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Anti-Infectives Knowledge Network

Anti-Infectives Knowledge Network

Bringing together resources from a number of major anti-infective congresses throughout 2012 and 2013, including ISICEM, EBMT, ECCMID, EHA, ESOT and TIMM; the Anti-infectives Knowledge Network shares the experience of a number of thought leaders.

Key transplantation reports and presentations from our 2013 coverage include:

Medical Videos

Heart Transplantation - The Reasons for Transplantation and the Success Rates
Heart Transplantation - The Reasons for Transplantation and the Success Rates
Corneal Transplant - The Diseases, Procedures and Success Rates
Corneal Transplant - The Diseases, Procedures and Success Rates
An Overview of Blood Transfusions
An Overview of Blood Transfusions
Lung Transplants - The Benefits and Limitations
Lung Transplants - The Benefits and Limitations

Recent Drug Updates

Medical Journal Abstracts on Transplantation

Experience of 100 solid organ transplants over a five–yr period from the first successful pediatric multi–organ transplant program in India

Mon 04 Aug 2014 -  Pediatric Transplantation

To analyze the clinical profile and outcome of pediatric patients who had undergone a liver and/or RT at our center over a five yr period, case records of all the patients who had undergone a ...

Antimicrobial prophylaxis in hematopoietic stem cell transplantation recipients: 10 years after

Thu 22 May 2014 -  Transplant Infectious Disease

Background:Antimicrobial prophylaxis is recommended for all patients undergoing hematopoietic stem cell transplantation. Evidence–based guidelines recently have been updated to incorporate the ...

Clinical Guidelines

Management of cytomegalovirus infection in haemopoietic stem cell transplantation

May 2013

These evidence-based guidelines expand and adapt previous guidance (Tomblyn et al, 2009; Andrews et..

... al, 2011). While specifically focusing on allogeneic haemopoietic stem cell transplantation (HSCT), they are relevant to other areas of haematological oncology where there is an increased risk of cytomegalovirus (CMV) infection, such as haematological cancers where intense anti-T-cell therapy has been deployed (O’Brien et al, 2006).

ESCMID guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT)

Dec 2012

Fungal diseases still play a major role in morbidity and mortality in patients with haematological..

... malignancies, including those undergoing haematopoietic stem cell transplantation. Although Aspergillus and other filamentous fungal diseases remain a major concern, Candida infections are still a major cause of mortality. This part of the ESCMID guidelines focuses on this patient population and reviews pertaining to prophylaxis, empirical/pre-emptive and targeted therapy of Candida diseases. AntiCandida prophylaxis is only recommended for patients receiving allogeneic stem cell transplantation.

Clinical Trials

Bile Acids and Incretins in Pancreas Kidney Transplant Patients (ITABI)

02-09-2014

Pancreas Kidney Transplantation (PKT) is the prominent treatment for type 1 diabetic patients with chronic kidney disease and improves patients' outcome. However, in spite of an optimized systemic insulin substitution, altered glucose metabolism and..

... beta cell function are reported in these patients. The mechanisms behind these abnormalities are still unclear. Duodena-pancreatic anastomosis is performed in a heterotopic site (ileum) and thus could change physical and chemical properties of intestinal secretions, gut flora, as well as intestinal permeability. The effect of this procedure on gut derived metabolic factors, the enterohepatic cycle of bile acids, incretin secretion and intestinal flora have never been studied. This pilot prospective, study is aimed to evaluate the modification of bile acids concentrations and composition in PKT subjects, and the impact in glucose and incretin metabolism (measured by oral glucose tolerance test) one year after transplantation. The results will be compared to those of kidney transplant patients and control subjects.

Human Microbiota and Liver Transplant

18-08-2014

The microbiota represents the collections of microbial communities that colonize a host. In health, the microbiota protects against pathogens and maturation of the immune system. In return, the immune system determines the composition of the microbiota...

... Altered microbial composition (dysbiosis) has been correlated with a number of diseases in humans. The real role of the microbiota in transplant recipients is still unknown even though we suspect that it may be affected directly or indirectly by immunosuppressive drugs and antimicrobial prophylaxis taken by transplant patients, as well as by inflammatory process secondary to ischemia/reperfusion injury.

A number of studies have investigated the impact of liver transplantation on the intestinal microbiota. In a recent analysis of stool flora (Microb Ecol 2013; 65: 781-791) in 12 liver transplant recipients, changes in the microbiota were correlated to post-transplant infections. The authors suggested that the shift to pathogenic strains of bacteria due to the use of prophylactic antibiotics may be contributing to post-transplant complications. In a larger study, Wu et al (Hepatobiliary Pancreat Dis Int 2012; 11: 40-50) demonstrated marked changes in the gut microbiota post-transplantation with an increase in Enterobacteriaceae and Enterococcus, and reduction in Eubacteria, Bifidobacterium and Lactobacillus species. These changes, however, resolved over time such that by 6 months, at times when bacterial prophylaxis ends and immunosuppression is reduced.

A better characterization of the impact of post-transplant therapy on the human microbiota has the potential to improve our understanding of the infection process and translate into development of new therapeutic strategies.

The main goal of this study is to characterize intestinal microbiota and confirm the same bacterial DNA in peripheral blood and portal lymph nodes in patients affected with end-stage chronic liver disease, and to analyze its evolution from the moment of inclusion in waiting list throughout the first year after liver transplantation. For each patient, a healthy CONTROL with a similar age (± 10 years) will be selected from the same family setting, in whom just one sample will be obtained during the enrollment phase.

The second goal is to analyze the potential associations between microbiota flora and transplant outcomes during the same period.

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