High-resolution CT findings of pulmonary infections after orthotopic liver transplantation in 453 patients

Qin, Jie; Xu, Jun; Dong, Yun-xu; Tang, Wen-wei; Wu, Benquan; An, Yi; Song, Hong

doi:10.1259/bjr/26230943

Cited by 13 publications

(7 citation statements)

References 29 publications

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“…Interestingly, of the 11 patients with possible IFD due to abnormal chest CT results, none had fungi detected by cfDNA NGS and nine (82%) of these patients received antifungal therapy for >1 week. While certain radiographic findings can be suggestive of IFD, an image‐guided diagnostic approach is often nonspecific and can lead to overdiagnosis of IFD in febrile neutropenic patients . Comparing abnormal imaging results to a noninvasive reliable blood test might help establish fungal pathogens as the causal agents.…”

Section: Discussionmentioning

confidence: 99%

Cell‐free DNA next‐generation sequencing successfully detects infectious pathogens in pediatric oncology and hematopoietic stem cell transplant patients at risk for invasive fungal disease

Armstrong

Rossoff

Hollemon³

et al. 2019

Pediatric Blood & Cancer

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Background We sought to determine if next‐generation sequencing (NGS) of microbial cell‐free DNA (cfDNA) in plasma would detect pathogens in pediatric patients at risk for invasive fungal disease (IFD). Procedures Pediatric hematology, oncology, and stem cell transplant patients deemed at risk for new IFD had blood samples drawn at three time‐points separated by 1‐month intervals. The primary outcome measure was detection of fungal pathogens compared to standard clinical testing. Secondary outcomes included identification of other infectious pathogens, relationship to European Organization for Research and Treatment of Cancer's Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases’ Mycoses Study Group (EORTC/MSG) guidelines, and assessment of antifungal therapy. Results NGS identified fungal pathogens in seven of 40 at‐risk patients for IFD and results were identical in four of six proven cases, including Aspergillus fumigatus by lung biopsy, Candida albicans by blood or pancreatic pseudocyst cultures, and Rhizopus delemar by skin biopsy. Rhizopus oryzae identified on skin biopsy and A. fumigatus isolated on day 27 of 28 of culture from lung biopsy were not detected by cfDNA NGS, possibly due to lack of bloodstream penetration and questionable pathogenicity, respectively. Numerous DNA viruses were detected in patients with prolonged febrile neutropenia or abnormal imaging. Extended antifungal therapy was used in 73% of patients. Follow‐up cfDNA sequencing in patients who were positive at enrollment was negative at 1 and 2 months. Conclusions cfDNA NGS detected fungal pathogens from blood confirming its potential to guide treatment decisions in pediatric patients at risk for IFD and limit excessive empiric antifungal use. Future studies are needed to better understand the sensitivity and specificity of this approach.

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Section: Discussionmentioning

confidence: 99%

Cell‐free DNA next‐generation sequencing successfully detects infectious pathogens in pediatric oncology and hematopoietic stem cell transplant patients at risk for invasive fungal disease

Armstrong

Rossoff

Hollemon³

et al. 2019

Pediatric Blood & Cancer

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“…Transplant patients with nosocomial pneumonia should undergo a chest computed tomography (CT) scan in order to detect less evident lesions or infiltrates, to better localize them and to detect complications [126]. Although specific radiological patterns may suggest certain aetiologies [127,128], atypical presentations are frequent, and imaging should not be a surrogate for microbiological diagnosis.…”

Section: Diagnosismentioning

confidence: 99%

Is hospital-acquired pneumonia different in transplant recipients?

Gudiol

Sabé

Carratalà

2019

Clinical Microbiology and Infection

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Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are serious complications in transplant patients. The aim of this review is to summarize the evidence regarding nosocomial pneumonia in transplant recipients, including HAP in non-ventilated patients and VAP, and to identify future directions for improvement.A comprehensive literature search in the PubMed/MEDLINE database was performed. Articles written in English and published between 1990 and November 2018 were included.HAP/VAP in transplant patients usually occurs early post-transplant, particularly during neutropenia in haematopoietic stem cell transplant recipients. Bacteria are the leading cause of nosocomial pneumonia for both immunocompetent and transplant recipients, being Gram negative organisms, and especially Pseudomonas aeruginosa, highly prevalent. Multidrug-resistant bacteria are of special concern. Pneumonia in the transplant setting may be caused by opportunistic pathogens, and the differential diagnosis needs to be extended to other non-infectious complications. The most relevant opportunistic pathogens are Aspergillus fumigatus, Pneumocystis jirovecii and cytomegalovirus. Nevertheless, they are an exceptional cause of nosocomial pneumonia, and usually occur in severely immunosuppressed patients not receiving antimicrobial prophylaxis. Performing bronchoalveolar lavage may improve the rate of aetiological diagnosis, leading to a change in therapeutic management and improved outcomes. The optimal length of antibiotic therapy for bacterial HAP/VAP has not been well defined, but it should perhaps be longer than in the general population. Mortality associated with HAP/VAP is high.HAP/VAP in transplant patients is frequent and is associated with increased mortality. There is room for improvement in gaining knowledge about the management of HAP/VAP in this population.

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“…[107][108][109] Risk factors for CMV infection include retransplantation, initial nonfunctioning liver graft, fulminant liver failure, CMV seropositive donor with CMV seronegative recipient (Dþ/RÀ), muromonab-CD3 (Orthoclone OKT3) or anti-thymocyte globulin treatment, steroid boluses, transfusion of >10 units of PRBCs, and postoperative mechanical ventilation. [107][108][109][110][111][112] Mortality is higher in recurrent disease and can be predicted by the presence of multiorgan involvement during the first episode. 110 Strategies for prevention of CMV include prophylaxis (administration of medications to at-risk patients) and preemptive therapy (administration of medications to patients with evidence of CMV replication).…”

Section: Fungalmentioning

confidence: 99%

Intensive Care of Pulmonary Complications Following Liver Transplantation

Lui

Spaho

Holzwanger

et al. 2018

J Intensive Care Med

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Chronic liver disease has been associated with pulmonary dysfunction both before and after liver transplantation. Post-liver transplantation pulmonary complications can affect both morbidity and mortality often necessitating intensive care during the immediate postoperative period. The major pulmonary complications include pneumonia, pleural effusions, pulmonary edema, and atelectasis. Poor clinical outcomes have been known to be associated with age, severity of liver dysfunction, and preexisting lung disease as well as perioperative events related to fluid balance, particularly transfusion and fluid volumes. Delineating each and every one of these pulmonary complications and their associated risk factors becomes paramount in guiding specific therapeutic strategies.

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High-resolution CT findings of pulmonary infections after orthotopic liver transplantation in 453 patients

Abstract: The presence of large nodules with the halo sign is most suggestive of fungal infection after OLT. Other HRCT patterns are not helpful in distinguishing among the various types of infection seen in liver transplant recipients.

Cited by 13 publications

References 29 publications

Cell‐free DNA next‐generation sequencing successfully detects infectious pathogens in pediatric oncology and hematopoietic stem cell transplant patients at risk for invasive fungal disease

Cell‐free DNA next‐generation sequencing successfully detects infectious pathogens in pediatric oncology and hematopoietic stem cell transplant patients at risk for invasive fungal disease

Is hospital-acquired pneumonia different in transplant recipients?

Intensive Care of Pulmonary Complications Following Liver Transplantation

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