Research Digest: Advancing Transplant ID

Research Digest is a periodic installment that recognizes the world-class clinical research performed right here at UNMC ID. Today, we review three articles covering the infectious complications of organ transplants. As always, check out the linked full articles for more details.

Dr. Zimmer, co-author of this review on GVHD-related bacterial pneumonia.

In the first article featured, co-authored by Dr. Andrea Zimmer, the post-organ transplant causes of bacterial pneumonia are outlined, particularly in regard to the chronic graft-versus-host disease (GVHD) population. GVHD is a systemic inflammatory response to organ transplantation where immune cells in the transplanted organ begin to attack the host. A severe complication of transplantation, treatment often necessitates long-term immunosuppression, which opens the door for opportunistic pathogens to cause disease. This review covers chronic GVHD and bacterial pneumonia pathophysiology and a host of specific causative pathogens including Mycobacterium tuberculosis, Legionnaires’ Disease, Nocardia, and Pseudomonas aeruginosa as well as preventative and treatment considerations. Read more here for the full details on this devastating transplant complication.

Dr. Abbas, the lead author of this article on WNv infections in transplant patients.

The second article, authored by Dr. Anum Abbas as well as Adia Sikyta, Dr. Diana Fluoresce, and others from the UNMC community, explores West Nile virus (WNv) infections following solid organ transplant. While WNv infection in immunocompetent individuals is typically asymptomatic or results in a mild fever, infection in immunocompromized solid organ transplant recipients can be much more severe, leading to neurological damage in some cases. Further, this patient population is at increased risk, with higher rates of infection than the general population. This study examined the medical records of solid organ transplant recipients at UNMC between 2010 and 2018, finding 8 patients with documented WNv infection. The majority of these patients previously received a kidney transplant and all presented with either meningitis, encephalitis, or both. The article explores the treatment, recovery, and outcome of these patients and compares this to the existing literature. Read on here for more information.

Dr. Stohs, lead author of this paper outline the utility of antimicrobial stewardship in the post-transplant patient population.

Lastly, Dr. Erica Stohs recently authored an article outlining the importance of antimicrobial stewardship in the care of solid organ transplant recipients. The article explains that antimicrobial stewardship is needed to combat rising antimicrobial resistance and associated adverse events (such as C. difficile infection) in this patient population. The paper explores, in great detail, exactly what can be done to combat these infectious transplant comorbidities, how to monitor progress, what works, and what likely doesn’t. The major take-aways were:

  • Clinicians can target C. difficile infections in transplant recipients through diagnostic testing stewardship and comparative trials of therapeutic and prophylactic agents.
  • Renal transplant¬†recipients do not benefit from treatment of asymptomatic bacteriuria when greater than 2¬†months from transplant.
  • Solid organ transplant recipients benefit from antibiotic allergy delabeling, allowing receipt of narrowed, targeted antibiotics.

Read the full story here.

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