ISSN: 2008-2258
Vol 16, No 1 (2023): Winter
The prevalence of latent infection in liver transplant candidates in Taleghani Hospital in Tehran, Iran, between 2020 to 2021
Gastroenterology and Hepatology from Bed to Bench,
,
https://doi.org/10.22037/ghfbb.v16i1.2664
Abstract
Background: Due to chronic immunosuppressive therapy, patients receiving organ transplants are at risk for reactivation of various infections. Due to the complications in the process of diagnosing and treating the post-transplant infection, screening the transplant recipients and donors is vital. So the present study aimed to study the prevalence of various latent infections in pre-transplant patients
Methods: This retrospective cohort study was performed between March 2020 to 2021. 193 patients receiving a liver transplant in Taleghani Hospital, Tehran, Iran were enrolled .
Results: One-hundred and three (53.4%) patients were men, with a mean age of 48.4 ± 13.3 years. Among viruses, 177 (91.7%) patients had a positive IgG titer for CMV. Anti-EBV IgG was positive in 169 (87.6%) patients. One-hundred and seventy-five (90.7%) patients had a positive IgG titer for the VZV. One-hundred and sixty-six (86.0%) had positive IgG anti-HSV antibodies. According to our findings, none of the patients were infected with HIV, but 9 (4.7%) and 141 (73.1%) had positive anti-HCV and anti-HAV IgG antibodies, respectively. HBV surface (HBs) antigen was also reported positive in 17 (8.8%) patients, while the HBs antibody was positive in 29 (15.0%) patients.
Conclusion: Due to changes in organ transplantation methods and changes in the response of infectious organisms to their treatment methods, the epidemiology of infections in recipients should always be examined over time. These new transplantation methods may lead to widespread changes in the epidemiology of transplant recipient infections and even the introduction of new pathogens.
Keywords:
- Latent infections, liver transplant, CMV IgG, Infection reactivation, Transplant candidat
How to Cite
Amirhassan Rabbani, Hesameddin Eghlimi, Mina Khoshkbarforoushan, & Baziboroun, M. (2022). The prevalence of latent infection in liver transplant candidates in Taleghani Hospital in Tehran, Iran, between 2020 to 2021. Gastroenterology and Hepatology from Bed to Bench, 16(1). https://doi.org/10.22037/ghfbb.v16i1.2664
References
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5. Rana A, Gruessner A, Agopian VG, Khalpey Z, Riaz IB, Kaplan B, et al. Survival benefit of solid-organ transplant in the United States. JAMA surgery. 2015;150(3):252-9.
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7. Patel R, Paya CV. Infections in solid-organ transplant recipients. Clin Microbiol Rev. 1997;10(1):86-124.
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9. GREEN M. Guidelines for the prevention and management of infectious complications of solid organ transplantation. Am J Transplant. 2004;10:5-166.
10. Avery RK. Recipient screening prior to solid-organ transplantation. Clin Infect Dis. 2002;35(12):1513-9.
11. Avery RK. Prophylactic strategies before solid-organ transplantation. Current Opinion in Infectious Diseases. 2004;17(4):353-6.
12. Goletti D, Delogu G, Matteelli A, Migliori GB. The role of IGRA in the diagnosis of tuberculosis infection, differentiating from active tuberculosis, and decision making for initiating treatment or preventive therapy of tuberculosis infection. Int J Infect Dis. 2022.
13. Nayak S, Acharjya B. VDRL test and its interpretation. Indian J Dermatol. 2012;57(1):3-8.
14. Grauhan O, Lohmann R, Lemmens P, Schattenfroh N, Jonas S, Keck H, et al. Mycobacterial infection after liver transplantation. Langenbecks Arch Chir. 1995;380(3):171-5.
15. Qunibi WY, al-Sibai MB, Taher S, Harder EJ, de Vol E, al-Furayh O, et al. Mycobacterial infection after renal transplantation--report of 14 cases and review of the literature. Q J Med. 1990;77(282):1039-60.
16. Morduchowicz G, Pitlik SD, Shapira Z, Shmueli D, Yussim A, Djalovski S, et al. Infections in renal transplant recipients in Israel. Isr J Med Sci. 1985;21(10):791-7.
17. Munoz P, Rodriguez C, Bouza E. Mycobacterium tuberculosis infection in recipients of solid organ transplants. Clin Infect Dis. 2005;40(4):581-7.
18. Singh N, Paterson DL. Mycobacterium tuberculosis infection in solid-organ transplant recipients: impact and implications for management. Clin Infect Dis. 1998;27(5):1266-77.
19. Subramanian AK, Theodoropoulos NM, Infectious Diseases Community of Practice of the American Society of T. Mycobacterium tuberculosis infections in solid organ transplantation: Guidelines from the infectious diseases community of practice of the American Society of Transplantation. Clin Transplant. 2019;33(9):e13513.
20. Chen CY, Liu CJ, Feng JY, Loong CC, Liu C, Hsia CY, et al. Incidence and Risk Factors for Tuberculosis After Liver Transplantation in an Endemic Area: A Nationwide Population-Based Matched Cohort Study. Am J Transplant. 2015;15(8):2180-7.
21. Lauar ID, Faria LC, Romanelli RMC, Clemente WT. Latent tuberculosis: Risk factors, screening and treatment in liver transplantation recipients from an endemic area. World J Transplant. 2021;11(12):512-22.
22. Novick RJ, Moreno-Cabral CE, Stinson EB, Oyer PE, Starnes VA, Hunt SA, et al. Nontuberculous mycobacterial infections in heart transplant recipients: a seventeen-year experience. J Heart Transplant. 1990;9(4):357-63.
23. MODDRY DL, STINSON EB, DYER PE, JAMIESON SW, BALDWIN JC, SHUMWAY NE. Acute rejection and massive cyclosporine requirements in heart transplant recipients treated with rifampin. Transplantation. 1985;39(3):313-4.
24. Rajagopala S, Olithselvan A, Varghese J, Shanmugam N, Rela M. Latent Mycobacterium tuberculosis Infection in Liver Transplant Recipients-Controversies in Current Diagnosis and Management. J Clin Exp Hepatol. 2011;1(1):34-7.
25. Lopez de Castilla D, Schluger NW. Tuberculosis following solid organ transplantation. Transpl Infect Dis. 2010;12(2):106-12.
26. Ozgen Alpaydin A, Ozbilgin M, Abdulleyeva M, Mersin SS, Egeli T, Unek T, et al. Determinants and characteristics of tuberculosis in liver transplant recipients. Turk J Med Sci. 2018;48(6):1162-6.
27. Torre-Cisneros J, Doblas A, Aguado JM, San Juan R, Blanes M, Montejo M, et al. Tuberculosis after solid-organ transplant: incidence, risk factors, and clinical characteristics in the RESITRA (Spanish Network of Infection in Transplantation) cohort. Clin Infect Dis. 2009;48(12):1657-65.
28. Imai S, Ito Y, Hirai T, Imai H, Ito I, Maekawa K, et al. Clinical features and risk factors of tuberculosis in living-donor liver transplant recipients. Transpl Infect Dis. 2012;14(1):9-16.
29. Malinis M, Boucher HW, Practice ASTIDCo. Screening of donor and candidate prior to solid organ transplantation-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13548.
30. Razonable RR. Epidemiology of cytomegalovirus disease in solid organ and hematopoietic stem cell transplant recipients. Am J Health Syst Pharm. 2005;62(8 Suppl 1):S7-13.
31. Dummer JS, Hardy A, Poorsattar A, Ho M. Early infections in kidney, heart, and liver transplant recipients on cyclosporine. Transplantation. 1983;36(3):259-67.
32. Ho M, editor Advances in understanding cytomegalovirus infection after transplantation. Transplantation proceedings; 1994.
33. Cheeseman SH, Rubin RH, Stewart JA, Tolkoff-Rubin NE, Cosimi AB, Cantell K, et al. Controlled clinical trial of prophylactic human-leukocyte interferon in renal transplantation. Effects on cytomegalovirus and herpes simplex virus infections. N Engl J Med. 1979;300(24):1345-9.
34. Griffiths P, Baraniak I, Reeves M. The pathogenesis of human cytomegalovirus. J Pathol. 2015;235(2):288-97.
35. Zuckerman RA, Limaye AP. Varicella zoster virus (VZV) and herpes simplex virus (HSV) in solid organ transplant patients. Am J Transplant. 2013;13 Suppl 3(s3):55-66; quiz
36. Miller G, Dummer J. Herpes simplex and varicella zoster viruses: forgotten but not gone. American journal of transplantation. 2007;7(4):741-7.
37. Singh N, Dummer JS, Kusne S, Breinig MK, Armstrong JA, Makowka L, et al. Infections with cytomegalovirus and other herpesviruses in 121 liver transplant recipients: transmission by donated organ and the effect of OKT3 antibodies. J Infect Dis. 1988;158(1):124-31.
38. Gray J, Wreghitt TG, Pavel P, Smyth RL, Parameshwar J, Stewart S, et al. Epstein-Barr virus infection in heart and heart-lung transplant recipients: incidence and clinical impact. J Heart Lung Transplant. 1995;14(4):640-6.
39. Garnier JL, Berger F, Betuel H, Vuillaume M, Chapuis-Cellier C, Blanc N, et al. Epstein-Barr virus associated lymphoproliferative diseases (B cell lymphoma) after transplantation. Nephrol Dial Transplant. 1989;4(9):818-23.
40. Preiksaitis JK, Keay S. Diagnosis and management of posttransplant lymphoproliferative disorder in solid-organ transplant recipients. Clin Infect Dis. 2001;33 Suppl 1(Supplement_1):S38-46.
41. Silva JT, Fernández-Ruiz M, Aguado JM. Prevention and therapy of viral infections in patients with solid organ transplantation. Enfermedades Infecciosas y Microbiología Clínica. 2021;39(2):87-97.
42. Arness T, Pedersen R, Dierkhising R, Kremers W, Patel R. Varicella zoster virus-associated disease in adult kidney transplant recipients: incidence and risk-factor analysis. Transpl Infect Dis. 2008;10(4):260-8.
43. Hope-Simpson RE. The nature of herpes zoster: a long-term study and a new hypothesis. SAGE Publications; 1965.
44. Kusne S, Dummer JS, Singh N, Iwatsuki S, Makowka L, Esquivel C, et al. Infections after liver transplantation. An analysis of 101 consecutive cases. Medicine (Baltimore). 1988;67(2):132-43.
45. Janier M, Hegyi V, Dupin N, Unemo M, Tiplica GS, Potocnik M, et al. 2014 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2014;28(12):1581-93.
46. Stoltey JE, Cohen SE. Syphilis transmission: a review of the current evidence. Sexual health. 2015;12(2):103-9.
47. Ison MG, Nalesnik MA. An update on donor-derived disease transmission in organ transplantation. Am J Transplant. 2011;11(6):1123-30.
48. Samuel D, Bismuth A, Serres C, Arulnaden J, Reynes M, Benhamou J, editors. HBV infection liver transplantation in HBsAg positive patients: experience with long-term immunoprophylaxis. Transplantation proceedings; 1991.
49. Patel R, Paya CV. Infections in solid-organ transplant recipients. Clinical microbiology reviews. 1997;10(1):86-124.
50. Davis CL, Gretch DR, Carithers Jr RL. Hepatitis B and transplantation. Infectious disease clinics of North America. 1995;9(4):925-41.
51. Pereira BJ, Natov SN, Bouthot BA, Murthy B, Ruthazer R, Schmid CH, et al. Effect of hepatitis C infection and renal transplantation on survival in end-stage renal disease. Kidney international. 1998;53(5):1374-81.
52. Pereira BJ, Milford EL, Kirkman RL, Levey AS. Transmission of hepatitis C virus by organ transplantation. New England Journal of Medicine. 1991;325(7):454-60.
53. Bogers A, van't Wout J, Cats VM, Quaegebeur J, Huysmans H. Mediastinal rupture of a thoracoabdominal mycotic aneurysm caused by Salmonella typhimurium in an immunocompromised patient. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 1987;1(2):116-8.
54. Caccamo L, Colledan M, Gridelli B, Rossi G, Doglia M, Gatti S, et al. Hepatitis C virus infection in liver allograft recipients. Research in Chronic Viral Hepatitis: Springer; 1993. p. 291-304.
55. Roth D, Zucker K, Cirocco R, DeMattos A, Burke GW, Nery J, et al. The impact of hepatitis C virus infection on renal allograft recipients. Kidney international. 1994;45(1):238-44.
2. Claeys E, Vermeire K. Immunosuppressive drugs in organ transplantation to prevent allograft rejection: Mode of action and side effects. Journal of immunological sciences. 2019;3(4):14-21.
3. Raza S, Rajak S, Upadhyay A, Tewari A, Sinha RA. Current treatment paradigms and emerging therapies for NAFLD/NASH. Frontiers in bioscience (Landmark edition). 2021;26:206.
4. Graham CN, Watson C, Barlev A, Stevenson M, Dharnidharka VR. Mean lifetime survival estimates following solid organ transplantation in the US and UK. Journal of Medical Economics. 2022;25(1):230-7.
5. Rana A, Gruessner A, Agopian VG, Khalpey Z, Riaz IB, Kaplan B, et al. Survival benefit of solid-organ transplant in the United States. JAMA surgery. 2015;150(3):252-9.
6. Singh N. The current management of infectious diseases in the liver transplant recipient. Clin Liver Dis. 2000;4(3):657-73, ix.
7. Patel R, Paya CV. Infections in solid-organ transplant recipients. Clin Microbiol Rev. 1997;10(1):86-124.
8. Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357(25):2601-14.
9. GREEN M. Guidelines for the prevention and management of infectious complications of solid organ transplantation. Am J Transplant. 2004;10:5-166.
10. Avery RK. Recipient screening prior to solid-organ transplantation. Clin Infect Dis. 2002;35(12):1513-9.
11. Avery RK. Prophylactic strategies before solid-organ transplantation. Current Opinion in Infectious Diseases. 2004;17(4):353-6.
12. Goletti D, Delogu G, Matteelli A, Migliori GB. The role of IGRA in the diagnosis of tuberculosis infection, differentiating from active tuberculosis, and decision making for initiating treatment or preventive therapy of tuberculosis infection. Int J Infect Dis. 2022.
13. Nayak S, Acharjya B. VDRL test and its interpretation. Indian J Dermatol. 2012;57(1):3-8.
14. Grauhan O, Lohmann R, Lemmens P, Schattenfroh N, Jonas S, Keck H, et al. Mycobacterial infection after liver transplantation. Langenbecks Arch Chir. 1995;380(3):171-5.
15. Qunibi WY, al-Sibai MB, Taher S, Harder EJ, de Vol E, al-Furayh O, et al. Mycobacterial infection after renal transplantation--report of 14 cases and review of the literature. Q J Med. 1990;77(282):1039-60.
16. Morduchowicz G, Pitlik SD, Shapira Z, Shmueli D, Yussim A, Djalovski S, et al. Infections in renal transplant recipients in Israel. Isr J Med Sci. 1985;21(10):791-7.
17. Munoz P, Rodriguez C, Bouza E. Mycobacterium tuberculosis infection in recipients of solid organ transplants. Clin Infect Dis. 2005;40(4):581-7.
18. Singh N, Paterson DL. Mycobacterium tuberculosis infection in solid-organ transplant recipients: impact and implications for management. Clin Infect Dis. 1998;27(5):1266-77.
19. Subramanian AK, Theodoropoulos NM, Infectious Diseases Community of Practice of the American Society of T. Mycobacterium tuberculosis infections in solid organ transplantation: Guidelines from the infectious diseases community of practice of the American Society of Transplantation. Clin Transplant. 2019;33(9):e13513.
20. Chen CY, Liu CJ, Feng JY, Loong CC, Liu C, Hsia CY, et al. Incidence and Risk Factors for Tuberculosis After Liver Transplantation in an Endemic Area: A Nationwide Population-Based Matched Cohort Study. Am J Transplant. 2015;15(8):2180-7.
21. Lauar ID, Faria LC, Romanelli RMC, Clemente WT. Latent tuberculosis: Risk factors, screening and treatment in liver transplantation recipients from an endemic area. World J Transplant. 2021;11(12):512-22.
22. Novick RJ, Moreno-Cabral CE, Stinson EB, Oyer PE, Starnes VA, Hunt SA, et al. Nontuberculous mycobacterial infections in heart transplant recipients: a seventeen-year experience. J Heart Transplant. 1990;9(4):357-63.
23. MODDRY DL, STINSON EB, DYER PE, JAMIESON SW, BALDWIN JC, SHUMWAY NE. Acute rejection and massive cyclosporine requirements in heart transplant recipients treated with rifampin. Transplantation. 1985;39(3):313-4.
24. Rajagopala S, Olithselvan A, Varghese J, Shanmugam N, Rela M. Latent Mycobacterium tuberculosis Infection in Liver Transplant Recipients-Controversies in Current Diagnosis and Management. J Clin Exp Hepatol. 2011;1(1):34-7.
25. Lopez de Castilla D, Schluger NW. Tuberculosis following solid organ transplantation. Transpl Infect Dis. 2010;12(2):106-12.
26. Ozgen Alpaydin A, Ozbilgin M, Abdulleyeva M, Mersin SS, Egeli T, Unek T, et al. Determinants and characteristics of tuberculosis in liver transplant recipients. Turk J Med Sci. 2018;48(6):1162-6.
27. Torre-Cisneros J, Doblas A, Aguado JM, San Juan R, Blanes M, Montejo M, et al. Tuberculosis after solid-organ transplant: incidence, risk factors, and clinical characteristics in the RESITRA (Spanish Network of Infection in Transplantation) cohort. Clin Infect Dis. 2009;48(12):1657-65.
28. Imai S, Ito Y, Hirai T, Imai H, Ito I, Maekawa K, et al. Clinical features and risk factors of tuberculosis in living-donor liver transplant recipients. Transpl Infect Dis. 2012;14(1):9-16.
29. Malinis M, Boucher HW, Practice ASTIDCo. Screening of donor and candidate prior to solid organ transplantation-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13548.
30. Razonable RR. Epidemiology of cytomegalovirus disease in solid organ and hematopoietic stem cell transplant recipients. Am J Health Syst Pharm. 2005;62(8 Suppl 1):S7-13.
31. Dummer JS, Hardy A, Poorsattar A, Ho M. Early infections in kidney, heart, and liver transplant recipients on cyclosporine. Transplantation. 1983;36(3):259-67.
32. Ho M, editor Advances in understanding cytomegalovirus infection after transplantation. Transplantation proceedings; 1994.
33. Cheeseman SH, Rubin RH, Stewart JA, Tolkoff-Rubin NE, Cosimi AB, Cantell K, et al. Controlled clinical trial of prophylactic human-leukocyte interferon in renal transplantation. Effects on cytomegalovirus and herpes simplex virus infections. N Engl J Med. 1979;300(24):1345-9.
34. Griffiths P, Baraniak I, Reeves M. The pathogenesis of human cytomegalovirus. J Pathol. 2015;235(2):288-97.
35. Zuckerman RA, Limaye AP. Varicella zoster virus (VZV) and herpes simplex virus (HSV) in solid organ transplant patients. Am J Transplant. 2013;13 Suppl 3(s3):55-66; quiz
36. Miller G, Dummer J. Herpes simplex and varicella zoster viruses: forgotten but not gone. American journal of transplantation. 2007;7(4):741-7.
37. Singh N, Dummer JS, Kusne S, Breinig MK, Armstrong JA, Makowka L, et al. Infections with cytomegalovirus and other herpesviruses in 121 liver transplant recipients: transmission by donated organ and the effect of OKT3 antibodies. J Infect Dis. 1988;158(1):124-31.
38. Gray J, Wreghitt TG, Pavel P, Smyth RL, Parameshwar J, Stewart S, et al. Epstein-Barr virus infection in heart and heart-lung transplant recipients: incidence and clinical impact. J Heart Lung Transplant. 1995;14(4):640-6.
39. Garnier JL, Berger F, Betuel H, Vuillaume M, Chapuis-Cellier C, Blanc N, et al. Epstein-Barr virus associated lymphoproliferative diseases (B cell lymphoma) after transplantation. Nephrol Dial Transplant. 1989;4(9):818-23.
40. Preiksaitis JK, Keay S. Diagnosis and management of posttransplant lymphoproliferative disorder in solid-organ transplant recipients. Clin Infect Dis. 2001;33 Suppl 1(Supplement_1):S38-46.
41. Silva JT, Fernández-Ruiz M, Aguado JM. Prevention and therapy of viral infections in patients with solid organ transplantation. Enfermedades Infecciosas y Microbiología Clínica. 2021;39(2):87-97.
42. Arness T, Pedersen R, Dierkhising R, Kremers W, Patel R. Varicella zoster virus-associated disease in adult kidney transplant recipients: incidence and risk-factor analysis. Transpl Infect Dis. 2008;10(4):260-8.
43. Hope-Simpson RE. The nature of herpes zoster: a long-term study and a new hypothesis. SAGE Publications; 1965.
44. Kusne S, Dummer JS, Singh N, Iwatsuki S, Makowka L, Esquivel C, et al. Infections after liver transplantation. An analysis of 101 consecutive cases. Medicine (Baltimore). 1988;67(2):132-43.
45. Janier M, Hegyi V, Dupin N, Unemo M, Tiplica GS, Potocnik M, et al. 2014 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2014;28(12):1581-93.
46. Stoltey JE, Cohen SE. Syphilis transmission: a review of the current evidence. Sexual health. 2015;12(2):103-9.
47. Ison MG, Nalesnik MA. An update on donor-derived disease transmission in organ transplantation. Am J Transplant. 2011;11(6):1123-30.
48. Samuel D, Bismuth A, Serres C, Arulnaden J, Reynes M, Benhamou J, editors. HBV infection liver transplantation in HBsAg positive patients: experience with long-term immunoprophylaxis. Transplantation proceedings; 1991.
49. Patel R, Paya CV. Infections in solid-organ transplant recipients. Clinical microbiology reviews. 1997;10(1):86-124.
50. Davis CL, Gretch DR, Carithers Jr RL. Hepatitis B and transplantation. Infectious disease clinics of North America. 1995;9(4):925-41.
51. Pereira BJ, Natov SN, Bouthot BA, Murthy B, Ruthazer R, Schmid CH, et al. Effect of hepatitis C infection and renal transplantation on survival in end-stage renal disease. Kidney international. 1998;53(5):1374-81.
52. Pereira BJ, Milford EL, Kirkman RL, Levey AS. Transmission of hepatitis C virus by organ transplantation. New England Journal of Medicine. 1991;325(7):454-60.
53. Bogers A, van't Wout J, Cats VM, Quaegebeur J, Huysmans H. Mediastinal rupture of a thoracoabdominal mycotic aneurysm caused by Salmonella typhimurium in an immunocompromised patient. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 1987;1(2):116-8.
54. Caccamo L, Colledan M, Gridelli B, Rossi G, Doglia M, Gatti S, et al. Hepatitis C virus infection in liver allograft recipients. Research in Chronic Viral Hepatitis: Springer; 1993. p. 291-304.
55. Roth D, Zucker K, Cirocco R, DeMattos A, Burke GW, Nery J, et al. The impact of hepatitis C virus infection on renal allograft recipients. Kidney international. 1994;45(1):238-44.
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