2023
Active and Passive Immunization Approaches in Transplant Recipients
Ringer M, Azar M, Malinis M. Active and Passive Immunization Approaches in Transplant Recipients. Current Transplantation Reports 2023, 10: 188-198. DOI: 10.1007/s40472-023-00406-4.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsSolid organ transplant recipientsImmune responseTransplant recipientsActive immunizationReviewThe COVID-19 pandemicMonoclonal antibodiesSARS-CoV2 vaccinesOrgan transplant recipientsDose of vaccinePassive immunization approachesTiming of vaccinationPassive immunization strategiesUse of adjuvantsBooster dosesConvalescent plasmaClinical efficacyPassive immunizationPoor outcomePassive immunityImmunization approachVaccinationImmunization strategiesImmunizationFurther studiesCOVID-19 pandemicRapid antimicrobial resistance detection methods for bloodstream infection in solid organ transplantation: Proposed clinical guidance, unmet needs, and future directions
Turbett S, Banach D, Bard J, Gandhi R, Letourneau A, Azar M. Rapid antimicrobial resistance detection methods for bloodstream infection in solid organ transplantation: Proposed clinical guidance, unmet needs, and future directions. Transplant Infectious Disease 2023, 25: e14113. PMID: 37594214, DOI: 10.1111/tid.14113.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsUnmet needSolid organ transplant recipientsOrgan transplant recipientsSolid organ transplantationTransplant infectious diseasesEffective antimicrobial therapyPositive blood culturesFast institutionSOT recipientsTransplant recipientsDiagnostic stewardshipBloodstream infectionsAntimicrobial therapyBlood culturesClinical guidanceOrgan transplantationConsensus conferenceClinical practiceInfectious diseasesClinical microbiologyAmerican SocietyTransplantationResistance detectionBacterial resistanceRecipientsCurrent Concepts in the Diagnosis and Management of Pneumocystis Pneumonia in Solid Organ Transplantation
Trubin P, Azar M. Current Concepts in the Diagnosis and Management of Pneumocystis Pneumonia in Solid Organ Transplantation. Infectious Disease Clinics Of North America 2023, 37: 617-640. PMID: 37142510, DOI: 10.1016/j.idc.2023.03.005.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsSolid organ transplant recipientsOrgan transplant recipientsFirst-choice agentsSolid organ transplantationAppropriate clinical contextTransplant recipientsInterstitial pneumoniaTrimethoprim-sulfamethoxazoleOptimal treatmentPneumocystis pneumoniaOrgan transplantationInfection manifestsPrevention strategiesNucleic acid amplificationDiagnostic testingRadiographic imagingTissue samplingClinical contextLung fluidCurrent conceptsHost susceptibilityPneumoniaAcid amplificationTreatmentProphylaxis
2022
A consensus conference to define the utility of advanced infectious disease diagnostics in solid organ transplant recipients
Azar MM, Turbett S, Gaston D, Gitman M, Razonable R, Koo S, Hanson K, Kotton C, Silveira F, Banach DB, Basu SS, Bhaskaran A, Danziger-Isakov L, Bard JD, Gandhi R, Hanisch B, John TM, John A, Letourneau AR, Luong M, Maron G, Miller S, Prinzi A, Schwartz I, Simner P, Kumar D, Group O. A consensus conference to define the utility of advanced infectious disease diagnostics in solid organ transplant recipients. American Journal Of Transplantation 2022, 22: 3150-3169. PMID: 35822346, DOI: 10.1111/ajt.17147.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsOrgan transplant recipientsTransplant recipientsConsensus conferenceSolid organ transplant recipientsInfectious diseasesSetting of transplantationInfectious disease diagnosticsTransplant infectious diseasesHigh-quality evidenceEvidence-based recommendationsMultiplex molecular assaysNext-generation sequencing assayDiagnostic stewardshipConsensus statementUnmet needMass spectrometry-based assayClinical useRecipientsClinical microbiologyMolecular assaysAmerican SocietyTransplantationFinancial barriersDiseaseSequencing assaysEvaluating clinical effectiveness of SARS‐CoV‐2 vaccine in solid organ transplant recipients: A propensity score matched analysis
Tucker M, Azar MM, Cohen E, Gan G, Deng Y, Palacios C, Malinis M. Evaluating clinical effectiveness of SARS‐CoV‐2 vaccine in solid organ transplant recipients: A propensity score matched analysis. Transplant Infectious Disease 2022, 24: e13876. PMID: 35684932, PMCID: PMC9348300, DOI: 10.1111/tid.13876.Peer-Reviewed Original ResearchConceptsSolid organ transplant recipientsSARS-CoV-2 infectionOrgan transplant recipientsCritical COVID-19Clinical effectivenessTransplant recipientsVaccine eraVaccinated solid organ transplant recipientsCOVID-19Propensity score-matched cohortSARS-CoV-2 vaccinationSevere coronavirus disease 2019Cause-specific Cox regression modelsCOVID-19-related mortalitySARS-CoV-2 vaccinesSARS-CoV-2 infection ratesCurrent vaccine recommendationsKey preventative strategiesPrimary vaccine seriesRetrospective cohort studyDoses of mRNACox regression modelCoronavirus disease 2019Poisson regression modelsVaccine seriesReal‐world experience with available, outpatient COVID‐19 therapies in solid organ transplant recipients during the omicron surge
Radcliffe C, Palacios CF, Azar MM, Cohen E, Malinis M. Real‐world experience with available, outpatient COVID‐19 therapies in solid organ transplant recipients during the omicron surge. American Journal Of Transplantation 2022, 22: 2458-2463. PMID: 35583664, PMCID: PMC9348251, DOI: 10.1111/ajt.17098.Peer-Reviewed Original ResearchConceptsSolid organ transplant recipientsOral antiviral agentsOrgan transplant recipientsOutpatient therapyTransplant recipientsAntiviral agentsCOVID-19-related morbidityMonoclonal antibodiesKidney transplant recipientsRate of hospitalizationCOVID-19 therapyReal-world effectivenessSARS-CoV-2 pandemicCOVID-19 diagnosisModerate diseaseRetrospective reviewMean ageOutpatient settingClinical trialsSubstantial burdenTherapyCoronavirus diseaseMean timeHealthcare systemReal-world experienceDematiaceous fungal infections in solid organ transplantation: Systematic review and Bayesian meta‐analysis
Radcliffe C, Radcliffe AJ, Azar MM, Grant M. Dematiaceous fungal infections in solid organ transplantation: Systematic review and Bayesian meta‐analysis. Transplant Infectious Disease 2022, 24: e13819. PMID: 35253959, DOI: 10.1111/tid.13819.Peer-Reviewed Original ResearchConceptsSolid organ transplant recipientsDematiaceous fungal infectionSoft tissue infectionsFungal infectionsInfectious syndromesSystematic reviewEarly post-transplant periodCentral nervous system infectionCommon infectious syndromesPost-transplant periodNervous system infectionOrgan transplant recipientsSolid organ transplantationEnglish-language reportsInfection typeKidney recipientsLiver recipientsPediatric reportsTransplant recipientsPulmonary infectionSystem infectionTissue infectionsWorse prognosisDisseminated infectionMean ageRectal screening for azole non‐susceptible Candida species in patients undergoing liver transplantation
Radcliffe C, Patel KK, Azar MM, Koff A, Belfield KD, Peaper DR, Topal JE, Malinis M. Rectal screening for azole non‐susceptible Candida species in patients undergoing liver transplantation. Transplant Infectious Disease 2022, 24: e13811. PMID: 35184347, DOI: 10.1111/tid.13811.Peer-Reviewed Original ResearchConceptsAppropriate antifungal prophylaxisAntifungal prophylaxisRisk factorsTransplant recipientsRectal swabsSolid organ transplant recipientsCommon invasive fungal infectionYale-New Haven HospitalDays of LTTime of LTLiver transplant recipientsOrgan transplant recipientsRetrospective chart reviewMore risk factorsMultiple risk factorsInvasive fungal infectionsNew Haven HospitalPrimary LTLiver transplantationAdult patientsChart reviewLT candidatesRectal screeningCandida infectionsMedian numberDelayed Mortality Among Solid Organ Transplant Recipients Hospitalized for COVID-19
Heldman MR, Kates OS, Safa K, Kotton CN, Multani A, Georgia SJ, Steinbrink JM, Alexander BD, Blumberg EA, Haydel B, Hemmige V, Hemmersbach-Miller M, La Hoz RM, Moni L, Condor Y, Flores S, Munoz CG, Guitierrez J, Diaz EI, Diaz D, Vianna R, Guerra G, Loebe M, Yabu JM, Kramer KH, Tanna SD, Ison MG, Rakita RM, Malinis M, Azar MM, McCort ME, Singh PP, Velioglu A, Mehta SA, van Duin D, Goldman JD, Lease ED, Wald A, Limaye AP, Fisher CE, Besharatian B, Crespo M, Tomic R, Sehgal S, Weisshaar D, Girgis R, Lawrence C, Nelson J, Bennett W, Leandro J, Sait A, Rumore A, West P, Jeng A, Bajrovic V, Bilgili E, Anderson-Haag T, Nastase A, Badami A, Alvarez-Garcia J, Bowman-Anger L, Julien L, Ortiz-Bautista C, Friedman-Morocco R, Gajurel K, Cahuayme-Zuniga L, Wakefield M, Fung M, Theodoropoulos N, Chuang S, Bhandaram S, Veroux M, Chopra B, Florescu D, Witteck D, Diaz D, Ripley K, Saharia K, Akkina S, McCarty T, Webb A, Arya A, Vedula G, El-Amm J, Dokus M, Narayanan A, de Camargo P, Ouseph R, Breuckner A, Luk A, Aujayeb A, Ganger D, Keith D, Meloni F, Haidar G, Zapernick L, Morales M, Goyal N, Sharma T, Malhotra U, Kuo A, Rossi A, Edwards A, Keller B, Beneri C, Derringer D, Dominguez E, Carlson E, Hashim F, Murad H, Wilkens H, Neumann H, Gani I, Kahwaji J, Popoola J, Michaels M, Jakharia N, De la Cruz O, Puing A, Motallebzadeh R, Velagapudi R, Kapoor R, Allam S, Silveira F, Vora S, Kelly U, Reddy U, Dharnidharka V, Wadei H, Zurabi L. Delayed Mortality Among Solid Organ Transplant Recipients Hospitalized for COVID-19. Clinical Infectious Diseases 2022, 78: 711-718. PMID: 35212363, PMCID: PMC9383518, DOI: 10.1093/cid/ciac159.Peer-Reviewed Original ResearchSOT recipientsDay 28Day 90Multivariable Cox proportional hazards modelsSolid organ transplant recipientsCOVID-19Cox proportional hazards modelCOVID-19 focusOrgan transplant recipientsChronic lung diseaseBody mass indexProportional hazards modelSARS-CoV-2 detectionLung transplantMulticenter registryTransplant recipientsHeart failureMass indexIllness onsetVital statusLung diseaseRisk factorsDay 29Lower mortalityMortalityClinical effectiveness of additional primary SARS‐CoV‐2 vaccine doses for solid organ transplant recipients
Radcliffe C, Azar MM, Cohen E, Tucker M, Grubaugh ND, Malinis M. Clinical effectiveness of additional primary SARS‐CoV‐2 vaccine doses for solid organ transplant recipients. Clinical Transplantation 2022, 36: e14601. PMID: 35064939, DOI: 10.1111/ctr.14601.Commentaries, Editorials and LettersConceptsSolid organ transplant recipientsOrgan transplant recipientsTransplant recipientsVaccine dosesClinical effectivenessDosesRecipientsAn outbreak of SARS‐CoV‐2 on a transplant unit in the early vaccination era
Roberts SC, Palacios C, Grubaugh ND, Alpert T, Ott IM, Breban MI, Initiative Y, Martinello RA, Smith C, Davis MW, Mcmanus D, Tirmizi S, Topal JE, Azar MM, Malinis M. An outbreak of SARS‐CoV‐2 on a transplant unit in the early vaccination era. Transplant Infectious Disease 2022, 24: e13782. PMID: 34969164, DOI: 10.1111/tid.13782.Peer-Reviewed Original ResearchConceptsSARS-CoV-2Infection prevention practicesSARS-CoV-2 outbreakTransplant unitCOVID-19-associated morbiditySolid organ transplant recipientsSARS-CoV-2 vaccinationPrevention practicesHospital day 18Potential index casesOrgan transplant recipientsInfection prevention behaviorsMonoclonal antibody therapyCOVID-19SARS-CoV-2 clustersHospital staff membersWhole-genome sequencingAsymptomatic patientsTransplant recipientsPositive patientsAtypical presentationImmunocompromised patientsAntibody therapyVaccination eraDisease progression
2021
Longitudinal Immune Profiling of a Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection in a Solid Organ Transplant Recipient
Klein J, Brito AF, Trubin P, Lu P, Wong P, Alpert T, Peña-Hernández MA, Haynes W, Kamath K, Liu F, Vogels CBF, Fauver JR, Lucas C, Oh J, Mao T, Silva J, Wyllie AL, Muenker MC, Casanovas-Massana A, Moore AJ, Petrone ME, Kalinich CC, Dela Cruz C, Farhadian S, Ring A, Shon J, Ko AI, Grubaugh ND, Israelow B, Iwasaki A, Azar MM, Team F. Longitudinal Immune Profiling of a Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection in a Solid Organ Transplant Recipient. The Journal Of Infectious Diseases 2021, 225: 374-384. PMID: 34718647, PMCID: PMC8807168, DOI: 10.1093/infdis/jiab553.Peer-Reviewed Original ResearchConceptsSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfectionLongitudinal immune profilingTransplant recipientsImmune profilingPrimary SARS-CoV-2 infectionCD4 T cell poolMale renal transplant recipientSolid organ transplant recipientsSARS-CoV-2 reinfectionSARS-CoV-2 antibodiesSARS-CoV-2 infectionWhole viral genome sequencingRenal transplant recipientsImmune escape mutationsOrgan transplant recipientsT cell poolTime of reinfectionCoronavirus disease 2019Lower neutralization titersHumoral memory responsesViral genome sequencingInitial diagnosisImmunologic deficiencyHumoral responseImmunologic investigationsNocardiosis and elevated beta-d-glucan in solid organ transplant recipients
Ringer M, Radcliffe C, Kerantzas CA, Malinis M, Azar MM. Nocardiosis and elevated beta-d-glucan in solid organ transplant recipients. IDCases 2021, 26: e01322. PMID: 34786341, PMCID: PMC8577490, DOI: 10.1016/j.idcr.2021.e01322.Peer-Reviewed Case Reports and Technical NotesSOT recipientsBeta-d-glucan (BDG) testingSolid organ transplantation recipientsSolid organ transplant recipientsElevated BDG levelsOrgan transplant recipientsOrgan transplantation recipientsCases of nocardiosisFuture prospective studiesCases of patientsInvasive fungal infectionsBDG testingTransplant recipientsTransplantation recipientsClinical courseCase seriesProspective studyCase definitionIdentified causeElevated betaBDG levelsNocardiosisCausal associationFungal infectionsRecipientsChanging trends in mortality among solid organ transplant recipients hospitalized for COVID‐19 during the course of the pandemic
Heldman MR, Kates OS, Safa K, Kotton CN, Georgia SJ, Steinbrink JM, Alexander BD, Hemmersbach‐Miller M, Blumberg EA, Multani A, Haydel B, La Hoz RM, Moni L, Condor Y, Flores S, Munoz CG, Guitierrez J, Diaz EI, Diaz D, Vianna R, Guerra G, Loebe M, Rakita RM, Malinis M, Azar MM, Hemmige V, McCort ME, Chaudhry ZS, Singh PP, Kramer K, Velioglu A, Yabu JM, Morillis JA, Mehta SA, Tanna SD, Ison MG, Derenge AC, van Duin D, Maximin A, Gilbert C, Goldman JD, Lease ED, Fisher CE, Limaye AP, Team T. Changing trends in mortality among solid organ transplant recipients hospitalized for COVID‐19 during the course of the pandemic. American Journal Of Transplantation 2021, 22: 279-288. PMID: 34514710, PMCID: PMC8653312, DOI: 10.1111/ajt.16840.Peer-Reviewed Original ResearchConceptsSolid organ transplant recipientsOrgan transplant recipientsTransplant recipientsCOVID-19IL-6/ILComorbidity-adjusted mortalityUse of corticosteroidsUse of hydroxychloroquineMultivariable logistic regressionBaseline comorbiditiesMulticenter registryImproved survivalReceptor inhibitorsGeneral populationMortality trendsMortalityLogistic regressionFurther studiesLater periodRecipientsCorticosteroidsComorbiditiesHydroxychloroquinePandemicPatientsResponse to “SARS‐CoV‐2 vaccine effectiveness trumps immunogenicity in solid organ transplant recipients”
Malinis M, Cohen E, Azar MM. Response to “SARS‐CoV‐2 vaccine effectiveness trumps immunogenicity in solid organ transplant recipients”. American Journal Of Transplantation 2021, 21: 4106-4107. PMID: 34328268, PMCID: PMC8441690, DOI: 10.1111/ajt.16770.Commentaries, Editorials and LettersConceptsSARS-CoV-2 vaccine effectivenessSolid organ transplant recipientsOrgan transplant recipientsTransplant recipientsVaccine effectivenessImmunogenicityRecipientsCOVID‐19 in hospitalized lung and non‐lung solid organ transplant recipients: A comparative analysis from a multicenter study
Heldman MR, Kates OS, Safa K, Kotton CN, Georgia SJ, Steinbrink JM, Alexander BD, Hemmersbach‐Miller M, Blumberg EA, Crespo MM, Multani A, Lewis AV, Beaird O, Haydel B, La Hoz RM, Moni L, Condor Y, Flores S, Munoz CG, Guitierrez J, Diaz EI, Diaz D, Vianna R, Guerra G, Loebe M, Rakita RM, Malinis M, Azar MM, Hemmige V, McCort ME, Chaudhry ZS, Singh P, Hughes K, Velioglu A, Yabu JM, Morillis JA, Mehta SA, Tanna SD, Ison MG, Tomic R, Derenge A, van Duin D, Maximin A, Gilbert C, Goldman JD, Sehgal S, Weisshaar D, Girgis RE, Nelson J, Lease ED, Limaye AP, Fisher CE, Team T. COVID‐19 in hospitalized lung and non‐lung solid organ transplant recipients: A comparative analysis from a multicenter study. American Journal Of Transplantation 2021, 21: 2774-2784. PMID: 34008917, PMCID: PMC9215359, DOI: 10.1111/ajt.16692.Peer-Reviewed Original ResearchConceptsSolid organ transplant recipientsLung transplant recipientsOrgan transplant recipientsTransplant recipientsRisk factorsAllograft dysfunctionAdult solid organ transplant recipientsCOVID-19High mortalityChronic lung allograft dysfunctionOnly independent risk factorMultivariable logistic regression modelChronic allograft dysfunctionComorbidity-adjusted mortalityLung allograft dysfunctionMulticenter cohort studyIndependent risk factorCoronavirus disease 2019Logistic regression modelsLung transplantCohort studyHeart failureMulticenter studyDisease 2019MortalityTransplant Adenovirus Infection: Clinical Syndromes, Diagnosis, and Management
Malinis M, Azar M. Transplant Adenovirus Infection: Clinical Syndromes, Diagnosis, and Management. 2021, 781-805. DOI: 10.1007/978-3-030-25869-6_33.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsSolid organ transplant recipientsInadequate clinical responseReduction of immunosuppressionCornerstone of treatmentOrgan transplant recipientsSolid organ transplantationManifestations of diseaseDirect antigen detectionGraft dysfunctionGraft lossImmunosuppression reductionTransplant recipientsClinical responseAntiviral therapySignificant morbidityAsymptomatic sheddingTherapeutic optionsViral cultureClinical syndromeAdenoviral diseaseOrgan transplantationHematopoietic stem cellsAntigen detectionAdenovirus infectionInfectionA retrospective matched cohort single‐center study evaluating outcomes of COVID‐19 and the impact of immunomodulation on COVID‐19‐related cytokine release syndrome in solid organ transplant recipients
Ringer M, Azmy V, Kaman K, Tang D, Cheung H, Azar MM, Price C, Malinis M. A retrospective matched cohort single‐center study evaluating outcomes of COVID‐19 and the impact of immunomodulation on COVID‐19‐related cytokine release syndrome in solid organ transplant recipients. Transplant Infectious Disease 2021, 23: e13556. PMID: 33378571, PMCID: PMC7883059, DOI: 10.1111/tid.13556.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAntibodies, Monoclonal, HumanizedCase-Control StudiesCohort StudiesComorbidityCOVID-19COVID-19 Drug TreatmentCytokine Release SyndromeFemaleGlucocorticoidsGraft RejectionHeart TransplantationHospitalizationHumansImmunologic FactorsImmunosuppressive AgentsInterleukin-10Interleukin-6Kidney TransplantationLiver TransplantationMaleMiddle AgedReceptors, Interleukin-2Retrospective StudiesSARS-CoV-2Severity of Illness IndexTreatment OutcomeYoung AdultConceptsCytokine release syndromeBody mass indexNon-SOT patientsSOT groupSOT patientsRelease syndromeInterleukin-6COVID-19-related cytokine release syndromeSoluble interleukin-2 receptor levelsControl groupInterleukin-2 receptor levelsSolid organ transplant patientsSolid organ transplant recipientsImpact of immunomodulationInterleukin-10 levelsOrgan transplant recipientsOrgan transplant patientsCritical care needsMulti-center studyCoronavirus disease 2019COVID-19Interleukin levelsIndex hospitalizationTransplant patientsTransplant recipients
2020
Clinical implications of SARS-CoV-2 cycle threshold values in solid organ transplant recipients
Gaston DC, Malinis M, Osborn R, Peaper DR, Landry M, Juthani-Mehta M, Azar MM. Clinical implications of SARS-CoV-2 cycle threshold values in solid organ transplant recipients. American Journal Of Transplantation 2020, 21: 1304-1311. PMID: 33043603, PMCID: PMC7675520, DOI: 10.1111/ajt.16357.Peer-Reviewed Original ResearchConceptsSolid organ transplant recipientsOrgan transplant recipientsClinical implicationsCycle threshold valuesSOT patientsTransplant recipientsSymptom onsetYale New Haven Health SystemUpper respiratory tract samplesSARS-CoV-2 viral RNASARS-CoV-2 viral dynamicsAdult SOT recipientsRetrospective chart reviewRespiratory tract samplesSARS-CoV-2 cycle threshold valuesInfection prevention measuresCOVID-19 severityViral RNAHigher clinical acuityPrimary diagnostic testRT-PCR assaysSOT recipientsChart reviewViral loadAdmission severityDiagnostic Testing of COVID-19 in Solid Organ Transplantation: Current Clinical Application and Future Strategies
Trubin PA, Azar MM, Malinis M. Diagnostic Testing of COVID-19 in Solid Organ Transplantation: Current Clinical Application and Future Strategies. Current Transplantation Reports 2020, 7: 390-398. PMID: 33134033, PMCID: PMC7585558, DOI: 10.1007/s40472-020-00307-w.Peer-Reviewed Original ResearchSARS-CoV-2 infectionSolid organ transplantationInfection prevention practicesOrgan transplantationTransplant recipientsPolymerase chain reactionAcute respiratory syndrome coronavirus 2 infectionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectionSolid organ transplant recipientsSyndrome coronavirus 2 infectionPrevention practicesCOVID-19 pandemicRecipient suitabilityCoronavirus 2 infectionOrgan transplant recipientsChain reactionCoronavirus disease 2019SARS-CoV-2Current clinical applicationsDiagnostic testing strategiesCOVID-19 diagnosticsMitigation of infectionPurpose of ReviewWhileOptimal donorViral kinetics