Clinical treatment and management of invasive fungal disease in recipients of solid organ transplantation / 器官移植

With widespread application of solid organ transplantation (SOT), the incidence of postoperative invasive fungal disease (IFD) in SOT recipients has been increased year by year. In recent years, the awareness of preventive antifungal therapy for SOT recipients has been gradually strengthened. However, the problem of fungal resistance has also emerged, leading to unsatisfactory efficacy of original standardized antifungal regimens. Drug-drug interaction and hepatorenal toxicity induced by drugs are also challenges facing clinicians. In this article, the characteristics of drug-drug interaction and hepatorenal toxicity among triazole, echinocandin and polyene antifungal drugs and immunosuppressants were reviewed, and postoperative preventive strategies for IFD in different types of SOT recipients and treatment strategies for IFD caused by infection of different pathogens were summarized, aiming to provide reference for physicians in organ transplantation and related disciplines.

Investigation of patients’preferences regarding therapeutic drug monitoring of mycophenolic acid in solid organ transplantation / 中国药房

OBJECTIVE To investigate the preferences of patients who underwent solid organ transplantation regarding therapeutic drug monitoring （TDM） of mycophenolic acid （MPA） and explore the factors influencing patients’ decision-making process， so as to provide support for the development of individualized medication guidelines for MPA and improvement of clinical decision-making. METHODS The cross-sectional study was used to design the questionnaire on the patients’ preferences to accept MPA TDM， and involved patients who underwent solid organ transplantation and received MPA treatment at two tertiary hospitals in Beijing from April 14， 2022， to June 27， 2022. The Likert 5-level scoring method was used to score the patients’ preferences to accept MPA TDM， the influencing factors and their correlation of the patients’ preferences to accept MPA TDM were analyzed by Pearson correlation analysis and binary Logistic regression analysis， and the nonparametric test and chi-square test were used to rank and analyze the consistency of the factors affecting patients’ preference decision. RESULTS A total of 140 questionnaires were collected， and the effective recovery rate was 77.35%. The average preference score of 140 patients to receive MPA TDM was （4.01±0.65）， and the overall preference value was high. There were 116 （82.86%） patients agreed or strongly agreed with MPA TDM. Significant differences were observed in preference scores between patients who had previously undergone MPA TDM and those who had never undergone it （[ 4.30±0.53） scores vs. （3.80±0.65） scores， P＜0.001]. Additionally， patients’ preference scores were significantly influenced by their understanding level and attention level （P＜0.001）. The ranking of factors contributing to decision-making exhibited consistency （P＜0.001）. The factors were ranked in descending order of clinical efficacy， safety， comfortability， economy and time cost. CONCLUSIONS The patients who underwent solid organ transplantation hold high preferences towards MPA TDM. The primary factors influencing their decisions are their prior experience， understanding level， and attention level.

Expert consensus on diabetes mellitus after solid organ transplantation in adults / 器官移植

Post-transplant diabetes mellitus (PTDM) is a common endocrine and metabolic disorder after adult solid organ transplant (SOT), affecting 10% to 40% of recipients. PTDM has been associated with increased mortality, heightened risk of infections, graft-related complications and cardiovascular diseases, all of which seriously threaten the quality of life and long-term survival of recipients. According to recent studies and the domestic healthcare system, this consensus provides a comprehensive overview of the epidemiology, risk factors, pathogenesis, screening and diagnosis, treatments, prevention strategies, cardiovascular risk factor management and microvascular complications associated with PTDM, in order to further standardize the diagnosis and treatment of PTDM. The objective is to standardize the comprehensive management of PTDM with the aim of enhancing the long-term quality of life and clinical outcomes for SOT recipients.

Chinese experts consensus on the management of surgical site infection in solid organ transplantation (2022 edition) / 器官移植

The quality of solid organ transplantation has been improved significantly in China in recent years. However, surgical site infection (SSI) is still a main factor affecting the survival of solid organ transplantation recipients. With the joint efforts of experts in fields of organ transplantation, infectious diseases, critical care medicine, laboratory medicine and clinical pharmacy, this expert consensus systematically summarizes the experiences of SSI management in solid organ transplantation in China, focusing on basic management principles, epidemiology, risk factors, special pathogen infection and diagnostic techniques of SSI. It aims to standardize the prevention measures of SSI in transplantation centers to reduce the incidence and mortality of SSI in solid organ transplantation recipients.

Progress in the diagnosis and treatment of secondary spinal infection after solid organ transplantation / 中华临床感染病杂志

Spinal infection is a serious health-threatening clinical condition, which more frequently occurs in solid organ transplantation receipients than in non transplant receipients. With the increase of solid organ transplantation, the incidence of secondary spinal infection has been increased in recent years. The symptoms and signs of secondary spinal infection are not obvious, and early diagnosis and treatment are difficult, leading to recurrent attacks and protracted disease courses. This article reviews the progress in the diagnosis and treatment of secondary spinal infection after solid organ transplantation.

Progress in diagnosis and treatment of Epstein-Barr virus associated lymphoproliferative disease after solid organ transplantation in children / 国际儿科学杂志

Post transplant lymphoproliferative disease(PTLD)is one of the most serious malignant complication in children after solid organ transplantation.Immunosuppression after transplantation and Epstein-Barr virus infection are the two main reasons for the onset of PTLD.The diagnosis of the disease depends on pathology, which includes early lesions, monomorphic PTLD, polymorphic PTLD and Hodgkin′s lymphoma PTLD.The treatment includes reduction in immunosuppression, rituximab, chemotherapy, radiotherapy and surgery, etc.The selection of chemotherapy mainly depends on pathology.The advance in the management of PTLD will be reviewed in the manuscript.

Systematic evaluation on PD-1 monoclonal antibody in the treatment of malignant tumor after solid organ transplantation / 器官移植

Objective To investigate the efficacy and safety of programmed cell death protein-1 (PD-1) monoclonal antibody on the treatment of malignant tumor after solid organ transplantation (SOT). Methods The relevant literatures in 7 databases were searched. The data on 54 cases of recipients with malignant tumors treated with PD-1 monoclonal antibody after SOT were collected, and the clinical effects and rejection of SOT recipients treated with PD-1 monoclonal antibody were analyzed. Results Total 32 acceptable articles including 54 SOT recipients were incorporated, including 43 males and 11 females aged 14-79 years old. There are 29 renal transplant recipients, 19 liver transplant recipients and 6 heart transplant recipients. The types of PD-1 monoclonal antibody agent used by SOT recipients included pembrolizumab for 28 patients and nivolumab for 26 patients. The overall remission rate, disease progression rate and fatality rate of PD-1 monoclonal antibody for postoperative malignant tumors of SOT recipients were 32% (17/54), 44% (24/54) and 36% (19/54), respectively. After treatment with PD-1 monoclonal antibody for postoperative malignant tumors of SOT recipients, the incidence of rejection was 39% (21/54), indicating no significant correlation between rejection and type of PD-1 monoclonal antibody (P > 0.05). Conclusions PD-1 monoclonal antibody can effectively treat postoperative malignant tumors of SOT recipients, and may induce rejection during the treatment. But rejection is not the most common cause for death of recipients.

Advances on cytomegalovirus infection after hematopoietic stem cell transplantation and solid-organ transplantation / 中国小儿急救医学

Cytomegalovirus ( CMV) infection continues to be one of the most common infections after hematopoietic stem cell transplantation and solid-organ transplantation( SOT) ,resulting in significant ad-verse outcomes and mortality. Management of CMV infection after hematopoietic stem cell transplantation and solid-organ transplantation is based on early prevention and early treatment, using of effective antiviral treatment regimens ,thus it has significantly improved the prognosis of CMV infection in transplant recipi-ents. This article reviewed the risk factors,diagnosis,standard treatment and emerging treatment of cytomega-lovirus infection after transplantation,in order to improve the understanding of the disease and understand the novel treatment.

Seronegativity to polio viruses among previously immunized adult candidates to solid organ transplantation

ABSTRACT In the current effort to eliminate polio from the world, it is important to recognize and vaccinate susceptible groups, especially immunocompromised patients living in countries where attenuated polio vaccine is still used. In this report, we describe the frequency of protective antibodies in a small sample of adult SOT candidates in whom previous vaccination could be ascertained. Patients included in this report were selected among the participants of an ongoing prospective study carried out at the Reference Center for Special Immunobiologicals of the Evandro Chagas National Institute of Infectious Diseases in Rio de Janeiro, Brazil. Among the first 100 patients enrolled in this study, only seven adult SOT candidates had proven polio vaccination at childhood. Three of these seven patients (43%) had no protective antibody titers to one or more poliovirus subtype before solid organ transplant. Proven childhood vaccination against polio does not reliably provide lifelong protective antibody titers for adult SOT candidates and should not be used as a criterion to analyze the need for vaccination in this population.

Transmission of dengue virus from deceased donors to solid organ transplant recipients: case report and literature review

ABSTRACT Dengue fever is a vector-transmitted viral infection. Non-vectorial forms of transmission can occur through organ transplantation. We reviewed medical records of donors and recipients with suspected dengue in the first post-transplant week. We used serologic and molecular analysis to confirm the infection. Herein, we describe four cases of dengue virus transmission through solid organ transplantation. The recipients had positive serology and RT-PCR. Infection in donors was detected through serology. All cases presented with fever within the first week after transplantation. There were no fatal cases. After these cases, we implemented dengue screening with NS1 antigen detection in donors during dengue outbreaks, and no new cases were detected. In the literature review, additional cases had been published through August 2017. Transmission of Dengue virus can occur through organ donation. In endemic regions, it is important to suspect and screen for dengue in febrile and thrombocytopenic recipients in the postoperative period.

Immunological Prediction of Cytomegalovirus (CMV) Replication Risk in Solid Organ Transplantation Recipients: Approaches for Regulating the Targeted Anti-CMV Prevention Strategies / 감염과화학요법

The current cytomegalovirus (CMV) prevention strategies in solid organ transplantation (SOT) recipients have contributed towards overcoming the detrimental effects caused by CMV lytic infection, and improving the long-term success rate of graft survival. Although the quantification of CMV in peripheral blood is the standard method, and an excellent end-point for diagnosing CMV replication and modulating the anti-CMV prevention strategies in SOT recipients, a novel biomarker mimicking the CMV control mechanism is required. CMV-specific immune monitoring can be employed as a basic tool predicting CMV infection or disease after SOT, since uncontrolled CMV replication mostly originates from the impairment of immune responses against CMV under immunosuppressive conditions in SOT recipients. Several studies conducted during the past few decades have indicated the possibility of measuring the CMV-specific cell-mediated immune response in clinical situations. Among several analytical assays, the most advancing standardized tool is the QuantiFERON®-CMV assay. The T-Track® CMV kit that uses the standardized enzyme-linked immunospot assay is also widely employed. In addition to these assays, immunophenotyping and intracellular cytokine analysis using flow cytometry (with fluorescence-labeled monoclonal antibodies or peptide-major histocompatibility complex multimers) needs to be adequately standardized and validated for potential clinical applications.

Posttransplantation lymphoproliferative disorder after pediatric solid organ transplantation: experiences of 20 years in a single center / 소아과

PURPOSE: To evaluate the clinical spectrum of posttransplantation lymphoproliferative disorder (PTLD) after solid organ transplantation (SOT) in children. METHODS: We retrospectively reviewed the medical records of 18 patients with PTLD who underwent liver (LT) or kidney transplantation (KT) between January 1995 and December 2014 in Seoul National University Children's Hospital. RESULTS: Eighteen patients (3.9% of pediatric SOTs; LT:KT, 11:7; male to female, 9:9) were diagnosed as having PTLD over the last 2 decades (4.8% for LT and 2.9% for KT). PTLD usually presented with fever or gastrointestinal symptoms in a median period of 7 months after SOT. Eight cases had malignant lesions, and all the patients except one had evidence of Epstein-Barr virus (EBV) involvement, assessed by using in situ hybridization of tumor tissue or EBV viral load quantitation of blood. Remission was achieved in all patients with reduction of immunosuppression and/or rituximab therapy or chemotherapy, although 1 patient had allograft kidney loss and another died from complications of chemotherapy. The first case of PTLD was encountered after the introduction of tacrolimus for pediatric SOT in 2003. The recent increase in PTLD incidence in KT coincided with modification of clinical practice since 2012 to increase the tacrolimus trough level. CONCLUSION: While the outcome was favorable in that all patients achieved complete remission, some patients still had allograft loss or mortality. To prevent PTLD and improve its outcome, monitoring for EBV infection is essential, which would lead to appropriate modification of immunosuppression and enhanced surveillance for PTLD.

Current Status of Solid Organ Xenotransplantation / 대한이식학회지

Solid organ xenotransplantation using transgenic pig organs is proposed as an alternative method for allo-transplantation. To accomplish this, immunologic and non-immunologic barriers for xenotransplantation should be overcome, and experiments on pigs to non-human primates (NHP) are now ongoing for clinical application. Before the clinical experiment, public consensus about ethical decisions must be considered. The results of NHP experiments on solid organ xenotransplantation are improving, and it is expected that xeno-solid organs can be used as new organs for human patients in the future.

Growth following solid organ transplantation in childhood

One of the ultimate goals of successful solid organ transplantation in pediatric recipients is attaining an optimal final adult height. This manuscript will discuss growth following transplantation in pediatric recipients of kidney, liver, heart, lung or small bowel transplants. Remarkably similar factors impact growth in all of these recipients. Age is a primary factor, with younger recipients exhibiting the greatest immediate catch-up growth. Graft function is a significant contributing factor, with a reduced glomerular filtration rate correlating with poor growth in kidney recipients and the need for re-transplantation with impaired growth in liver recipients. The known adverse impact of steroids on growth has led to modification of the steroid dose and even steroid withdrawal and avoidance. In kidney and liver recipients, this strategy has been associated with the development of acute rejection. In infant heart transplantation, avoiding maintenance corticosteroid immunosuppression is associated with normal growth velocity in the majority of patients. With marked improvements in patient and graft survival rates in pediatric organ recipients, quality of life issues, such as normal adult height, should now receive paramount attention. In general, normal growth following solid organ transplantation should be an achievable goal that results in normal adult height.

Enfermedad inflamatoria intestinal y trasplante de órgano sólido: ¿Qué factores hay que considerar en el manejo? Revisión de la literatura a partir de un caso clínico / Inflammatory bowel disease and solid organ transplant. What factors must be considered for management?: case report and review of the literature

Inflammatory bowel disease (IBD), is a chronic condition, nevertheless its association with solid organ transplantation (SOT) is rare. Its presence stresses decisions on best options dealing with IBD management, immunosuppressive therapy and colorectal cancer (CRC) risks in this group of patients. Literature focused on this topic is scarce. Most of the literature corresponds to retrospective or case series of IBD patients submitted to hepatic orthotropic transplant, due to primary sclerosing cholangitis. The aim of this review is, from an individual clinical case, to tackle the different issues that could be of interest in patients requiring SOT, with or without previous IBD. The interest is focused on IBD evolution, de novo- active IBD and CRC risk. In conclusion, the most important point is that the need to perform a proctocolectomy is more related to the IBD severity than to the transplant itself. The recommendation is that these patients should be managed by a multidisciplinary team on a case by case analysis.

Aunque la enfermedad inflamatoria intestinal (EII) es una condición crónica, la asociación de pacientes con EII y trasplante de órgano sólido (TOS) ocurre de manera muy infrecuente. Sin embargo, su presencia sin duda estresa las decisiones sobre cuáles son las mejores opciones en el manejo de la EII, la terapia inmunosupresora y el riesgo de cáncer colorectal (CCR) en este grupo de pacientes. Hasta la fecha, existe escasa literatura sobre este tema y la mayoría se basa en series retrospectivas y casos clínicos de pacientes con EII que han sufrido un trasplante hepático por colangitis esclerosante primaria. El objetivo de esta revisión es mencionar a partir de un caso clínico, los diferentes aspectos relacionados con pacientes que requieren un TOS con o sin EII previa, destacando la evolución de la EII, el desarrollo de una EII-de novo y el riesgo de CCR. Sin duda, el punto más importante es que la decisión de realizar una colectomía está determinada por la gravedad de la EII y no por el TOS en sí. Es recomendable que estos pacientes sean abordados por un equipo multidisciplinario experto, y analizados caso a caso.

Profilaxis antifúngica en niños y adultos sometidos a trasplante de órganos sólidos y de precursores hematopoyéticos / Prophylaxis against fungal infections in solid organ and hematopoietic stem cells transplantation

Invasive fungal infections are an important cause of morbidity and mortality in SOT and HSCT recipients. The main species involved are Candida spp. and Aspergillus spp, less frequently Cryptococcus spp., causal agents of mucormycosis and Fusarium spp. Usually occur within the first six months post-transplant, but they do it later, especially during episodes of rejection, which maintains the state of immune system involvement. Prophylaxis recommendations are specific to each type of transplant. In liver transplantation use of fluconazole is recommended only in selected cases by high risk factor for invasive fungal infections (A1). If the patient has a high risk of aspergillosis, there are some suggestions for adults population to use amphotericin B-deoxycholate, liposomal amphotericin B or caspofungin (C2) without being validated none of these recommendations in pediatric population. In adult lung transplant patients where the risk of aspergillosis is higher than in other locations, we recommend universal prophylaxis with itraconazole 200 mg/day, nebulised liposomal amphotericin B or voriconazole (C2), no validated recommendations for pediatrics. In HSCT, universal prophylaxis is recommended only in allogeneic and autologous selected cases. The most accepted indication is fluconazole (A1), and posaconazole (A1) or micafungin (A1) in selected cases with high risk of aspergillosis.

Las infecciones fúngicas invasoras constituyen una importante causa de morbilidad y mortalidad en los pacientes receptores de TOS y TPH. Los principales agentes involucrados son Candida spp. y Aspergillus spp, menos frecuentemente Cryptococcus spp., agentes causales de mucormicosis y Fusarium spp. Se presentan habitualmente dentro de los primeros seis meses posttrasplante, pero también lo hacen en forma más tardía, especialmente durante episodios de rechazo, en que se mantiene el estado de compromiso del sistema inmune. Existen recomendaciones de proilaxis especíicas para cada tipo de trasplante. En trasplante hepático se recomienda el uso de fluconazol sólo en casos seleccionados por factores de riesgo (A1). Si existe riesgo de asper-gilosis, hay algunas sugerencias en adultos para el uso de anfotericina B-deoxicolato, anfotericina liposomal o caspofungina (todo en categoría C2), sin estar validada ninguna de estas recomendaciones en pediatría. En trasplante pulmonar en paciente adulto, donde el riesgo de aspergilosis es superior a otras localizaciones, se recomienda proilaxis universal, con itraconazol 200 mg/día, anfotericina liposomal nebulizada o voriconazol (C2), sin recomendaciones validadas para pediatría. En TPH, se recomienda proilaxis universal en trasplante alogénico y sólo para casos seleccionados en trasplantes autólogos. La indicación más aceptada es fluconazol (A1), siendo alternativas a evaluar dependiendo del riesgo de aspergilosis, posaconazol (A1) y micafungina (A1).

Profilaxis de neumonía por Pneumocystis jiroveci en niños y adultos sometidos a trasplante de órganos sólidos y de precursores hematopoyéticos / Prophylaxis against Pneumocystis pneumonia in pediatric and adult patients undergoing solid organ or hematopoietic stem cells transplantation

Pneumocystis jiroveci is an important pathogen in patients undergoing SOT and HSCT. Universal prophylaxis is recommended for all adults and children with SOT and HSCT, considering that its use significantly reduces the occurrence and mortality associated with pneumonia by this agent. The drug of choice is cotrimoxazole (A1) three times a week, low-dose scheme, that has proved equally effective and better tolerated than the daily regimen and/or at high doses. Prophylaxis starts 7 to 14 days post transplant in SOT recipients and post-implant in HSCT, with an average duration of 6 months except in liver and lung transplant as in HSCT with significant degree of immunosuppression, that lasts for 1 year. Alternatives for prophylaxis are dapsone (B2), aerosolized pentamidine (B2) and atovaquone (C2).

Pneumocystis jiroveci es un patógeno importante en pacientes sometidos a TOS y TPH. Se recomienda proilaxis universal a todos los pacientes adultos y niños sometidos a TOS o TPH porque su uso reduce signiicati-vamente la ocurrencia y mortalidad asociada a neumonía por este agente. El medicamento de elección es cotrimoxa-zol (A1) tres veces por semana, en dosis bajas, esquema que ha demostrado igual eicacia y mejor tolerancia que el esquema diario y/o con dosis altas. La proilaxis se inicia 7 a 14 días post trasplante en TOS y posterior al implante en TPH, con una duración promedio de 6 meses salvo en trasplante de hígado y pulmón en que se prolonga por 1 año, al igual que en TPH con grado importante de inmunosupresión. Son alternativas de profilaxis dapsona (B2), pentamidina aerosolizada (B2) y atavacuona (C2).

Profilaxis de citomegalovirus en niños y adultos sometidos a trasplante de órganos sólidos y de precursores hematopoyéticos / Prophylaxis against cytomegalovirus infection in pediatric and adult patients undergoing solid organ and hematopoietic stem cells transplantation

CMV is one of the main infectious problems for SOT and HSCT. The severity of the complications are mainly associated with the type of transplant and immune status against the virus of the transplant donor and the transplant recipient. It is important to prevent exposure, using safe blood transfusion CMV seronegative donors (B1) and/or use of blood leucocytes-depleted by filtration (Al). In addition to preventing exposure, there are two widely used prevention strategies: universal prophylaxis with antiviral therapy or "pre-emptive" strategy based on the use of antivirals only to the early detection of CMV replication in blood. The first option is most used in the SOT management, especially for those identified as the high risk group of CMV disease: R (+), with D (+) or D (-) (Al), where the recommended drug is ganciclovir or valganciclovir . The second approach is preferable for HSCT, which recommends weekly monitoring for CMV viral load from day 10 to 100 post transplant (A3). This strategy requires having a viral laboratory support (A2). The selected antiviral in the case of pre emptive therapy is intravenous ganciclovir (A1).

La infección y enfermedad por CMV son problemas comunes en pacientes con TOS y TPH. La gravedad de las complicaciones asociadas a este virus dependen fundamentalmente del tipo de trasplante y de la experiencia inmunológica previa contra el virus del donante y el receptor. Es importante prevenir la exposición, utilizando transfusiones de sangre segura para CMV con donantes seronegativos (B1) y/o uso de sangre leuco-depletada por iltración (A1). Además de prevenir la exposición, existen dos estrategias de prevención ampliamente utilizadas: La proilaxis universal con antivirales y la terapia adelantada o estrategia "pre-emptive" basada en el uso de antivirales sólo ante la detección precoz de replicación del CMV en sangre. La primera opción es de mayor uso en TOS, especialmente para aquellos binomios identficados como de mayor riesgo de enfermedad por CMV: R (+), con D (+) o D (-) (A1), siendo el medicamento recomendado ganciclovir o valganciclovir. La segunda opción es de elección en TPH, en cuyo caso se recomienda monitoreo semanal con carga viral para CMV desde el día 10 al 100 post trasplante (A3), lo que implica contar con un laboratorio de apoyo en diagnóstico virológico (A2). El antiviral de elección en este caso es ganciclovir iv (A1).

Profilaxis de infección por virus respiratorios en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos / Prophylaxis against respiratory viral disease in pediatric and adult patients undergoing solid organ and hematopoietic stem cells transplantation

Respiratory viruses have been identified as a cause of morbidity and mortality in patients undergoing SOT and HSCT, specially in children. The most frequent are respiratory syncytial virus (RSV), influenza (FLU), parainfluenza (PI) and adenovirus (ADV). These infections are associated with progression to severe lower respiratory tract infections in up to 60% of the cases. It is advised to apply universal protection recommendations for respiratory viruses (A2) and some specific measures for FLU and AD. FLU: Annual anti-influenza vaccination (from 4-6 months post-transplantation in SOT, 6 months in HSCT (A2)); post- exposure prophylaxis in FLU (oseltamivir for 10 days (B2)). In lung transplantion, the prophylaxis should last as long as the risk period (B2). ADV: There is no vaccine nor valid chemoprophylaxis strategy to prevent ADV disease. In some specific HSCT recipients, weekly PCR monitoring is recommended until day+100 (A3).

Los virus respiratorios se han identificado como causa de morbi-mortalidad en pacientes sometidos a TOS y TPH, particularmente en pediatría. Los más frecuentes son virus respiratorio sincicial (VRS), influenza (FLU), parainfluenza (PI) y adenovirus (ADV). La fuente de contagio está en la comunidad y en el hospital afectando al paciente en cualquier período post-trasplante. Se describe progresión a infecciones graves del tracto respiratorio bajo hasta en 60 % de los casos. Se recomienda aplicar medidas de aislamiento de precaución universal para todos los virus respiratorios (A2) y se describen algunas medidas específicas para FLU y AlDV. Vacunación anti-influenza anual con vacuna inactivada (en TOS a partir de 4-6 meses post-trasplante (A2), en TPH a partir de 6 meses (A2)); profilaxis post exposición a virus FLU (oseltamivir durante 10 días (B2)). En trasplante de pulmón, la duración de la profilaxis se extenderá mientras dure el período de riesgo (B2). Con respecto a ADV, no se dispone de una vacuna adecuada y no existe a la fecha una estrategia validada de quimioprofilaxis para prevenir enfermedad por ADV; en casos específicos de TPH pediátrico, se recomienda vigilancia semanal con RPC en sangre periférica hasta el día +100 post-TPH (A3).

Profilaxis de toxoplasmosis en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos / Prophylaxis against Toxoplasma gondii disease in pediatric and adult patients undergoing solid organ and hematopoietic stem cells transplantation

Toxoplasmosis is a widely distributed zoonosis produced by the parasite T. gondii. In Chile the seroprevalence has been estimated between 20-37% in general population. Defined risk groups acquire or reactivate the infection by T. gondii in patients undergoing SOT and HSCT are: heart transplant or heart-lung with D (+) and R (-), allogeneic HSCT with R (+), HSCT with cord cells, GVHD, history of previous clinical toxoplasmosis and use of corticosteroids for prolonged periods or in high doses. Hand washing, hygiene in food handling and weekly post-transplant surveillance since day 15 post transplant for six months, are universally recommended. All patients with SOT and HSCT, regardless of risk, should receive prophylaxis with cotrimoxazole and require no another specific prophylaxis against T. gondii (A2). It is particularly important in high-risk patients who cannot receive cotrimoxazole prophylaxis establish specific alternative against T. gondii (B3).

Toxoplasmosis es una zoonosis ampliamente distribuida, producida por el parásito T. gondii. En Chile la seroprevalencia se ha estimado entre 20-37% en la población general. Se han deinido grupos de riesgo de adquirir o reactivar la infección por T. gondii en pacientes sometidos a TOS y a TPH: trasplante cardíaco o de corazón-pulmón con D (+) y R (-); TPH alogénico con R (+); TPH con células de cordón; EICH activa; antecedentes de toxoplasmosis clínica previa y uso de corticoesteroides por tiempo prolongado o en altas dosis. De manera universal son importantes el lavado de manos e higiene en manipulación de alimentos y el seguimiento periódico post-trasplante con RPC desde los 15 días, una vez por semana, durante seis meses. Todos los pacientes con TOS y TPH, independiente de su riesgo, deben recibir proilaxis universal con cotrimoxazol y no requieren otra proilaxis especíica contra T. gondii ( A2 ). Es particularmente importante que en los pacientes de alto riesgo que no puedan recibir cotrimoxazol, se establezca proilaxis alternativa especíica contra T. gondii (B3).