Management of Infectious Complications in Solid-Organ Transplant Recipients

Grim, Shellee A.; Clark, Nina M.

doi:10.1038/clpt.2011.90

Cited by 19 publications

(20 citation statements)

References 29 publications

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“…Cell-based therapy is increasingly being used in clinical trials worldwide for treatment of acute tissue and organ injuries, degenerative diseases as well as congenital, metabolic, and immunological disorders [1], [2], and [3]. The development of clinical-grade cells (ie.…”

Section: Introductionmentioning

confidence: 99%

Thiol-ene Michael-type formation of gelatin/poly(ethylene glycol) biomatrices for three-dimensional mesenchymal stromal/stem cell administration to cutaneous wounds

Cantu

et al. 2013

Acta Biomaterialia

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Mesenchymal stromal/stem cells (MSCs) are considered promising cellular therapeutics in the fields of tissue engineering and regenerative medicine. MSCs secrete high concentrations of immunomodulatory cytokines and growth factors, which exert paracrine effects on infiltrating immune and resident cells of the wound microenvironment that could favorably promote healing after acute injury. However, better spatial delivery and improved retention at the site of injury are two factors that could improve the clinical application of MSCs. In this study, we utilized thiol-ene Michael-type addition for rapid encapsulation of MSCs within a gelatin/poly(ethylene glycol) biomatrix; this biomatrix was also applied as a provisional dressing to full-thickness wounds in Sprague-Dawley rats. The three-way interaction of MSCs, gelatin/poly(ethylene glycol) biomatrices, and host immune cells and adjacent resident cells of the wound microenvironment favorably modulated wound progression and host response. In this model we observed attenuated immune cell infiltration, lack of foreign giant cell (FBGC) formation, accelerated wound closure and re-epithelialization, as well as enhanced neovascularization and granulation tissue formation by 7 days. The MSC-entrapped gelatin/poly(ethylene glycol) biomatrix localized the presentation of MSCs adjacent to the wound microenvironment and thus, mediated early resolution of inflammatory events and facilitated proliferative phases in wound healing.

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Section: Introductionmentioning

confidence: 99%

Thiol-ene Michael-type formation of gelatin/poly(ethylene glycol) biomatrices for three-dimensional mesenchymal stromal/stem cell administration to cutaneous wounds

Cantu

et al. 2013

Acta Biomaterialia

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“…Corticosteroids should be maintained to prevent adrenal insufficiency. The role of granulocyte colonystimulating factor (G-CSF) drugs is controversial, and G-CSF has been used by some centers for leukocyte counts of less than 3000 cells/mm [3,38]. Echinocandins like caspofungin should also be considered in patients with septic shock without a focus especially in patients with risk factors for invasive candidiasis such as older age, central venous catheters, Candida colonization, total parenteral nutrition (TPN), prolonged neutropenia, prolonged intensive care unit stay, diabetes, renal replacement therapy, and/or broad-spectrum antibiotic therapy [42,43].…”

Section: Bloodstream Infections and Sepsismentioning

confidence: 99%

“…Over the past few years, there has been a significant improvement in survival and reduction in rejection after solid organ transplantation (SOT) as a result of more effective immunosuppression therapy. However, infections and particularly bloodstream infections (BSIs) still remain as a common complication and a major cause of death after transplant [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Another risk factor for infection is the presence of unrecognized infection in the donor or the recipient. Rejection, which is often treated with intensified immunosuppression, also increases the incidence of infections, particularly viral and nosocomially acquired pathogens [3]. In addition, cytomegalovirus (CMV) infection may increase the risk of other infections, including bacterial and fungal infections [3,7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Bacterial infections are very common in patients with endorgan disease prior to and after SOT, and represent one of the most important causes of progression of liver failure, development of complications, and death in patients with end-stage liver disease (ESLD) [9]. Nosocomial bacterial infections are the most common cause of infection in this group of patients in the first month after transplantation [3,5,10]. Furthermore, liver, pancreas, and intestinal recipients are especially at risk for fatal fungal infections, primarily caused by Candida species which may occur together with bacterial infections.…”

Section: Introductionmentioning

confidence: 99%

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Management of Antimicrobial Agents in Abdominal Organ Transplant Patients in Intensive Care Unit

2020

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Purpose of Review Early diagnosis of infections and immediate initiation of appropriate antimicrobials are crucial in the management of patients before and after organ transplantation. We reviewed the most recent literature and guidelines in this field and organized the current recommendations for healthcare professionals caring for critically ill organ transplant recipients. Recent Findings The incidence of multidrug-resistant organisms is increasing. Multidrug-resistant Gram-negative bacteria comprise about 14% of organisms. Vancomycin-resistant enterococci bloodstream infections are also on the rise, as 20.5% of nosocomial enterococci are now vancomycin-resistant, changing empiric antibiotic selection. Fluconazole-resistant Candida species comprise up to 46% of cases of candidemia in hospitalized patients. Consequently, new guidelines recommend primary use of echinocandins in patients with candidemia who have moderate-to-severe disease. Finally, the incidence of emergence of ganciclovir-resistant cytomegalovirus infection in patients is 5-12%, requiring early recognition and change to alternative regimens in the case of poor response to therapy. Summary Bloodstream infections are a major cause of mortality and morbidity in solid organ transplantation. Mortality as high as 24% and 50% have been reported with sepsis and septic shock respectively. As such, bloodstream infections should be diagnosed rapidly and intravenous antibiotics should be started immediately. Appropriate resuscitation should be initiated and the number and/or dose of immunosuppressive drugs should be reduced. Proper source control must also be achieved with radiologic drainage or surgical intervention as appropriate. Initial antibiotic treatment of these patients should cover both Grampositive organisms, especially in the presence of intravascular catheters, and Gram-negative bacteria. Echinocandins like caspofungin should also be considered especially in critically ill patients, particularly if a patient has been on total parenteral nutrition or broad-spectrum antibiotics.

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Combinatorial Biomatrix/Cell‐Based Therapies for Restoration of Host Tissue Architecture and Function

Cantu

Kao

2013

Adv Healthcare Materials

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This Progress Report reviews recent advances in the utility of extracellular matrix (ECM)-mimic biomaterials in presenting and delivering therapeutic cells to promote tissue healing. This overview gives a brief introduction of different cell types being used in regenerative medicine and tissue engineering while addressing critical issues that must be overcome before cell-based approaches can be routinely employed in the clinic. A selection of 5 commonly used cell-associated, biomaterial platforms (collagen, hyaluronic acid, fibrin, alginate, and poly(ethylene glycol)) are reviewed for treatment of a number of acute injury or diseases with emphasis on animal models and clinical trials. This article concludes with current challenges and future perspectives regarding foreign body host response to biomaterials and immunological reactions to allogeneic or xenogeneic cells, vascularization and angiogenesis, matching mechanical strength and anisotropy of native tissues, as well as other non-technical issues regarding the clinical translation of biomatrix/cell-based therapies.

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Management of Infectious Complications in Solid-Organ Transplant Recipients

Cited by 19 publications

References 29 publications

Thiol-ene Michael-type formation of gelatin/poly(ethylene glycol) biomatrices for three-dimensional mesenchymal stromal/stem cell administration to cutaneous wounds

Thiol-ene Michael-type formation of gelatin/poly(ethylene glycol) biomatrices for three-dimensional mesenchymal stromal/stem cell administration to cutaneous wounds

Management of Antimicrobial Agents in Abdominal Organ Transplant Patients in Intensive Care Unit

Combinatorial Biomatrix/Cell‐Based Therapies for Restoration of Host Tissue Architecture and Function

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