recipients in contrast with pulmonary TB presentation in LTx recipients. Treatment for LTBi with isoniazid was effective, since no patient had recurrence of tuberculosis.Our data suggest the importance of active surveillance for TB infection or LTBi in thoracic organ transplant center in endemic countries.

Impact of Primary Clostridium Difficile Prophylaxis in Thoracic Transplant Recipients

<h3>Purpose</h3> <i>Clostridium difficile</i> infection (CDI) is associated with increased morbidity and mortality after thoracic transplant. In response to a series of cases, our institution implemented primary CDI prophylaxis with oral vancomycin 125 mg twice daily. <h3>Methods</h3> We retrospectively reviewed all thoracic transplant recipients from January 2018 to March 2020. Exclusion criteria included postoperative antibiotics < 48 hours, history of CDI, less than 80% overlap of prophylaxis with antibiotics, and in-hospital mortality. Patients were categorized based on the receipt of oral vancomycin prophylaxis (OVP) or no prophylaxis (No PPX). The primary outcome, CDI during index hospitalization, was compared using Kaplan-Meier survival analysis. <h3>Results</h3> In total, we reviewed 164 thoracic transplant recipients. We excluded 55 patients for a final cohort of 109 patients. There were 63 lung and 46 heart transplant recipients. Twenty-two patients (20%) received prophylaxis and 87 patients (80%) did not. Baseline demographics and hospitalization or receipt of antibiotics within prior 90 days did not differ between groups. Median length of stay was 30 and 43 days in the No PPX and OVP groups, respectively (p=0.01). Post-transplant, more patients in the OVP group were mechanically ventilated greater than 72 hours (16% vs. 46%, p=0.003) or on ECMO (7% vs. 27%, p=0.006). Median duration of antibiotics was 18 and 28 days in the No PPX and OVP groups, respectively (p=0.002). OVP overlapped a median of 95% of antibiotic days and continued for a median of 4 days after antibiotic discontinuation. During hospitalization, CDI occurred in 6 patients (7%) in the No PPX arm and 0 patients in the OVP arm (p=0.35). CDI-free survival did not differ between groups based on the Kaplan-Meier survival analysis (p=0.16). <h3>Conclusion</h3> Despite a higher degree of post-transplant organ support and significantly longer duration of antibiotics and length of stay, the incidence of CDI trended lower with the use of OVP. Primary OVP should be investigated in larger cohorts.

Management and tolerability of glecaprevir-pibrentasvir pharmacotherapy in hepatitis C viremic heart and lung transplant recipients.

We conducted a retrospective review of thoracic transplant recipients (22 heart and 16 lung transplant recipients) prospectively enrolled in a single-center observational study of HCV NAT+ organ transplantation in HCV NAT- recipients. All recipients were treated with 8weeks of glecaprevir-pibrentasvir (GP) for HCV viremia in addition to standard triple immunosuppression post-transplant. Thoracic transplant recipients of HCV NAT- organs were used as a control (24 heart and 22 lung transplant recipients). Our primary outcome was to assess the effect of GP on tacrolimus dose requirements. Secondary objectives included assessing drug interactions with common post-transplant medications, adverse effects, and the need to hold or discontinue GP therapy. The median tacrolimus concentration-to-dose ratio (CDR) in the cohort was 184 (99-260) during GP therapy and 154 (78-304) over the first month after GP (P=.79). Trends in median tacrolimus CDR were similar on a per-week basis and per-patient basis. In three instances, concomitant posaconazole and GP led to hyperbilirubinemia and interruption of posaconazole. GP therapy was held in one heart transplant recipient and discontinued in another due to unresolving hyperbilirubinemia. Utilization of GP to treat HCV viremia post-thoracic transplant is feasible and safe, but requires modifications to post-transplant pharmacotherapy and careful monitoring for adverse effects.

Donor heart and lung procurement: A consensus statement

Heart and lung procurements are multiphased processes often accompanied by an array of complex logistics. Approaches to donor evaluation and management, organ procurement, and organ preservation vary among individual procurement teams. Because early graft failure remains a major cause of mortality in contemporary thoracic organ transplant recipients, we sought to establish some standardization in the procurement process. This paper, in this vein, represents an international consensus statement on donor heart and lung procurement and is designed to serve as a guide for physicians, surgeons, and other providers who manage donors to best optimize the clinical status for the procurement of both heart and lungs for transplantation. Donation after brain death (DBD) and donation after circulatory determination death (referred to as donation after circulatory death [DCD] for the remainder of the paper) for both heart and lung transplantation will be discussed in this paper. Although the data available on DCD heart donation are limited, information regarding the surgical technique for procurement is included within this consensus statement. Furthermore, this paper will focus on adult DBD and DCD heart and lung procurement. Currently, no certification, which is either recognized and/or endorsed by the transplant community at large, exists for the training of a cardiothoracic procurement surgeon. Nevertheless, establishing a training curriculum and credentialing requirements are beyond the scope of this paper.

Quadritherapy vs standard tritherapy immunosuppressant regimen after heart transplantation: A propensity score-matched cohort analysis.

After heart transplant, adding everolimus (EVL) to standard immunosuppressive regimen mostly relies on converting calcineurin inhibitors (CNIs) into EVL. The aim of this study was to describe the effects of combining low-dose EVL and CNIs in maintenance immunosuppression regimen (quadritherapy) and compare it with standard tritherapy associating standard-dose CNIs, mycophenolate mofetil, and corticosteroids. In the 3-year registry cohort of heart transplanted patients, those who received quadritherapy were compared with those who received tritherapy. EVL was added after 3months posttransplant. Three analyses were performed to control for confounders: propensity score matching, multivariable survival, and inverse probability score weighting analyses. Among 213 patients who were included (75 with quadritherapy), propensity score matching selected 64 unique pairs of patients with similar characteristics. In the matched cohort (n=128), quadritherapy was associated with fewer deaths (3 [4.7%] vs 17 [21.9%], P=.007) and biopsy-proven acute rejections (15 [23.4%] vs 31 [48.4%], P=.002). These results were confirmed in the overall cohort (n=213), after multivariable and inverse probability score weighting analyses. Renal function and donor-specific HLA-antibodies remained similar in both groups. Low-dose combination quadritherapy was associated with fewer deaths and rejections, compared with standard immunosuppression tritherapy.

Travel Practices and Associated Risks in Thoracic Transplant Recipients: A Monocentric Survey

Little is known regarding the travel practices of thoracic organ transplant recipients and their potential associated morbidity. A questionnaire was distributed to thoracic organ transplant recipients in the transplant clinic at a single French center between October, 2015, and October, 2018. Questions addressed demographics, transplant history, current immune suppression, knowledge regarding vaccination status, past history of travel (any destination outside metropolitan France), including pre-travel advice, health issues during travels outside Europe, and travel intentions during the following year. 117 patients completed the survey (82 lung, 14 heart and 21 heart-lung transplant recipients). Mean age was 49.4 years, 61.5% were female. 19 patients (17%) were born outside metropolitan France. At the time of survey completion, 70%, 68%, 96% and 12% of patients were receiving steroids, mycophenolate, calcineurin inhibitors, and mTOR inhibitors, respectively. 36%, 16%, and 10% of respondents considered that being a transplant recipient increased their risk of travel-related health issues mildly, moderately, and greatly, respectively. 58 patients (50%) had traveled outside metropolitan France after transplant (mean number of travels=7; mean number of destinations=3.3). Among 34 subjects who had traveled outside Europe in the last 5 years, 23 had received pre-travel advice, predominantly by their transplant physician. Among 41 respondents having traveled outside metropolitan France, 6 (15%) had experienced health issues (all outside Europe), which led to consultation and hospitalization in 3 and 1 cases, respectively. No immunosuppressives shortage was reported. Among 102 respondents, 61 (60%) intended to travel within the following year, and 50 (82%) to sought medical advice before departure, predominantly from their transplant physician (50 patients, including 17 in combination with a general practitioner or a travel medicine center). These data highlight the significant number of international travels undertaken by thoracic transplant recipients, and a relatively low travel-associated morbidity. As very few patients intend to seek advice from travel medicine specialists, transplant physicians are expected to be the major players of pre-travel counselling in this specific population.