solid organ transplantation

实体器官移植
  • 文章类型: Journal Article
    在过去的15年中,诊断流式细胞术服务的活动已经从监测HIV-1感染中的CD4T细胞亚群发展到筛查原发性和继发性免疫缺陷综合征以及评估B细胞消耗治疗和移植后的免疫构成。高收入国家实验室活动的变化是由HIV-1开始抗逆转录病毒治疗(ART)驱动的,无论CD4T细胞计数如何,增加对原发性免疫缺陷综合征的认识以及B细胞消耗治疗和移植在临床实践中的广泛应用。实验室应利用其在HIV-1感染中CD4T细胞计数标准化和质量保证方面的经验,为原发性和继发性免疫缺陷患者提供免疫监测服务。B细胞消耗剂和移植后免疫重建的评估也可以利用流式细胞术实验室获得的专业知识来检测CD34干细胞和评估血液恶性肿瘤中的MRD。本指南为临床实验室提供流式细胞术服务,筛查免疫缺陷及其在B细胞靶向治疗和移植后免疫重建的新作用提供建议。
    Over the last 15 years activity of diagnostic flow cytometry services have evolved from monitoring of CD4 T cell subsets in HIV-1 infection to screening for primary and secondary immune deficiencies syndromes and assessment of immune constitution following B cell depleting therapy and transplantation. Changes in laboratory activity in high income countries have been driven by initiation of anti-retroviral therapy (ART) in HIV-1 regardless of CD4 T cell counts, increasing recognition of primary immune deficiency syndromes and the wider application of B cell depleting therapy and transplantation in clinical practice. Laboratories should use their experience in standardization and quality assurance of CD4 T cell counting in HIV-1 infection to provide immune monitoring services to patients with primary and secondary immune deficiencies. Assessment of immune reconstitution post B cell depleting agents and transplantation can also draw on the expertise acquired by flow cytometry laboratories for detection of CD34 stem cell and assessment of MRD in hematological malignancies. This guideline provides recommendations for clinical laboratories on providing flow cytometry services in screening for immune deficiencies and its emerging role immune reconstitution after B cell targeting therapies and transplantation.
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  • 文章类型: Journal Article
    国际小儿移植协会召开了一次专家共识会议,以评估当前证据并就小儿实体器官移植后移植后淋巴增生性疾病(PTLD)的各个方面提出建议。本报告阐述了PTLD管理工作组的审议结果。强烈建议将减少免疫抑制作为管理的第一步。同样,对于使用抗CD20单克隆抗体(利妥昔单抗),我们提出了强有力的建议,就像在某些情况下进行化疗一样.在某些情况下,在缺乏现有证据但集体临床经验推动决策的情况下,建议的强度与现有证据不一致.值得注意的是,没有大的,儿童年龄组PTLD任何治疗的随机III期试验。强调了当前的差距和未来的研究重点。
    The International Pediatric Transplant Association convened an expert consensus conference to assess current evidence and develop recommendations for various aspects of care relating to post-transplant lymphoproliferative disorders (PTLD) after pediatric solid organ transplantation. This report addresses the outcomes of deliberations by the PTLD Management Working Group. A strong recommendation was made for reduction in immunosuppression as the first step in management. Similarly, strong recommendations were made for the use of the anti-CD20 monoclonal antibody (rituximab) as was the case for chemotherapy in selected scenarios. In some scenarios, there is uncoupling of the strength of the recommendations from the available evidence in situations where such evidence is lacking but collective clinical experiences drive decision-making. Of note, there are no large, randomized phase III trials of any treatment for PTLD in the pediatric age group. Current gaps and future research priorities are highlighted.
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  • 文章类型: Review
    EB病毒(EBV)疾病,在接受实体器官移植(SOT)和造血细胞移植(HCT)的儿童中,包括EBV相关的移植后淋巴增生性疾病(PTLD)仍然是发病和死亡的重要原因.尽管在HCT中预防包括PTLD(EBV/PTLD)在内的EBV疾病方面取得了进展,预防中的关键问题,这些感染性并发症的管理仍未解决。本手稿的目的是突出要点和建议,这些要点和建议来自国际儿科移植协会和欧洲白血病感染会议发布的共识指南,用于接受SOT和HCT的儿童,分别。此外,我们提供了在这些儿童的预防和管理中使用EBV病毒载量测量的背景和指导.
    Epstein-Barr Virus (EBV) diseases, including EBV-associated post-transplant lymphoproliferative disorder (PTLD) remain important causes of morbidity and mortality in children undergoing solid organ transplantation (SOT) and hematopoietic cell transplantation (HCT). Despite progress in the prevention of EBV disease including PTLD (EBV/PTLD) in HCT, key questions in the prevention, and management of these infectious complications remain unanswered. The goal of this manuscript is to highlight key points and recommendations derived from the consensus guidelines published by the International Pediatric Transplant Association and the European Conference on Infections in Leukemia for children undergoing SOT and HCT, respectively. Additionally, we provide background and guidance on the use of EBV viral load measurement in the prevention and management of these children.
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  • 文章类型: Journal Article
    国际小儿移植协会召开了一次专家共识会议,以评估当前证据并就儿童实体器官移植后移植后淋巴增生性疾病的各个方面提出建议。在病毒载量和生物标志物监测工作组的这份报告中,我们回顾了有关Epstein-Barr病毒载量和外周血中其他生物标志物在预测PTLD发展中的作用的现有文献,对于PTLD诊断,以及监测对治疗的反应。该小组的主要建议强调了强烈建议使用术语EBVDNA血症而不是“病毒血症”来描述外周血中的EBVDNA水平,以及对在不同机构进行的EBVDNA血症测量结果的比较的担忧,即使使用WHO国际标准校准测试。工作组得出结论,全血或血浆均可用作EBVDNA测量的基质;最佳标本类型可能取决于临床情况。全血测试对于监测具有一些优势,可以告知先发制人的干预措施,而在临床症状和治疗监测的情况下,血浆测试可能是首选。然而,不建议单独进行EBVDNA血症检测用于PTLD诊断。建议进行定量EBVDNA血症监测,以确定有PTLD风险的患者,并建议对EBV血清阴性的患者进行先发制人的干预。相比之下,除了肠道移植受者或在SOT之前最近有原发性EBV感染的受者,不建议对移植前EBV血清阳性的儿童SOT受者进行监测.讨论了病毒载量动力学参数(包括峰值载量和病毒设定点)对先发制人PTLD预防监测算法的影响。使用额外的标记,讨论了包括EBV特异性细胞介导的免疫的测量,但不推荐,尽管从前瞻性多中心研究中获得额外数据的重要性被强调为关键研究重点.
    The International Pediatric Transplant Association convened an expert consensus conference to assess current evidence and develop recommendations for various aspects of care relating to post-transplant lymphoproliferative disorders after solid organ transplantation in children. In this report from the Viral Load and Biomarker Monitoring Working Group, we reviewed the existing literature regarding the role of Epstein-Barr viral load and other biomarkers in peripheral blood for predicting the development of PTLD, for PTLD diagnosis, and for monitoring of response to treatment. Key recommendations from the group highlighted the strong recommendation for use of the term EBV DNAemia instead of \"viremia\" to describe EBV DNA levels in peripheral blood as well as concerns with comparison of EBV DNAemia measurement results performed at different institutions even when tests are calibrated using the WHO international standard. The working group concluded that either whole blood or plasma could be used as matrices for EBV DNA measurement; optimal specimen type may be clinical context dependent. Whole blood testing has some advantages for surveillance to inform pre-emptive interventions while plasma testing may be preferred in the setting of clinical symptoms and treatment monitoring. However, EBV DNAemia testing alone was not recommended for PTLD diagnosis. Quantitative EBV DNAemia surveillance to identify patients at risk for PTLD and to inform pre-emptive interventions in patients who are EBV seronegative pre-transplant was recommended. In contrast, with the exception of intestinal transplant recipients or those with recent primary EBV infection prior to SOT, surveillance was not recommended in pediatric SOT recipients EBV seropositive pre-transplant. Implications of viral load kinetic parameters including peak load and viral set point on pre-emptive PTLD prevention monitoring algorithms were discussed. Use of additional markers, including measurements of EBV specific cell mediated immunity was discussed but not recommended though the importance of obtaining additional data from prospective multicenter studies was highlighted as a key research priority.
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  • 文章类型: Journal Article
    自2000年代初以来,全球范围内ABO不相容的实体器官移植(ABOiSOT)的数量显着增加。我们调查了ABO组用于ABOiSOT中成分输血的选择。我们通过电子邮件向韩国77家主要医院的血库专家发送调查问卷,其中34人回答了调查。在ABOiSOT少校,对于红细胞(RBC),收件人的类型(70.6%)是最常见的选择,其次是O组(29.4%);对于血小板,AB组(50.0%)是最常见的选择,其次是供体类型(38.2%);对于血浆,AB组(55.9%)是最常见的选择,其次是供体类型(32.4%)。在双向ABOiSOT中,对于红细胞,收件人的类型(55.9%)是最常见的选择,其次是O组(44.1%);对于血小板和血浆,AB组是最常见的选择(94.1%和97.1%,分别)。ABOiSOT的输血政策多种多样。我们建议在ABOiSOT中选择ABO组输血的指南,以确保患者健康并有效利用血液成分。
    The number of ABO-incompatible solid organ transplantations (ABOi SOTs) has markedly increased worldwide since the early 2000s. We investigated the choice of ABO group for blood component transfusion in ABOi SOT. We conducted a survey by e-mailing a questionnaire to blood bank specialists at 77 major hospitals in Korea, among whom 34 responded to the survey. In major ABOi SOT, for red blood cells (RBCs), the recipient\'s type (70.6%) was the most common choice, followed by group O (29.4%); for platelets, group AB (50.0%) was the most common choice, followed by the donor type (38.2%); for plasma, group AB (55.9%) was the most common choice, followed by the donor type (32.4%). In bidirectional ABOi SOT, for RBCs, the recipient\'s type (55.9%) was the most common choice, followed by group O (44.1%); for platelets and plasma, group AB was the most common choice (94.1% and 97.1%, respectively). The policies for transfusion in ABOi SOT were diverse. We suggest a guideline on the choice of ABO group for transfusion in ABOi SOT to secure patient health and enable an efficient use of blood components.
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  • 文章类型: Journal Article
    背景:由于最突出的疫苗的III期试验排除了免疫受损或免疫抑制的患者,关于SARS-CoV-2疫苗用于实体器官移植受者的安全性和有效性的数据很少.
    目的:我们的研究提供了与现有数据相一致的专家意见的综合,以解决移植患者SARS-CoV-2疫苗临床管理的关键问题。
    方法:进行了一项在线研究,检索了国家和国际移植组织以及国家机构对移植受者的SARS-CoV2疫苗接种管理的可用建议。
    结果:从18个国家和国际协会的建议中确定了11个关键声明,并通过社会建议共识评分评估个人陈述的共识。尽管预期免疫反应减弱,但发现移植患者优先接种疫苗的最高共识水平(SRCA)。所有目前授权的疫苗对移植患者(SRCA)都是安全的。免疫抑制药物的处理,及时管理疫苗,和其他方面与现有的专家意见一致。
    结论:专家共识可以确定实施SARS-CoV-2疫苗接种计划的关键方面。在获得经验数据之前,我们特此提供即时决策的工具。
    BACKGROUND: Since phase III trials for the most prominent vaccines excluded immunocompromised or immunosuppressed patients, data on safety and efficacy of SARS-CoV-2 vaccines for recipients of solid organ transplantations are scarce.
    OBJECTIVE: Our study offers a synthesis of expert opinions aligned with available data addressing key questions of the clinical management of SARS-CoV-2 vaccinations for transplant patients.
    METHODS: An online research was performed retrieving available recommendations by national and international transplantation organizations and state institutions on SARS-CoV2 vaccination management for transplant recipients.
    RESULTS: Eleven key statements were identified from recommendations by 18 national and international societies, and consensus for the individual statements was evaluated by means of the Society Recommendation Consensus score. The highest consensus level (SRC A) was found for prioritized access to vaccination for transplant patients despite anticipation of a weakened immune response. All currently authorized vaccines can be considered safe for transplant patients (SRC A). The handling of immunosuppressive medication, the timely management of vaccines, and other aspects were aligned with available expert opinions.
    CONCLUSIONS: Expert consensus can be determined for crucial aspects of the implementation of SARS-CoV-2 vaccination programs. We hereby offer a tool for immediate decision-making until empirical data becomes available.
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  • 文章类型: Journal Article
    循环性死亡(DCD)后捐赠中的常温区域灌注(NRP)是原位冷却和快速采购的安全替代方法。越来越多的国家和中心正在执行NRP,一个具有技术和后勤挑战性的程序。该共识文件提供了关于在不受控制和受控制的DCD中使用NRP的循证建议。它还提供了最低限度的道德,构成安全有效的NRP计划基础的后勤和技术要求。本文基于移植学习之旅项目Workstream04的欧洲专家小组提出的证据和意见,这是欧洲器官移植协会的一部分。
    Normothermic regional perfusion (NRP) in donation after circulatory death (DCD) is a safe alternative to in situ cooling and rapid procurement. An increasing number of countries and centres are performing NRP, a technically and logistically challenging procedure. This consensus document provides evidence-based recommendations on the use of NRP in uncontrolled and controlled DCDs. It also offers minimal ethical, logistical and technical requirements that form the foundation of a safe and effective NRP programme. The present article is based on evidence and opinions formulated by a panel of European experts of Workstream 04 of the Transplantation Learning Journey project, which is part of the European Society for Organ Transplantation.
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  • 文章类型: Journal Article
    受体从实体器官移植中接受的免疫抑制治疗阻碍了对感染的防御反应。如果不采取适当的预防措施,其从供体的传播会导致移植物功能障碍或丧失,甚至导致接受者死亡。应彻底评估这种潜在风险,以最大程度地减少从供体到受体的感染传播风险。特别是来自感染供体的器官移植,而不会增加移植物功能障碍和受体的发病率和死亡率。本文件旨在回顾有关潜在供体感染筛查的最新知识,并根据现有的科学证据提供有关感染供体器官使用的临床和微生物学建议。
    The immunosuppressive treatment that recipients receive from a solid organ transplantation hinders the defensive response to infection. Its transmission from the donor can cause dysfunction or loss of the graft and even death of the recipient if proper preventive measures are not established. This potential risk should be thoroughly evaluated to minimise the risk of infection transmission from donor to recipient, especially with organ transplantation from donors with infections, without increasing graft dysfunction and morbidity and mortality in the recipient. This document aims to review current knowledge about infection screening in potential donors and offer clinical and microbiological recommendations about the use of organs from donors with infection based on available scientific evidence.
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  • 文章类型: Journal Article
    These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the epidemiology, diagnosis, prevention, and management of methicillin-resistant Staphylococcus aureus (MRSA) infections in solid organ transplantation. Despite an increasing armamentarium of antimicrobials active against MRSA, improved diagnostic tools, and overall declining rates of infection, MRSA infections remain a substantial cause of morbidity and mortality in solid organ transplant recipients. Pre- and post-transplant MRSA colonization is a significant risk factor for post-transplant MRSA infection. The preferred initial treatment of MRSA bacteremia remains vancomycin. Hand hygiene, chlorhexidine bathing in the ICU, central-line bundles that focus on reducing unnecessary catheter use, disinfection of patient equipment, and the environment along with antimicrobial stewardship are all aspects of an infection prevention approach to prevent MRSA transmission and decrease healthcare-associated infections.
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  • 文章类型: Journal Article
    These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of infections due to multidrug-resistant (MDR) Gram-negative bacilli in the pre- and post-transplant period. MDR Gram-negative bacilli, including carbapenem-resistant Enterobacteriaceae, MDR Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii, remain a threat to successful organ transplantation. Clinicians now have access to at least five novel agents with activity against some of these organisms, with others in the advanced stages of clinical development. No agent, however, provides universal and predictable activity against any of these pathogens, and very little is available to treat infections with MDR nonfermenting Gram-negative bacilli including A baumannii. Despite advances, empiric antibiotics should be tailored to local microbiology and targeted regimens should be tailored to susceptibilities. Source control remains an important part of the therapeutic armamentarium. Morbidity and mortality associated with infections due to MDR Gram-negative organisms remain unacceptably high. Heightened infection control and antimicrobial stewardship initiatives are needed to prevent these infections, curtail their transmission, and limit the evolution of MDR Gram-negative pathogens, especially in the setting of organ transplantation.
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