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Chin-Hong P.V.,University of California at San Francisco | Schwartz B.S.,University of California at San Francisco | Bern C.,Centers for Disease Control and Prevention | Montgomery S.P.,Centers for Disease Control and Prevention | And 6 more authors.
American Journal of Transplantation | Year: 2011

Donor-derived transmission of Trypanosoma cruzi, the etiologic agent of Chagas disease, has emerged as an issue in the United States over the past 10 years. Acute T. cruzi infection causes substantial morbidity and mortality in the posttransplant setting if not recognized and treated early. We assembled a working group of transplant infectious disease specialists, laboratory medicine specialists, organ procurement organization representatives and epidemiologists with expertise in Chagas disease. Based on review of published and unpublished data, the working group prepared evidence-based recommendations for donor screening, and follow-up testing and treatment of recipients of organs from infected donors. We advise targeted T. cruzi screening of potential donors born in Mexico, Central America and South America. Programs can consider transplantation of kidneys and livers from T. cruzi-infected donors with informed consent from recipients. However, we recommend against heart transplantation from infected donors. For other organs, we recommend caution based on the anticipated degree of immunosuppression. Our recommendations stress the need for systematic monitoring of recipients by polymerase chain reaction, and microscopy of buffy coat and advance planning for immediate antitrypanosomal treatment if recipient infection is detected. Data on management and outcomes of all cases should be collected to inform future guidelines and to assist in coordination with public health authorities. © 2011 The Authors.

Ellingson K.,Centers for Disease Control and Prevention | Seem D.,Centers for Disease Control and Prevention | Nowicki M.,Mendez National Institute of Transplantation | Nowicki M.,University of Southern California | And 2 more authors.
American Journal of Transplantation | Year: 2011

To prevent unintentional transmission of bloodborne pathogens through organ transplantation, organ procurement organizations (OPOs) screen potential donors by serologic testing to identify human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. Newly acquired infection, however, may be undetectable by serologic testing. Our objective was to estimate the incidence of undetected infection among potential organ donors and to assess the significance of risk reductions conferred by nucleic acid testing (NAT) versus serology alone. We calculated prevalence of HIV and HCV-stratified by OPO risk designation-in 13 667 potential organ donors managed by 17 OPOs from 1/1/2004 to 7/1/2008. We calculated incidence of undetected infection using the incidence-window period approach. The prevalence of HIV was 0.10% for normal risk potential donors and 0.50% for high risk potential donors; HCV prevalence was 3.45% and 18.20%, respectively. For HIV, the estimated incidence of undetected infection by serologic screening was 1 in 50 000 for normal risk potential donors and 1 in 11 000 for high risk potential donors; for HCV, undetected incidence by serologic screening was 1 in 5000 and 1 in 1000, respectively. Projected estimates of undetected infection with NAT screening versus serology alone suggest that NAT screening could significantly reduce the rate of undetected HCV for all donor risk strata. Results from this study suggest that the risk of undetected HCV infection among potential organ donors can be significantly reduced by screening with Nucleic Acid Testing as opposed to serology testing for both normal- and high-risk donors. See editorial by Pruett on page 1115. © 2011 The American Society of Transplantation and the American Society of Transplant Surgeons.

Sampaio M.S.,Mendez National Institute of Transplantation | Cho Y.W.,Mendez National Institute of Transplantation | Shah T.,Mendez National Institute of Transplantation | Shah T.,Saint Vincent Medical Center | And 3 more authors.
Nephrology Dialysis Transplantation | Year: 2012

Background Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of transplantation. Methods Using the OPTN/UNOS database, primary kidney recipients (20002009) were stratified according to transplant type (deceased donor, DD or living donor, LD), donor (D) and recipient (R) EpsteinBarr virus (EBV) serostatus (R+; D/R-and D-/R-) and recipient age. Incidence and adjusted risk of PTLD and death were compared. Results Of the 137 939 primary kidney recipients transplanted between 2000 and 2009, 913 subsequently developed PTLD. In 90 208 recipients with known EBV serostatus, we found a trend toward a decrease in PTLD incidence in years 20072009 when compared to 20002003. This was due to a significant decrease in PTLD incidence in EBV-recipients. Of those, 61 273 had a known donor serostatus and were further examined. In adults, PTLD incidence (in 1000 person-years) in DD and LD was 7.0 and 7.0 in D +R-; 3.0 and 2.5 in D-/R-and 1.2 and 1.0 in R+, respectively. The hazard ratio (HR) for PTLD (R+ as reference) in D +R-(6.2 in DD and 7.2 in LD) was double to thrice than for D-/R-transplants (2.4 in both DD and LD). In pediatric recipients, PTLD incidence in DD and LD was 15.9 and 17.3 in D +R-; 12 and 18 in D-/R-and 1.2 and 2.2 in R+, respectively. The HR for PTLD was 17.4 and 6.9 in D +R-and 15.9 and 7.6 in D-/R-in DD and LD, respectively. Conclusion A D/R-, compared with a D-/R-transplant, may contribute to an increase in PTLD incidence of 35 and 42% in adult DD and LD transplants, respectively. © 2012 The Author.

Sampaio M.S.,Mendez National Institute of Transplantation | Cho Y.W.,Mendez National Institute of Transplantation | Cho Y.W.,University of Southern California | Qazi Y.,University of Southern California | And 5 more authors.
Transplantation | Year: 2012

Background: De novo posttransplant malignancy (PTM) is a serious complication of transplantation. Incidences may vary among solid organ transplantations (SOTs) and may take to particular screening recommendations and posttransplantation care. Methods: Adult recipients, from the U.S. Organ Procurement Transplant Network/United Network for Organ Sharing database (data as of September 3, 2010), of a primary kidney transplantation (KT), liver transplantation (LT), heart transplantation (HT) or lung transplantation (LuT) performed in the United States between 1999 and 2008 were selected. Multiple-organ recipients and those whose grafts failed within 2 weeks after transplantation were excluded. The incidence of PTM (in 1000 person-years) was estimated using the Kaplan-Meier product-limit method and compared with SOT and the general population. Results: The cohort included 193,905 recipients (123,380 KT; 43,106 LT; 16511 HT; and 10,908 LuT). PTM incidence was 8.03, 11.0, 14.3, and 19.8 in KT, LT, HT, and LuT, respectively. In general, PTM recipients were 3 to 5 years older, mostly whites, and are males in all SOTs. In KT, the type of cancer with the highest incidence was posttransplant lymphoproliferative disorder (PTLD, 1.58%), followed by lung (1.12%), prostate (0.82%), and kidney (0.79%) cancers; in LT, PTLD (2.44%), lung and bronchial (2.18%), primary hepatic (0.91%), and prostate (0.88%) cancers; in HT, lung and bronchial (3.24%) and prostate (3.07%) cancers, and PTLD (2.24%); and in LuT, lung and bronchial cancers (5.94%), PTLD (5.72%), and colorectal cancer (1.38%). PTLD, Kaposi sarcoma, and lung and bronchial cancers were increased in all SOTs, when compared with an older (55-to 59-year-old) population. Conclusions: Cancer incidence is different among solid organ transplantations, and ratios may be higher than those in the 55-to 59-year-old population. © 2012 Lippincott Williams & Wilkins.

Fong T.-L.,University of Southern California | Cho Y.W.,University of Southern California | Cho Y.W.,Mendez National Institute of Transplantation | Hou L.,University of Southern California | And 3 more authors.
Transplantation | Year: 2011

Background: The estimated prevalence of hepatitis C virus (HCV) infection among lung transplant (LT) recipients is 1.9%. Many thoracic transplant programs are reluctant to transplant HCV-seropositive patients due to concerns of hepatic dysfunction caused by immunosuppression. The aims of this study are to survey current practices of US LT programs regarding HCV-seropositive patients and using the Organ Procurement and Transplantation Network/United Network for Organ Sharing database and to assess the clinical outcomes of HCV-positive compared with HCV-negative LT recipients. Methods: A survey of US transplant centers that have performed more than 100 LTs was conducted. In addition, 170 HCV-seropositive and 9259 HCV-seronegative recipients who received HCV-seronegative donor organs between January 1, 2000, to December 31, 2007, were identified from the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. Outcome variables including patient survival were compared between the two groups. Results: A total of 64.4% centers responded to the survey. Ten of 29 (34.5%) programs would not consider HCV-seropositive patients for LT. Among the 19 programs that will consider HCV-seropositive patients, only five centers would transplant actively viremic patients. Overall patient survival rates of HCV-seropositive patients were similar to HCV-seronegative patients (84.7% at 1 year, 63.9% at 3 years, 49.4% at 5 years for HCV-seropositive group vs. 82.0% at 1 year, 65.0% at 3 years, 51.4% at 5 years for HCV-seronegative group, P=0.712). Relative risk of recipients for death remained statistically insignificant after adjusting for recipient age, donor age, obesity, sensitization, serum creatinine, and medical condition at time of transplant (relative risk [RR]=1.07 [0.84-1.38], P=0.581). Conclusions: Since 2000, patient survival rates of HCV-positive patients are identical to those who are HCV-negative. However, most of these HCV-seropositive patients were probably nonviremic. © 2011 by Lippincott Williams & Wilkins.

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