Saturday, September 3, 2016

Prevention and Management of Tuberculosis in Transplant Recipients: From Guidelines to Clinical Practice

Transplantation - Most Popular Articles Prevention and Management of Tuberculosis in Transplant Recipients: From Guidelines to Clinical Practice

imageAbstract: Transplant recipients are at increased risk for tuberculosis (TB), which can adversely affect graft viability and patient survival. Scientific societies and official organizations have therefore issued guidelines and consensus statements for TB prevention and treatment. However, due to the poor supporting evidence, the current recommendations largely rely on expert opinion rather than on properly designed studies. In this overview, we aim to gather together the previous experience and compare and contrast the main current guidelines on the prevention and treatment of TB in solid organ transplantation and hematopoietic stem cell transplantation.


http://journals.lww.com/transplantjournal/Fulltext/2016/09000/Prevention_and_Management_of_Tuberculosis_in.15.aspx

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Thursday, September 1, 2016

Cancer Screening Recommendations for Solid Organ Transplant Recipients: A Systematic Review of Clinical Practice Guidelines



Solid organ transplant recipients (SOTRs) are at increased risk of developing and dying from cancer. However, controversies exist around cancer screening in this population owing to reduced life expectancy and competing causes of death. This systematic review assesses the availability, quality and consistency of cancer screening recommendations in clinical practice guidelines (CPGs). We systematically searched bibliographic databases and gray literature to identify CPGs and assessed their quality using AGREE II. Recommendations were extracted along with their supporting evidence. Thirteen guidelines were included in the review. CPGs for kidney recipients were the most frequent source of screening recommendations, and recommendations for skin cancer screening were most frequently presented. Some screening recommendations differed from those for the general population, based on literature demonstrating higher cancer incidence among SOTRs versus direct evidence of screening effectiveness. Relevant stakeholders such as oncology specialists, primary care providers and public health experts were not involved in the formulation of the screening recommendations. In conclusion, although several guidelines make recommendations for cancer screening in SOTRs, the availability of cancer screening recommendations varied considerably by transplanted organ. More studies are required to inform cancer screening recommendations in SOTRs, and guideline development should involve transplant patients, oncologists and cancer screening specialists.

Wednesday, August 24, 2016

Recurrent IgA Nephropathy After Kidney Transplantation

Transplantation - Current Issue Recurrent IgA Nephropathy After Kidney Transplantation

imageAbstract: Large numbers of patients with end-stage kidney disease caused by IgA nephropathy are transplanted every year, and each of these patients faces the risk of recurrence in their kidney graft. We review the epidemiology, diagnosis, and outcomes of recurrent IgA nephropathy. Mechanistic insights, therapeutic options, and knowledge gaps are reviewed, and we discuss future options to better understand and manage this disorder.


http://journals.lww.com/transplantjournal/Fulltext/2016/09000/Recurrent_IgA_Nephropathy_After_Kidney.13.aspx

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Prevention and Management of Tuberculosis in Transplant Recipients: From Guidelines to Clinical Practice

Transplantation - Current Issue Prevention and Management of Tuberculosis in Transplant Recipients: From Guidelines to Clinical Practice

imageAbstract: Transplant recipients are at increased risk for tuberculosis (TB), which can adversely affect graft viability and patient survival. Scientific societies and official organizations have therefore issued guidelines and consensus statements for TB prevention and treatment. However, due to the poor supporting evidence, the current recommendations largely rely on expert opinion rather than on properly designed studies. In this overview, we aim to gather together the previous experience and compare and contrast the main current guidelines on the prevention and treatment of TB in solid organ transplantation and hematopoietic stem cell transplantation.


http://journals.lww.com/transplantjournal/Fulltext/2016/09000/Prevention_and_Management_of_Tuberculosis_in.15.aspx

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Wednesday, August 3, 2016

Chronic norovirus infection as a risk factor for secondary lactose maldigestion in renal transplant recipients: a prospective parallel cohort pilot study.

Transplantation - Published Ahead-of-Print Chronic norovirus infection as a risk factor for secondary lactose maldigestion in renal transplant recipients: a prospective parallel cohort pilot study.

Background: Chronic norovirus infection is an emerging challenge in the immunocompromised host, in whom it may be asymptomatic or present as chronic diarrhea. The mechanisms of diarrhea in chronic norovirus infection are not well understood, but in analogy to Gardia lamblia and rotavirus infections, secondary lactose maldigestion (LM) might be implicated. Methods: Adult renal transplant recipients (RTRs) who had symptomatic chronic norovirus infection with diarrhea were asked to participate in this prospective parallel cohort study. RTRs with otherwise unexplainable chronic diarrhea but absent infection served as control group. In both groups, a lactose hydrogen breath test (LHBT) and a lactose tolerance test (LTT) were performed after exclusion of primary LM by a negative lactase gene test. Results: Of approximately 800 patients in the cohort of RTRs at our institution, 15 subjects were included in the present study. Of these, 7 had chronic symptomatic norovirus infection with diarrhea (noro group) and 8 had diarrhea in the absence of norovirus (control group). LHBT and LTT were positive in all 7 patients (100%) in the noro group, whereas only 1 of 8 patients (12.5%) in the control group had a positive test. Thus, secondary LM was highly prevalent in the noro compared to the control group with an odds ratio of 75.0 (95% CI 2.6, 2153, p=0.01). Conclusions: This is the first report showing a positive association of chronic norovirus infection and secondary LM. Further studies with larger patient numbers and longer follow-up are needed to test a causative relationship between both entities. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.


http://pdfs.journals.lww.com/transplantjournal/9000/00000/Chronic_norovirus_infection_as_a_risk_factor_for.97297.pdf

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Friday, July 29, 2016

Calcineurin Inhibitor Nephrotoxicity Through the Lens of Longitudinal Histology: Comparison of Cyclosporine and Tacrolimus Eras

Transplantation - Most Popular Articles Calcineurin Inhibitor Nephrotoxicity Through the Lens of Longitudinal Histology: Comparison of Cyclosporine and Tacrolimus Eras

imageBackground: The contribution of calcineurin inhibitors (CNI) nephrotoxicity to progressive kidney transplant injury remains debated, with little long-term data from the modern tacrolimus (TAC) era using lower doses. Methods: This longitudinal cohort study evaluated histological evidence of CNI nephrotoxicity from normal donor kidneys of successful kidney-pancreas transplant recipients during cyclosporine (CSA) and TAC eras, analyzed by intention-to-treat. Results: From 200 patients, 1622 adequate prospective protocol (84.3%) and indication (15.7%) kidney biopsies yielded 8.1 ± 4.1 samples per patient, over 7.4 ± 4.4 years posttransplant. The TAC era demonstrated less rejection and reduced early immune-mediated tubular damage, compared with CSA (P < 0.001). The incidences of acute mild arteriolopathy, striped interstitial fibrosis, glomerular congestion, and tubular microcalcification were all greater with CSA (hazard ratios of 1.70, 9.35, and 3.78, respectively) and maximal within the first posttransplant year, compared with TAC-treated patients (P < 0.001). However, the 1-, 5-, and 10-year prevalence moderate arteriolar hyalinosis was similar: CSA was 5.4%, 38.4%, and 79.1%; and TAC was 4.3%, 33.6% and 77.2%, respectively (P = NS). Morphometric measurement demonstrated lumenal narrowing from inwards collapse of hyalinized arteriolar walls unable to maintain its structural integrity. Severe hyalinosis was calculated to reduce arteriolar blood flow to 20 ± 34% of normal. Severity of arteriolar hyalinosis correlated with contemporaneous glomerulosclerosis (r = 0.44, P < 0.001), and subsequent progression in 1356 sequential biopsy pairs, consistent with glomerular ischemia. Conclusions: Tacrolimus-based therapy appeared superior to the CSA era, with less early CNI nephrotoxicity and fewer rejection episodes, but comparable chronic arteriolar toxicity. Calcineurin inhibitors are imperfect long-term maintenance immunosuppressive agents because of frequent and irreversible chronic toxicity.


http://journals.lww.com/transplantjournal/Fulltext/2016/08000/Calcineurin_Inhibitor_Nephrotoxicity_Through_the.26.aspx

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Alberto Reino Buelvas