• Mucorales
• hematologic malignancies
• immunosuppressed
• infections
• mucormycosis

• Clostridioides difficile infection
• antimicrobial prescription
• latent tuberculosis infection
• liver transplantation
• moxifloxacin
• multidrug‐resistant bacteria
• tuberculosis

• Humans
• Liver Transplantation/adverse effects
• Moxifloxacin/therapeutic use
• Moxifloxacin/administration & dosage
• Retrospective Studies
• Male
• Middle Aged
• Female
• Latent Tuberculosis/prevention & control
• Latent Tuberculosis/drug therapy
• Latent Tuberculosis/diagnosis
• Antitubercular Agents/therapeutic use
• Antitubercular Agents/administration & dosage
• Antitubercular Agents/adverse effects
• Adult
• Aged
• Transplant Recipients
• Incidence

• Instituto de Salud Carlos III

• Antitubercular therapy
• Donor
• Interferon-gamma release assays
• Isoniazid
• Kidney transplantation
• Latent
• Rifampicin
• Tuberculin
• Tuberculosis

• Humans
• Bronchiectasis/microbiology
• Bronchiectasis/epidemiology
• Bronchiectasis/diagnosis
• Bronchiectasis/therapy
• Bronchiectasis/drug therapy
• Mycobacterium Infections, Nontuberculous/epidemiology
• Mycobacterium Infections, Nontuberculous/diagnosis
• Mycobacterium Infections, Nontuberculous/microbiology
• Mycobacterium Infections, Nontuberculous/therapy
• Mycobacterium Infections, Nontuberculous/drug therapy
• Risk Factors
• Nontuberculous Mycobacteria/pathogenicity
• Nontuberculous Mycobacteria/isolation & purification
• Anti-Bacterial Agents/therapeutic use
• Treatment Outcome
• Prevalence
• Host-Pathogen Interactions
• Predictive Value of Tests

• Latent tuberculosis
• Liver transplant
• Pre-transplant screening
• Prevention
• Tuberculosis

• Female
• Humans
• Middle Aged
• Latent Tuberculosis/diagnosis
• Latent Tuberculosis/drug therapy
• Latent Tuberculosis/epidemiology
• Liver Transplantation/adverse effects
• Retrospective Studies
• Tuberculosis/diagnosis
• Tuberculosis/drug therapy
• Tuberculosis/epidemiology
• Risk Factors

• Critical care
• Heart transplant
• Infections
• Lung transplant

• Humans
• Transplant Recipients
• Lung
• Risk Factors
• Lung Transplantation/adverse effects

• Humans
• Renal Dialysis
• Tuberculosis/epidemiology
• Latent Tuberculosis/epidemiology
• Male
• Female
• Middle Aged

• Allogeneic graft rejection
• Immunosuppression
• RapaLink-1
• Rapamycin
• mTOR
• p-4E-BP1

• Animals
• Mice
• Mechanistic Target of Rapamycin Complex 1
• MTOR Inhibitors
• Sirolimus/therapeutic use
• TOR Serine-Threonine Kinases
• Allografts
• Mammals

• Candidate
• Recipient
• Solid organ
• Transplant
• Tuberculosis

• Humans
• Taiwan/epidemiology
• Tuberculosis/diagnosis
• Tuberculosis/drug therapy
• Tuberculosis/epidemiology
• Organ Transplantation/adverse effects
• Antitubercular Agents/therapeutic use
• Immunosuppressive Agents/adverse effects

• burkitt lymphoma
• kidney transplantation
• post-transplant lymphoproliferative disorder
• pulmonary tuberculosis
• tuberculosis

• Humans
• Female
• Young Adult
• Adult
• Burkitt Lymphoma/complications
• Burkitt Lymphoma/diagnosis
• Kidney Transplantation/adverse effects
• Epstein-Barr Virus Infections/complications
• Herpesvirus 4, Human/genetics
• Tuberculosis/diagnosis

• antifungal
• antimycotic
• aspergillosis
• candidiasis
• invasive fungal infections
• liver transplant
• transplant

• breakthrough infections
• echinocandins
• invasive fungal infections
• liver transplantation
• targeted antimycotic prophylaxis

• adverse events
• antifungal
• antimycotic
• complications
• fungi
• invasive infection
• liver
• mortality
• prophylaxis
• transplantation

Tuberculosis (TB) in kidney transplant (KT) recipients is an important opportunistic infection with higher incidence and prevalence than in the general population and is associated with important morbidity and mortality. We performed an extensive literature review of articles published between 1 January 2000 and 15 June 2022 to provide an evidence-based review of epidemiology, pathogenesis, diagnosis, treatment and outcomes of TB in KT recipients. We included all studies which reported epidemiological and/or outcome data regarding active TB in KT, and we approached the diagnostic and treatment challenges according to the current guidelines. Prevalence of active TB in KT recipients ranges between 0.3–15.2%. KT recipients with active TB could have a rejection rate up to 55.6%, a rate of graft loss that varies from 2.2% to 66.6% and a mortality rate up to 60%. Understanding the epidemiological risk, risk factors, transmission modalities, diagnosis and treatment challenges is critical for clinicians in providing an appropriate management for KT with TB. Among diagnostic challenges, which are at the same time associated with delay in management, the following should be considered: atypical clinical presentation, association with co-infections, decreased predictive values of screening tests, diverse radiological aspects and particular diagnostic methods. Regarding treatment challenges in KT recipients with TB, drug interactions, drug toxicities and therapeutical adherence must be considered.

Infection with SARS-CoV-2 increases the risk of acute graft dysfunction (AGD) in renal transplant recipients (RTR), and the risk of concurrently presenting with opportunistic infections is also increased. There is no current consensus on the management of immunosuppression during SARS-CoV-2 infection in RTR. Case Presentation. A 35-year-old male RTR from a living related donor presented with SARS-CoV-2 infection (January 2021). Two months later, despite alterations to his immunosuppression regimen (tacrolimus (TAC) was reduced by 50%, and the mycophenolic acid (MMF) was suspended with the remission of symptoms), the patient presented with pulmonary tuberculosis, pneumonia due to respiratory syncytial virus (RSV), cytomegalovirus (CMV) pneumonitis, and histoplasmosis (HP). Management was initiated with antituberculosis medications, ganciclovir, antibiotics, and liposomal amphotericin B, and the immunosuppressants were suspended, yet the patient's evolution was catastrophic and the outcome fatal.

We recommend that in RTR post-COVID-19, the immunosuppression regimen should be gradually reinstated along with strict vigilance in observing for highly prevalent coinfections (TB, HP, and CMV).

End-stage liver disease patients undergoing liver transplantation are prone to develop numerous infectious complications because of immunosuppression, surgical interventions, and malnutrition. Infections in transplant recipients account for the main cause of mortality and morbidity with rates of up to 80%. The challenges faced in the early post-transplant period tend to be linked to transplant procedures and nosocomial infections commonly in bloodstream, surgical, and intra-abdominal sites. Viral infections represent an additional complication of immunosuppression; they can be donor-derived, reactivated from a latent virus, nosocomial or community-acquired. Bacterial and viral infections in solid organ transplantation are managed by prophylaxis, multi-drug resistant screening, risk assessment, vaccination, infection control and antimicrobial stewardship. The aim of this review was to discuss the epidemiology of bacterial and viral infections in liver transplants, infection control issues, as well as surgical frontiers of ex situ liver perfusion.

• COVID-19
• Candida
• SARS-CoV-2
• Treg
• fungi
• inflammation
• mycobiome

• R01 DE026923 NIDCR NIH HHS
• DE026923 NIDCR NIH HHS

Mycobacterium tuberculosis (MTB) infection in solid organ transplant (SOT) recipients remains a major challenge for physicians and surgeons. Active tuberculosis (TB) is associated with increased morbidity and mortality in SOT recipients. MTB usually develops after transplantation in a recipient with latent TB infection (LTBI) before transplantation and may also be transmitted from the donor or acquired from the community. Therefore, screening for LTBI in donors and recipients before transplantation is very important in preventing active disease after transplantation. This review article is based on recently published data, case series, and expert recommendations. We reviewed updated information about the epidemiology, diagnosis, and treatment of latent and active TB before and after transplantation. We also reviewed recent treatments for multidrug-resistant TB.

• Abscess/diagnosis
• Abscess/drug therapy
• Abscess/etiology
• Antitubercular Agents/therapeutic use
• Humans
• Immunosuppressive Agents/adverse effects
• Kidney Transplantation/adverse effects
• Transplant Recipients
• Tuberculosis/diagnosis
• Tuberculosis/drug therapy

Patients undergoing solid organ transplantation, particularly those who live or have lived in tuberculosis (TB) endemic areas, are at a high risk of developing TB. The majority of post-transplantation TB cases are associated with reactivation of latent TB infection (LTBI). Brazil is in a single position with overlapping areas of high TB endemicity and high transplant activity. In liver transplant (LT), one should be aware of the potential hepatotoxicity associated with the treatment regimens for LTBI.

To evaluate the frequency of LTBI in LT patients and treatment-related issues.

This was a retrospective analysis of a cohort of cirrhotic patients aged ≥ 18 years, who underwent LT at a high-complexity teaching hospital from January 2005 to December 2012.

Overall, 429 patients underwent LT during the study period. Of these, 213 (49.7%) underwent the tuberculin skin test (TST) during the pre-transplant period, and 35 (16.4%) of them had a positive result. The treatment for LTBI was initiated after LT in 12 (34.3%) of the TST-positive patients; in 3 (25.0%), treatment was maintained for at least 6 mo.

The prevalence of LTBI was lower than expected. Initiation and completion of LTBI treatment was limited by difficulties in the management of these special patients.

• Latent tuberculosis
• Liver transplantation
• Tuberculosis
• Infection
• Transplantation
• Risk factors

• Mycobacterium abscessus
• Mycobacterium avium
• Mycobacterium xenopi
• NTM
• inhaled amikacin
• nontuberculous mycobacterial pulmonary disease

• Antitubercular Agents/therapeutic use
• Humans
• Latent Tuberculosis/diagnosis
• Latent Tuberculosis/drug therapy
• Liver Transplantation/adverse effects
• Moxifloxacin/therapeutic use
• Mycobacterium tuberculosis
• Prospective Studies

Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral.

We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019.

There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402).

In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.

Donor-derived tuberculosis (DD-TB) accounts for less than 5% of TB cases and is considered a rare event. In the transplant setting, the frequency of active TB is estimated to be 20 to 74 times higher than that in the general population, and it is associated with high mortality. In this context, the main strategy to minimize the risk of DD transmission is to identify high-risk donors. Despite screening recommendations, failures may result in a breakdown of safety that ends in the transmission of potentially fatal diseases. This report describes a case of DD-TB and emphasizes communication gaps that may occur between organ procurement organizations and transplant centers. Failure in reporting results, lack of exchanging information regarding recipients from the same donor, and inefficient communication between organ procurement organizations and transplant centers are lacks that may be prevented by a more efficient approach towards screening protocols and communication.

To summarize the long-term complications after pancreas transplantation that affect graft function, a literature search was carried out on the long-term complications of pancreatic transplantation, namely, complications from postoperative 3^rd mo onwards, in terms of loss of graft function, late infection and vascular complications as pseudoaneurysms. The most relevant reviews and studies were selected to obtain the current evidence on these topics. The definition of graft failure varies among different studies, so it is difficult to evaluate, a standardized definition is of utmost importance to know the magnitude of the problem in all worldwide series. Chronic rejection is the main cause of long-term graft failure, occurring in 10% of patients. From the 3rd mo of transplantation onwards, the main risk factor for late infections is immunosuppression, and patients have opportunistic infections like: Cytomegalovirus, hepatitis B and C viruses, Epstein-Barr virus and varicella-zoster virus; opportunistic bacteria, reactivation of latent infections as tuberculosis or fungal infections. Complete preoperative studies and serological tests should be made in all recipients to avoid these infections, adding perioperative prophylactic treatments when indicated. Pseudoaneurysm are uncommon, but one of the main causes of late bleeding, which can be fatal. The treatment should be performed with radiological endovascular approaches or open surgery in case of failure. Despite all therapeutic options for the complications mentioned above, transplantectomy is a necessary option in approximately 50% of relaparotomies, especially in life-threatening complications. Late complications in pancreatic transplantation threatens long-term graft function. An exhaustive follow-up as well as a correct immunosuppression protocol are necessary for prevention.

• Pancreas transplantation
• Pancreas allograft failure
• Pancreas transplant rejection
• Pseudoaneurysm
• Allograft pancreatectomy

Tuberculosis (TB) is a major complication following transplantation. The likelihood of TB may be increased in transplant patients living in TB‐endemic areas such as Saudi Arabia. In areas where TB is less common, guidelines recommend isoniazid (INH) for TB prophylaxis depending on patient and donor screening results. However, in TB‐endemic regions, studies have supported its use in all transplant patients regardless of TB screening results. This study aimed to compare the safety and effectiveness of administering INH prophylaxis therapy based on the TB screening results of lung transplant (LT) recipients.

We conducted a single‐center retrospective cohort study on LT recipients. The outcomes were compared between patients who were administered screening‐based prophylaxis (SBP) with INH based on their tuberculin skin tests (TSTs) or QuantiFERON results and those who were administered empirical prophylaxis (EP) with INH regardless of TB screening results. The primary endpoint was the incidence of TB infection, and the secondary endpoints were INH‐induced hepatotoxicity and INH resistance.

A total of 50 patients received SBP and 30 received EP. TB incidences were 8% and 0%, respectively (P = .0487). One of these patients had INH resistance, and one patient experienced INH‐induced hepatotoxicity (P = .1591); both were in the SBP group.

The low rates of TB infection, INH‐induced hepatotoxicity, and INH resistance in the EP group suggest that INH prophylaxis appears to prevent TB and can be safely used in all LT recipients. However, prospective studies using large sample sizes are required to confirm these findings.

• isoniazid
• latent tuberculosis
• lung transplantation
• tuberculosis
• tuberculosis prophylaxis

The Interaction between anti-tuberculous and immunosuppressive drugs which may increase the risk of graft rejections is a major challenge in managing transplant recipients with tuberculosis (TB). Instead of rifampicin (RFM), most guidelines recommended the use of rifabutin (RFB) because of its reduced capacity to induce immunosuppressant metabolism while maintaining the same efficacy as RFM against TB. However, there has been no available data directly comparing the outcome of RFB from RFM-based anti-TB regimens in liver transplant patients with TB. This study aimed to compare the effects of RFB from RFM-based treatment in terms of the drug interaction with immunosuppressants, as well as the safety, efficacy and clinical outcomes of living donor liver transplant (LDLT) recipients with active TB.

A retrospective study was conducted on all adult LDLT recipients diagnosed with active TB from June 1994 to May 2016 that had concurrently and continuously received either RFB or RFM-based treatment and immunosuppressants.

Twenty-two patients were included. Twelve (55%) patients were in the RFM group. Ten (45%) patients were in the RFB group. RFB group showed a lesser rate of immunosuppressant trough level reduction (20% vs 50%, p = 0.009) during TB treatment. There was no TB recurrence and no significant change in platelet or leukocyte count in either group. Acute cellular rejection (ACR), rate of TB-treatment completion and overall survival, rates were excellent and statistically similar in both groups.

The use of RFB in LDLT recipients with active TB, had a lesser drug interaction than when RFM was used. However, RFB did not significantly reduced the rate of ACR. RFB and RFM are both effective and safe to use in LDLT recipients with active TB.

• Adult
• Drug Interactions
• Humans
• Immunosuppressive Agents/therapeutic use
• Liver Transplantation
• Living Donors
• Retrospective Studies
• Rifabutin/therapeutic use
• Rifampin/therapeutic use
• Transplant Recipients
• Tuberculosis/drug therapy

• donor-derived infections
• solid organ transplantation
• tuberculosis

• Targeted therapies
• autoimmune diseases
• biologics
• immune-compromised hosts
• immunocompromised host
• opportunistic infections

Infection is the most common cause of mortality within the first year after lung transplantation (LTx). The management of perioperative antibiotic therapy is a major issue, but little is known about worldwide practices.

We sent by email a survey dealing with 5 daily clinical vignettes concerning perioperative antibiotic therapy to 180 LTx centers around the world. The invitation and a weekly reminder were sent to lung transplant specialists for a single consensus answer per center during a 3-month period.

We received a total of 99 responses from 24 countries, mostly from Western Europe (n = 46) and the USA (n = 34). Systematic screening for bronchial recipient colonization before LTx was mostly performed with sputum samples (72%), regardless of the underlying lung disease. In recipients without colonization, antibiotics with activity against gram-negative bacteria resistant strains (piperacillin / tazobactam, cefepime, ceftazidime, carbapenems) were reported in 72% of the centers, and antibiotics with activity against methicillin-resistant Staphylococcus aureus (mainly vancomycin) were reported in 38% of the centers. For these recipients, the duration of antibiotics reported was 7 days (33%) or less (26%) or stopped when cultures of donor and recipients were reported negatives (12%). In recipients with previous colonization, antibiotics were adapted to the susceptibility of the most resistant strain and given for at least 14 days (67%).

Practices vary widely around the world, but resistant bacterial strains are mostly targeted even if no colonization occurs. The antibiotic duration reported was longer for colonized recipients.

• Antibiotic therapy
• Bronchial colonization
• Lung transplantation
• Perioperative
• Survey

• Mycobacterium tuberculosis
• anti-TB drugs
• prevention
• solid organ transplant
• treatment

• Mycobacterium tuberculosis
• latent TB
• solid organ transplant

• adults
• chemoprevention
• kidney transplantation
• opportunistic infections
• tuberculosis

• drug-induced liver toxicity
• graft rejection
• immunocompromised patient
• orthotopic liver transplantation (olt)
• pulmonary arteriovenous malformation (pavm)
• tuberculosis (tb)

• Antitubercular Agents/therapeutic use
• Diagnosis, Differential
• Female
• Graft Rejection
• Hemoptysis/etiology
• Humans
• Immunocompromised Host
• Liver Transplantation
• Tomography, X-Ray Computed
• Tuberculosis, Pulmonary/diagnosis
• Tuberculosis, Pulmonary/diagnostic imaging
• Tuberculosis, Pulmonary/drug therapy
• Young Adult

Solid organ transplantation (SOT) is the best treatment option for end-stage organ disease. Newer immunosuppressive agents have reduced the incidence of graft rejection but have increased the risk of infection, particularly due to the reactivation of latent infections due to opportunistic agents such as Mycobacterium tuberculosis. Active tuberculosis (TB) after SOT is a significant cause of morbidity and mortality. Most cases of posttransplant TB are secondary to reactivation of latent tuberculosis infection (LTBI) due to the effects of long-term immunosuppressive therapy. Risk minimization strategies have been developed to diagnose LTBI and initiate treatment prior to transplantation. Isoniazid with vitamin B6 supplementation is the treatment of choice. However, liver transplantation (LT) candidates and recipients have an increased risk of isoniazid-induced liver toxicity, leading to lower treatment completion rates than in other SOT populations. Fluoroquinolones (FQs) exhibit good in vitro antimycobacterial activity and a lower risk of drug-induced liver injury than isoniazid. In the present review, we highlight the disease burden posed by posttransplant TB and summarize the emerging clinical evidence supporting the use of FQs for the treatment of LTBI in LT recipients and candidates.

• Fluoroquinolones
• Mycobacterium tuberculosis
• Latent tuberculosis infection
• Liver transplantation
• Drug-induced liver graft injury

• Allografts
• Antitubercular Agents/administration & dosage
• Antitubercular Agents/adverse effects
• Chemical and Drug Induced Liver Injury/etiology
• Chemical and Drug Induced Liver Injury/prevention & control
• End Stage Liver Disease/surgery
• Fluoroquinolones/administration & dosage
• Graft Rejection/epidemiology
• Graft Rejection/immunology
• Graft Rejection/prevention & control
• Humans
• Immunosuppressive Agents/adverse effects
• Incidence
• Isoniazid/adverse effects
• Latent Tuberculosis/drug therapy
• Latent Tuberculosis/immunology
• Latent Tuberculosis/microbiology
• Liver
• Liver Transplantation/adverse effects
• Mycobacterium tuberculosis/immunology
• Mycobacterium tuberculosis/isolation & purification
• Postoperative Complications/drug therapy
• Postoperative Complications/immunology
• Postoperative Complications/microbiology
• Risk Factors
• Treatment Outcome

• Haematopoietic stem cell transplant
• Hospitalized-acquired pneumonia
• Nosocomial infection
• Nosocomial pneumonia
• Solid organ transplant
• Transplant patients
• Transplantation
• Ventilator-associated pneumonia

The lungs are the only transplanted organ in direct contact with the ‘outside world’. Infection is a significant cause of morbidity and mortality in lung transplantation. Early accurate diagnosis and optimal management is essential to prevent short and long term complications. Bacteria, including Mycobacteria and Nocardia, viruses and fungi are common pathogens. Organisms may be present in the recipient prior to transplantation, transmitted with the donor lungs or acquired after transplantation. The degree of immunosuppression and the routine use of antimicrobial prophylaxis alters the pattern of post-transplant infections.

• Donor-derived infections
• Donor-transmitted infections
• Lymphocytic choriomeningitis virus
• Organ donor screening
• Transplant infections

• Liver transplantation
• Mycobacterium tuberculosis
• Transplantation hépatique

• Donor-derived infections
• Donor-transmitted infections
• Lymphocytic choriomeningitis virus
• Organ donor screening
• Transplant infections