Camille N. Kotton

Updated International Consensus Guidelines on the Management of Cytomegalovirus in Solid-Organ Transplantation

Cytomegalovirus (CMV) remains one of the most common infections after solid organ transplantation, resulting in significant morbidity, graft loss, and occasional mortality. Management of CMV varies considerably among transplant centers. A panel of experts on CMV and solid organ transplant was convened by The Infectious Diseases Section of The Transplantation Society to develop evidence and expert opinion-based consensus guidelines on CMV management including diagnostics, immunology, prevention, treatment, drug resistance, and pediatric issues.

Outcome of Kidney Transplantation Using Expanded Criteria Donors and Donation After Cardiac Death Kidneys: Realities and Costs

Expanded criteria donors (ECDs) and donation after cardiac death (DCD) provide more kidneys in the donor pool. However, the financial impact and the long‐term benefits of these kidneys have been questioned. From 1998 to 2005, we performed 271 deceased donor kidney transplants into adult recipients. There were 163 (60.1%) SCDs, 44 (16.2%) ECDs, 53 (19.6%) DCDs and 11 (4.1%) ECD/DCDs. The mean follow‐up was 50 months. ECD and DCD kidneys had a significantly higher incidence of delayed graft function, longer time to reach serum creatinine below 3 (mg/dL), longer length of stay and more readmissions compared to SCDs. The hospital charge was also higher for ECD, ECD/DCD and DCD kidneys compared to SCDs, primarily due to the longer length of stay and increased requirement for dialysis (

Enteric Pathogens as Vaccine Vectors for Foreign Antigen Delivery

70 030,

CMV: Prevention, Diagnosis and Therapy

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Guidance on novel influenza A/H1N1 in solid organ transplant recipients.

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Influenza Vaccination in the Organ Transplant Recipient: Review and Summary Recommendations

47 462, respectively, p < 0.001). Early graft survival rates were comparable among all groups. However, after a mean follow‐up of 50 months, graft survival was significantly less in the ECD group compared to other groups. Although our observations support the utilization of ECD and DCD kidneys, these transplants are associated with increased costs and resource utilization. Revised reimbursement guidelines will be required for centers that utilize these organs.

Nucleic acid testing (NAT) of organ donors: is the 'best' test the right test? A consensus conference report.

Live attenuated bacteria are attractive vaccine vectors that can elicit host immune responses to foreign antigens. Bacterial vectors may mimic natural infection and therefore interact with the mucosal, humoral, and cellular compartments of the immune system. A plethora of foreign (heterologous) antigens derived from bacterial, fungal, viral, or parasitic organisms have been expressed within bacterial vectors. Delivery of contraceptive and tumor antigens, cytokines, and adjuvants has also been explored. The result is a type of “vaccine factory” (29) in which the bacterial vector produces a foreign protein. Since bacterial vectors replicate within the host, it is hoped that they provide sustained exposure to the antigen, potentially augmenting the type and level of immune response. In addition, bacteria naturally possess immunostimulatory molecules such as lipopolysaccharide (LPS) and flagella that can stimulate immune responses (56). Internationally, there are three live bacterial vaccines commercially available and in clinical use: Salmonella enterica serovar Typhi Ty21a, Vibrio cholerae CVD 103-HgR, and Mycobacterium bovis BCG. These strains plus many other attenuated strains have been used as vectors to express heterologous antigens. Live bacterial vector vaccines have been evaluated in numerous animal and human studies, but there are currently no licensed live bacterial vector vaccines being used clinically. The most compelling rationales for the development of live bacterial vectors are the possibility of oral delivery and protection at mucosal surfaces. This review will cover attenuated bacterial enteric pathogens used as vectors to express foreign (heterologous) antigens, with emphasis on those that have reached clinical study, including Salmonella, Shigella, V. cholerae, and Listeria. This review will not cover bacterial vectors used to deliver DNA vaccines or subunit and conjugate vaccines.

Zoonoses in Solid-Organ and Hematopoietic Stem Cell Transplant Recipients

Cytomegalovirus (CMV) is the most common infection after organ transplantation and has a major impact on morbidity, mortality and graft survival. Optimal prevention, diagnosis and treatment of active CMV infection enhance transplant outcomes, and are the focus of this section. Methods to prevent CMV include universal prophylaxis and preemptive therapy; each has its merits, and will be compared and contrasted. Diagnostics have improved substantially in recent years, both in type and quality, allowing for more accurate and savvy treatment; advances in diagnostics include the development of an international standard, which should allow comparison of results across different methodologies, and assays for cellular immune function against CMV. Therapy primarily involves ganciclovir, now rendered more versatile by data suggesting oral therapy with valganciclovir is not inferior to intravenous therapy with ganciclovir. Treatment of resistant virus remains problematic, but is enhanced by the availability of multiple novel therapeutic agents.

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Novel influenza A/H1N1 virus has caused significant illness worldwide. In response to this global crisis, the American Society of Transplantation (AST) Infectious Diseases Community of Practice and the Transplant Infectious Diseases section of The Transplantation Society (TTS) developed a guidance document for novel H1N1. In this paper, we discuss current guidance for H1N1 as it relates to solid organ transplantation. We include discussion around clinical presentation, diagnosis, therapy and prevention specifically addressing areas such as chemoprophylaxis, immunization and donor‐derived infection. Although this document addresses conditions specific to novel H1N1, many principles could be applied to future pandemics. As new information emerges about novel H1N1, updates will be made to the electronic version of the document posted on the websites of the AST and TTS.

Management of cytomegalovirus infection in solid organ transplantation

Influenza virus causes a spectrum of illness in transplant recipients with a high rate of lower respiratory disease. Seasonal influenza vaccination is an important public health measure recommended for transplant recipients and their close contacts. Vaccine has been shown to be safe and generally well tolerated in both adult and pediatric transplant recipients. However, responses to vaccine are variable and are dependent on various factors including time from transplantation and specific immunosuppressive medication. Seasonal influenza vaccine has demonstrated safety and no conclusive evidence exists for a link between vaccination and allograft dysfunction. Annually updated trivalent inactivated influenza vaccines have been available and routinely used for several decades, although newer influenza vaccination formulations including high‐dose vaccine, adjuvanted vaccine, quadrivalent inactivated vaccine and vaccine by intradermal delivery system are now available or will be available in the near future. Safety and immunogenicity data of these new formulations in transplant recipients requires investigation. In this document, we review the current state of knowledge on influenza vaccines in transplant recipients and make recommendations on the use of vaccine in both adult and pediatric organ transplant recipients.