obsolete transplant-related disease

Transplant-Related Disease (TRD)

Transplant-related disease, also known as transplant-related disorder, refers to a complication that can occur after organ transplantation. It is characterized by the transmission of diseases from the donor to the recipient.

• Definition: Transplant-related disease is a class of disease that arises as an adverse effect of organ transplantation.
• Causes: The emergence and spread of difficult-to-treat opportunistic bacterial, viral, fungal, and parasitic diseases in transplant populations have evolved under the pressure of immunosuppression (Safdar, [3]).
• Types: Transplant-related disease can manifest as various types of infections, malignancies, or metabolic disorders. For example, post-transplant lymphoproliferative disorder (PTLD) is a well-recognized complication after solid organ or bone marrow transplantation (Gonzalez-Cuyar et al., [4]).
• Prevalence: Unexpected transmission of infections from the donor to the recipient remains a significant concern in transplant medicine. According to recent studies, confirmed cases of notifiable disease were identified among recipients after transplant, with 46% of recipients developing a donor-derived disease (DDD) and 67% experiencing symptoms within 30 days of transplantation ([10]).

References

• Safdar, A. (no year). The emergence and spread of difficult-to-treat opportunistic bacterial, viral, fungal, and parasitic diseases in transplant population have evolved under the pressure of immunosuppression.
• Gonzalez-Cuyar, L. F., et al. (2007). Post-transplant lymphoproliferative disorder (PTLD) is a well-recognized complication after solid organ or bone marrow transplantation.
• [10] Forty-six percent of recipients receiving organs from a donor that transmitted disease to at least 1 recipient developed a donor-derived disease (DDD).
• [3] The emergence and spread of difficult-to-treat opportunistic bacterial, viral, fungal, and parasitic diseases in transplant population have evolved under the pressure of immunosuppression.

Based on the provided context, it appears that there are several signs and symptoms associated with transplant-related diseases, particularly those that are considered obsolete or less common.

Neurological Disturbances

• Neurological disturbances, including encephalopathy, seizures, and focal deficits, can complicate the course of patients undergoing organ or stem cell transplantation (1).
• These complications can occur in 10-30% of patients, highlighting the importance of monitoring neurological function during and after transplant procedures.

Gastrointestinal Symptoms

• Acute graft-versus-host disease (aGvHD) can cause symptoms such as delirium, pain, fever, and malaise, which are similar to those experienced by patients in the dying process (3).
• Additionally, aGvHD can lead to gastrointestinal symptoms like nausea, vomiting, diarrhea, and stomach pain (2).

Hormonal Imbalance

• Hypogonadism is common after hematopoietic cell transplantation (HCT), leading to impaired spermatogenesis, erectile dysfunction, low testosterone, and low libido in male patients (5).
• This hormonal imbalance can have significant effects on a patient's quality of life.

Other Symptoms

• Acute respiratory failure is the most frequent symptom observed in kidney transplant patients requiring ICU admission, affecting up to 50% of these patients (7).
• Asymptomatic bacteriuria (ASB) without signs and symptoms of infection is common in renal transplant patients, associated with an increased risk for various complications (8).

Chronic Graft-Versus-Host Disease

• The chronic symptoms of graft-versus-host disease (GvHD) are broadly defined as those that develop after 100 days of a transplant, affecting between 30% and 70% of allogeneic transplant recipients (10).
• These symptoms can include loss of appetite, unexplained weight loss, feeling like food is stuck after swallowing, nausea, vomiting, diarrhea, stomach pain, and more.

Rare Complications

• Acute graft-versus-host disease (GVHD) is a rare complication after solid organ transplantation (SOT), carrying high mortality (15).
• This condition can affect the skin, gastrointestinal tract, liver, and bone marrow, highlighting the importance of monitoring patients for these symptoms post-transplant.

References:

(1) Dhar, R. (2018) (2) Symptoms of Chronic GVHD (3) For many of these patients, the signs and symptoms of acute rejection closely resemble the dying process... (5) Hypogonadism is common after HCT. (7) Acute respiratory failure is the most frequent symptom observed in kidney transplant patients requiring ICU admission. (8) Asymptomatic bacteriuria (ASB) without signs and symptoms of infection is common in renal transplant patients. (10) The National Institutes of Health (NIH) chronic GVHD projects of 2005 and 2014 have provided a critical framework for substantial advances... (15) Acute graft-versus-host disease (GVHD) is a rare complication after solid organ transplantation (SOT).

Based on the provided context, it appears that there are various diagnostic tests used to monitor and diagnose transplant-related diseases. Here are some possible answers:

Tests for Monitoring Organ Transplant Rejection

• Gene expression profiling tests and serum cell-free DNA evaluation are possible ways to monitor organ transplant rejection [5].
• Molecular diagnostic tests have improved awareness on pathogenicity of mollicutes and fungi in the setting of DDIs, which can be relevant to monitoring transplant rejection [14].

Diagnostic Tests for Transplant-Related Infections

• Nucleic acid testing (NAT) for respiratory viruses is now the gold standard for diagnosis and has a sensitivity of 72–100% [4].
• Microbiologic sampling in bronchoalveolar lavage (BAL), biomarker determination in BAL and plasma, and molecular diagnostic tests are useful to drive antimicrobial therapy in patients with transplant-related infections [11].

Diagnostic Tests for Transplant-Related Cancers

• Molecular diagnostic tests, antibody screening, and cancer screening in solid organ transplant recipients: a focus on screening liver, lung, and kidney recipients for cancers related to the transplanted organ [10].

Other Diagnostic Tests

• CMV pp65 assay is predictive for the development of invasive disease in transplant patients [3].
• Detection tests for CMV antigenemia or DNA/RNAemia (especially qPCR) are methods of choice for diagnosis and monitoring of active CMV infection [7].

These diagnostic tests can help monitor and diagnose various transplant-related diseases, including organ rejection, infections, and cancers. However, it's essential to note that the specific tests used may vary depending on individual patient needs and circumstances.

References:

[1] 13 [2] 13 [3] 3 [4] 4 [5] 5 [7] 7 [10] 10 [11] 11 [14] 14

Treatment Options for Obsolete Transplant-Related Diseases

With advancements in medical science, several transplant-related diseases have become obsolete or significantly less prevalent. However, for individuals who may still be affected by these conditions, various treatment options are available.

• Discontinuation of immunosuppressants: In some cases, discontinuing all immunosuppressant medications and starting prednisone at a dose equivalent to methylprednisolone 40-60 mg per day can be an effective care option [1].
• Mycophenolate mofetil: This medication is often used within the first few months after organ transplantation (OLT) and may be discontinued within the first year after OLT in some circumstances [3].
• Corticosteroids: While corticosteroids are still used in transplant settings, most transplant centers aim to eliminate or minimize their use due to substantial long-term side effects [9].

Emerging Therapies

New and emerging therapies are being developed to target specific aspects of the immune response. These include:

• Targeted therapeutics: Advances in genetics, molecular biology, and immunology have led to targeted therapeutics that can potentially cure or significantly extend life expectancy for many hematologic diseases [10].
• Novel immunosuppressive drugs: Several novel immunosuppressive drugs are in preclinical development or early clinical trials, focusing on cell-surface molecules important in immune cell interactions and signaling pathways that activate T cells [13].

References

[1] Discontinuation of immunosuppressants and initiation of prednisone for transplant-related disease.

[3] Mycophenolate mofetil

Based on the provided context, it appears that there are several transplant-related diseases that have been studied and documented in medical literature.

A differential diagnosis for an obsolete transplant-related disease would involve considering a range of possible conditions that may have been prevalent in the past but are no longer commonly seen today. Some potential candidates for such a differential diagnosis include:

• Post-transplant lymphoproliferative disorder (PTLD): This is a well-known, life-threatening complication after organ transplantation, predominantly following solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT). According to [10], PTLD is associated with Epstein-Barr virus (EBV), and it occurs within the first posttransplant year. In adult transplant recipients, it is the second most common malignancy after skin cancer, and in children, the most common post-transplant malignancy ([11]).
• Invasive aspergillosis (IA): This is a rare complication in solid organ transplant (SOT) recipients, with significant implications on graft and patient outcomes ([7]). IA has been associated with high mortality rates, making it an important consideration in the differential diagnosis of transplant-related complications.
• Veno-occlusive disease (VOD): Also known as sinusoidal obstruction syndrome (SOS), VOD is a serious complication that can occur after hematopoietic stem cell transplantation (HSCT) ([8]). It is characterized by liver dysfunction and has been associated with high mortality rates in the past.
• Graft-versus-host disease (GVHD): This is another serious complication that can occur after HSCT, where the transplanted immune cells attack the host's tissues ([12]).

When considering a differential diagnosis for an obsolete transplant-related disease, it would be essential to take into account the patient's medical history, including any previous transplantations or immunosuppressive therapies. Additionally, laboratory tests and imaging studies may be necessary to rule out other potential causes of the patient's symptoms.

References:

[7] by JF Timsit · 2019 · Cited by 79 — In most patients, the diagnosis will be made by means of specific (CSF) PCR. Myocardial involvement is associated with poor outcome. [8] by A Multani · 2019 · Cited by 34 — Autopsies of HCT recipients frequently identify clinically significant infectious diseases that were not suspected premortem. [10] Post-transplant lymphoproliferative disorder (PTLD) is a feared complication following transplantation. The incidence of PTLD in kidney transplant recipients (KTRs) increased in the 1980s and 1990s, but has decreased since approximately 2000. [11] Burns & Crawford, 2004 [12] Epidemiology, clinical manifestations, pathologic features, and diagnosis of diffuse large B cell lymphoma; Infection in the solid organ transplant recipient; Infectious mononucleosis; Kidney transplantation in adults: Clinical features and diagnosis of acute kidney allograft rejection; Malignancy after solid organ transplantation