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  1. Article ; Online: Recent advances in cytomegalovirus infection management in solid organ transplant recipients.

    Grossi, Paolo Antonio / Peghin, Maddalena

    Current opinion in organ transplantation

    2024  Volume 29, Issue 2, Page(s) 131–137

    Abstract: Purpose of review: Human cytomegalovirus (CMV) continues to be the most important infectious complication following solid organ transplantation (SOT).: Recent findings: Universal prophylaxis and preemptive therapy are the most adopted strategies for ... ...

    Abstract Purpose of review: Human cytomegalovirus (CMV) continues to be the most important infectious complication following solid organ transplantation (SOT).
    Recent findings: Universal prophylaxis and preemptive therapy are the most adopted strategies for prevention of CMV disease globally. Prophylaxis with valganciclovir is the most widely used approach to CMV prevention, however leukopenia and late onset CMV disease after discontinuation of prophylaxis requires new strategies to prevent this complication. The use of assays detecting CMV-specific T cell-mediated immunity may individualize the duration of antiviral prophylaxis after transplantation. Letermovir has been recently approved for prophylaxis in kidney transplant recipients. CMV-RNAemia used together with CMV-DNAemia in the viral surveillance of CMV infection provides accurate information on viral load kinetics, mostly in patients receiving letermovir prophylaxis/therapy. The development of refractory and resistant CMV infection remains a major challenge and a new treatment with maribavir is currently available. In the present paper we will review the most recent advances in prevention and treatment of CMV diseases in SOT recipients.
    Summary: Recent findings, summarized in the present paper, may be useful to optimize prevention and treatment of CMV infection in SOT.
    MeSH term(s) Humans ; Antiviral Agents/therapeutic use ; Cytomegalovirus Infections/diagnosis ; Cytomegalovirus Infections/drug therapy ; Cytomegalovirus Infections/prevention & control ; Valganciclovir/therapeutic use ; Transplant Recipients ; Organ Transplantation/adverse effects ; Acetates ; Quinazolines
    Chemical Substances letermovir (1H09Y5WO1F) ; Antiviral Agents ; Valganciclovir (GCU97FKN3R) ; Acetates ; Quinazolines
    Language English
    Publishing date 2024-01-30
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 1390429-2
    ISSN 1531-7013 ; 1087-2418
    ISSN (online) 1531-7013
    ISSN 1087-2418
    DOI 10.1097/MOT.0000000000001139
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  2. Article ; Online: Donor-derived infections in solid organ transplant recipients.

    Peghin, Maddalena / Grossi, Paolo Antonio

    Current opinion in organ transplantation

    2023  Volume 28, Issue 5, Page(s) 384–390

    Abstract: Purpose of review: The potential for transmission of donor-derived infections (DDIs) is impossible to eliminate, but a thoughtful and systematic approach to donor evaluation can mitigate the risk. Prevention is a key issue and clinicians must maintain a ...

    Abstract Purpose of review: The potential for transmission of donor-derived infections (DDIs) is impossible to eliminate, but a thoughtful and systematic approach to donor evaluation can mitigate the risk. Prevention is a key issue and clinicians must maintain a high index of suspicion and remain vigilant in staying up to date on emerging infections. COVID-19 and Monkeypox have represented a new challenge for infectious disease screening and recommendations have been evolving, as knowledge in the field has grown. Additional considerations for pretransplant deceased donor screening include testing for neglected and endemic infectious diseases such as strongyloidiasis and HTLV 1/2. Molecular diagnostic tests have improved awareness on pathogenicity of mollicutes and fungi in the setting of DDIs. The aim of this review is to provide an update on the most recent literature on DDI with a special focus on these emerging hot topics.
    Recent findings: Donor screening for uncommon pathogens must be guided by knowledge of changing epidemiology of infectious disease and availability of new diagnostic methods.
    Summary: Appropriate screening, early recognition, timely reporting, close monitoring, and appropriate management are essential to help reducing the risk of emerging DDIs.
    MeSH term(s) Humans ; Organ Transplantation/adverse effects ; COVID-19/diagnosis ; COVID-19/epidemiology ; Strongyloidiasis ; Tissue Donors ; Communicable Diseases ; Transplant Recipients
    Language English
    Publishing date 2023-08-08
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 1390429-2
    ISSN 1531-7013 ; 1087-2418
    ISSN (online) 1531-7013
    ISSN 1087-2418
    DOI 10.1097/MOT.0000000000001094
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  3. Article ; Online: COVID-19 positive donor for solid organ transplantation.

    Peghin, Maddalena / Grossi, Paolo Antonio

    Journal of hepatology

    2022  Volume 77, Issue 4, Page(s) 1198–1204

    Abstract: The COVID-19 pandemic has significantly changed organ donation and transplantation worldwide. Since the beginning of the pandemic, the uncertainty regarding the potential route of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV- ... ...

    Abstract The COVID-19 pandemic has significantly changed organ donation and transplantation worldwide. Since the beginning of the pandemic, the uncertainty regarding the potential route of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created tremendous pressures on transplantation communities, and international organisations have advised against using organs from deceased donors who have tested positive for SARS-CoV-2. The possibility of SARS-CoV-2 transmission through organ donation has only been reported for lung transplantation; hence, based on current experience, transplantation of non-lung organs from donors with active SARS-CoV-2 infection has been considered possible and safe, at least over short-term follow-up. As the evolving outbreak of SARS-CoV-2 continues, alongside the presence of vaccines and new treatment options, clinicians should consider transplanting organs from deceased donors with active SARS-CoV-2 infection to recipients with limited opportunities for transplantation and those with specific natural or vaccine-induced immunity. This article proffers an expert opinion on the use of organs from deceased donors with resolved or active SARS-CoV-2 infection in the absence of more definitive data and standardised acceptance patterns.
    MeSH term(s) COVID-19/epidemiology ; Humans ; Organ Transplantation/adverse effects ; Pandemics/prevention & control ; SARS-CoV-2 ; Tissue Donors ; Tissue and Organ Procurement
    Language English
    Publishing date 2022-07-04
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 605953-3
    ISSN 1600-0641 ; 0168-8278
    ISSN (online) 1600-0641
    ISSN 0168-8278
    DOI 10.1016/j.jhep.2022.06.021
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  4. Article ; Online: Urban Spread of Flaviviruses: A New Challenge in Solid-organ Transplant Recipients.

    Grossi, Paolo Antonio

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2019  Volume 70, Issue 1, Page(s) 149–151

    Abstract: Yellow fever has never previously been reported in transplant recipients. The first reported case of yellow fever in a kidney transplant recipient in Brazil and the re-emergence of arboviruses in many areas of the world dictate the need of studies aimed ... ...

    Abstract Yellow fever has never previously been reported in transplant recipients. The first reported case of yellow fever in a kidney transplant recipient in Brazil and the re-emergence of arboviruses in many areas of the world dictate the need of studies aimed to answer multiple unanswered questions.
    MeSH term(s) Brazil/epidemiology ; Flavivirus ; Humans ; Transplant Recipients ; Yellow Fever/epidemiology
    Language English
    Publishing date 2019-05-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciz390
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  5. Article ; Online: Skin and soft tissue infections in solid organ transplants.

    Peghin, Maddalena / Graziano, Elena / Grossi, Paolo Antonio

    Current opinion in infectious diseases

    2023  Volume 37, Issue 2, Page(s) 112–120

    Abstract: Purpose of review: Skin and soft tissue infections (SSTI) in solid organ transplant (SOT) recipients may be a great challenge for clinicians caring for SOT due to the involvement of both common and opportunistic pathogens associated with a blunted ... ...

    Abstract Purpose of review: Skin and soft tissue infections (SSTI) in solid organ transplant (SOT) recipients may be a great challenge for clinicians caring for SOT due to the involvement of both common and opportunistic pathogens associated with a blunted immune response. The purpose of this review is to outline current literature and describe open issues on the management of SSTI in this special population.
    Recent findings: Clinical presentation in SOT recipients can manifest as isolated skin lesions after primary inoculation or be the sign of a disseminated infection. Tissue samples for microscopy and histopathology are crucial to making an accurate diagnosis given the nonspecific and heterogeneous appearance of skin lesions. Multidisciplinary teams are required for a comprehensive diagnosis and management.
    Summary: SSTI are frequent contributors to morbidity and mortality in SOT. Specific research focused on the clinical presentation, risk factors and management in this special population is needed.
    MeSH term(s) Humans ; Soft Tissue Infections/diagnosis ; Soft Tissue Infections/epidemiology ; Soft Tissue Infections/etiology ; Organ Transplantation/adverse effects ; Transplant Recipients ; Transplants
    Language English
    Publishing date 2023-12-04
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 645085-4
    ISSN 1473-6527 ; 1535-3877 ; 0951-7375 ; 1355-834X
    ISSN (online) 1473-6527 ; 1535-3877
    ISSN 0951-7375 ; 1355-834X
    DOI 10.1097/QCO.0000000000000998
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  6. Article ; Online: Donor-derived infections, lessons learnt from the past, and what is the future going to bring us.

    Grossi, Paolo Antonio

    Current opinion in organ transplantation

    2018  Volume 23, Issue 4, Page(s) 417–422

    Abstract: Purpose of review: Donor-derived transmission of infectious diseases is a well-recognized complication of solid organ transplantation (SOT). Most donor-derived disease transmissions are expected. Although uncommon, unexpected donor-derived infections ... ...

    Abstract Purpose of review: Donor-derived transmission of infectious diseases is a well-recognized complication of solid organ transplantation (SOT). Most donor-derived disease transmissions are expected. Although uncommon, unexpected donor-derived infections can be associated with significant morbidity and mortality, and as the volume of patients undergoing SOT increases, the number of infections transmitted through organ donation can also be expected to rise. The growing gap between the number of patients waiting for transplantation and available organs continue in fact to be the number one issue facing the transplant community. As a consequence the major focus in organ transplantation has been developing strategies to increase the available organs, including the use of organs from donors with infections or risky behaviors that have disqualified them from the donation in the past.
    Recent findings: In addition to the commonly reported donor-derived transmissions, an increasing number of studies have reported unusual infections transmitted by SOT.
    Summary: Transplant surgeons and physicians should increase their awareness toward uncommon donor-derived infections including them in the differential diagnosis of unusual clinical pictures in their recipients.
    MeSH term(s) Humans ; Infection/transmission ; Infection Control/methods ; Organ Transplantation/adverse effects ; Organ Transplantation/methods ; Tissue Donors ; Tissue and Organ Procurement/methods ; Tissue and Organ Procurement/standards
    Language English
    Publishing date 2018-06-19
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1390429-2
    ISSN 1531-7013 ; 1087-2418
    ISSN (online) 1531-7013
    ISSN 1087-2418
    DOI 10.1097/MOT.0000000000000551
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  7. Article ; Online: Current management of SARS-CoV-2 infection in solid organ transplant recipients: Experience derived from an ESGICH-ESOT survey.

    Visentin, Alessandro / Pickavance, Elise / San-Juan, Rafael / Grossi, Paolo Antonio / Manuel, Oriol / Aguado, Jose M

    Transplant infectious disease : an official journal of the Transplantation Society

    2024  Volume 26, Issue 2, Page(s) e14252

    Abstract: Objective: Solid organ transplant (SOT) recipients have a poorer SARS-CoV-2 vaccine response and higher risk for COVID-19-associated complications. However, there is no consensus on the current management of COVID-19 and data on persistent COVID-19 ... ...

    Abstract Objective: Solid organ transplant (SOT) recipients have a poorer SARS-CoV-2 vaccine response and higher risk for COVID-19-associated complications. However, there is no consensus on the current management of COVID-19 and data on persistent COVID-19 rates in SOT recipients are lacking.
    Methods: An electronic survey concerning the management of COVID-19 in SOT recipients was distributed among all members of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in Compromised Hosts (ESGICH) and of the European Society for Organ Transplantation (ESOT). Four major sections were covered: prevention, early COVID-19, late COVID-19, and persistent COVID-19. We developed a structured questionnaire including eight multiple-choice questions with branching logic in case of positive answers and three open-ended questions related to clinical practice. Questions were asked separately for lung and non-lung transplantation.
    Results: Thirty-two physicians from 24 different centers participated. Most answers (n = 30) were provided by European physicians. Thirty of 32 (93.75%) physicians managed non-lung transplant recipients and 12 of 32 (33.3%) lung transplant recipients. There was a huge variability in practice regarding the treatment of COVID-19, and particularly noticeable when considering lung and non-lung transplant recipients. Main discordances included the use of nirmatrelvir alone or in combination therapy for early COVID-19, the use of immunomodulatory drugs other than steroids for late COVID-19, and the need for treating asymptomatic viral shedding in persistent COVID-19. There was more similarity in terms of prophylaxis recommendations.
    Conclusion: Despite a low number of respondents, this survey shows that there are many differences on how experts manage SARS-CoV-2 infections in SOT recipients.
    MeSH term(s) Humans ; COVID-19 ; COVID-19 Vaccines ; Organ Transplantation ; SARS-CoV-2 ; Surveys and Questionnaires ; Transplant Recipients
    Chemical Substances COVID-19 Vaccines
    Language English
    Publishing date 2024-02-20
    Publishing country Denmark
    Document type Journal Article
    ZDB-ID 1476094-0
    ISSN 1399-3062 ; 1398-2273
    ISSN (online) 1399-3062
    ISSN 1398-2273
    DOI 10.1111/tid.14252
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  8. Article ; Online: Prevention and treatment of recurrent cellulitis.

    Peghin, Maddalena / Graziano, Elena / Rovelli, Cristina / Grossi, Paolo Antonio

    Current opinion in infectious diseases

    2023  Volume 36, Issue 2, Page(s) 95–101

    Abstract: Purpose of review: Recurrent cellulitis is a challenging clinical condition affecting up to 47% of patients after the first episode, especially those with predisposing risk factors. The purpose of this review is to describe the state of the art of ... ...

    Abstract Purpose of review: Recurrent cellulitis is a challenging clinical condition affecting up to 47% of patients after the first episode, especially those with predisposing risk factors. The purpose of this review is to describe the state of the art of literature evidence and to highlight recent developments in its management.
    Recent findings: Recurrent cellulitis can occur after successful treatment of cellulitis. Conditions that commonly increase the risk of cellulitis include local and systemic modifiable and nonmodifiable factors. A rigorous approach to the management of risk factors and treatment of acute infection is important as the risk of recurrence rises with repeated episodes. Risk factors, if present, need to be targeted in association with antibiotic prophylaxis. Penicillin V is the preferred antibiotic for prevention but other antibiotics and new drugs can be considered in cases of β-lactam allergy, intolerance, or failure.
    Summary: Recurrent cellulitis is associated with short term and long-term morbidity as well as significant healthcare costs. Management of underlying predisposing conditions is crucial to prevent recurrence in addition with evaluation of pharmacological measures, but specialized and multidisciplinary skills are needed. More efforts are needed to prevent and treat this underestimated problem.
    MeSH term(s) Humans ; Cellulitis/drug therapy ; Cellulitis/prevention & control ; Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis ; Penicillin V/therapeutic use ; Secondary Prevention ; Chronic Disease ; Recurrence
    Chemical Substances Anti-Bacterial Agents ; Penicillin V (Z61I075U2W)
    Language English
    Publishing date 2023-02-09
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 645085-4
    ISSN 1473-6527 ; 1535-3877 ; 0951-7375 ; 1355-834X
    ISSN (online) 1473-6527 ; 1535-3877
    ISSN 0951-7375 ; 1355-834X
    DOI 10.1097/QCO.0000000000000903
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  9. Article: SARS-CoV-2 Vaccination in Solid-Organ Transplant Recipients.

    Peghin, Maddalena / Graziano, Elena / Grossi, Paolo Antonio

    Vaccines

    2022  Volume 10, Issue 9

    Abstract: The coronavirus disease 2019 (COVID-19) pandemic has posed significant global challenges for solid organ transplant (SOT) recipients. Mortality rates of COVID-19 in this patient population remain high, despite new available therapeutic options and Severe ...

    Abstract The coronavirus disease 2019 (COVID-19) pandemic has posed significant global challenges for solid organ transplant (SOT) recipients. Mortality rates of COVID-19 in this patient population remain high, despite new available therapeutic options and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination. Priority access to SARS-CoV-2 vaccination for waitlisted candidates and for SOT patients and their family members is recommended since the advantage from vaccination reduces the risk of COVID-19-related complications. However, immunogenicity and efficacy of COVID-19 vaccines are lower in waitlisted candidates and SOT recipients than in the general population. Routine systematic assessment of humoral and cellular immune responses after SARS-CoV-2 vaccination is controversial, although highly recommended for investigation and improvement of knowledge. SOT recipients should continue to adhere to preventive protective measures despite vaccination and may undergo passive antibody prophylaxis. This article seeks to provide an update on SARS-CoV-2 vaccination and preventive measures in SOT recipients based on existing literature and international guidelines.
    Language English
    Publishing date 2022-08-30
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2703319-3
    ISSN 2076-393X
    ISSN 2076-393X
    DOI 10.3390/vaccines10091430
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  10. Article ; Online: Perioperative antibiotic stewardship in the organ transplant setting.

    Graziano, Elena / Peghin, Maddalena / Grossi, Paolo Antonio

    Transplant infectious disease : an official journal of the Transplantation Society

    2022  Volume 24, Issue 5, Page(s) e13895

    Abstract: Background: Solid organ transplant (SOT) recipients can benefit from traditional antimicrobial stewardship (AMS) activities directed to improve judicious perioperative prescribing and management, but evidence is lacking. The aim of this expert opinion ... ...

    Abstract Background: Solid organ transplant (SOT) recipients can benefit from traditional antimicrobial stewardship (AMS) activities directed to improve judicious perioperative prescribing and management, but evidence is lacking. The aim of this expert opinion review is to provide an update on the current landscape of application of AMS practices for optimization of perioperative prophylaxis (PP).
    Methods: We reviewed the available literature on early postoperative infectious complications in SOT and PP management, on modified perioperative approaches in case of infection or colonization in recipients and donors and on AMS in transplantation PP.
    Results: SOT recipients are at high risk for early postoperative infectious complications due to the complexity of surgical procedures, severity of end stage organ disease, net state of immunosuppression in the posttransplant period and to the high risk for multidrug resistant organism. Moreover, SOT may be exposed to preservation fluid infections and expected or unexpected donor-derived infections. We summarize main factors to take into account when prescribing transplant PP.
    Conclusion: Creating personalized PP to avoid unwanted consequences of antimicrobials while improving outcomes is an emerging and critical aspect in SOT setting. Further studies are needed to offer best PP tailored to SOT type and to evaluate interventions efficacy and safety.
    MeSH term(s) Antimicrobial Stewardship/methods ; Communicable Diseases ; Humans ; Organ Transplantation/adverse effects ; Organ Transplantation/methods ; Tissue Donors ; Transplant Recipients ; Transplants
    Language English
    Publishing date 2022-07-23
    Publishing country Denmark
    Document type Journal Article ; Review
    ZDB-ID 1476094-0
    ISSN 1399-3062 ; 1398-2273
    ISSN (online) 1399-3062
    ISSN 1398-2273
    DOI 10.1111/tid.13895
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