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Background: Delays in diagnosing pulmonary invasive aspergillosis (IA), a significant cause of morbidity and mortality among heart transplant recipients (HTRs), may impact on successful treatment. The appropriate screening strategy for IA in these patients remains undefined, particularly in the setting of nosocomial outbreaks. We describe our experience employing chest computed tomography (CT) scans as a screening method for IA. In addition, we comment on antimicrobial prophylaxis in HTRs in the setting of an outbreak., Methods: Screening CT scans of the chest and serum galactomannan (GM) were performed in HTRs during an outbreak that followed the index case of IA. Abnormal CT findings prompted a diagnostic workup. Antimicrobial prophylaxis for new transplants recipients included intravenous micafungin while hospitalized, followed by outpatient inhaled amphotericin B for up to 3 months., Results: During a 10-month period, five cases of IA were identified among HTRs. Two additional asymptomatic patients were diagnosed with IA among 15 asymptomatic HTRs who underwent screening chest CT scans. Among the five cases of IA in HTRs, two of five (40%) had a partial response and the other three failed voriconazole therapy. Complete response to voriconazole therapy assessed at 12 weeks was achieved in these two asymptomatic HTRs diagnosed via screening CTs. Serum GM was positive only in one of the symptomatic cases. The negative predictive value of CT scans was 100% (95% confidence interval, 71.5%-100%)., Conclusions: In an outbreak setting, screening CT scans of the chest may aid in early detection of asymptomatic HTRs with IA and improve outcome., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Post transplantation, a major complication is the development of malignancies. Human Leukocyte Antigen (HLA)-G is a molecule that inhibits the immune system and it is utilized by malignant cells to hide from the immune system. Expression of HLA-G from the donor and recipient cells in transplant patients is regulated by gene variations however, the association between genotype and cancer remains unknown. Our objective was to determine the association between genotype and outcome., Methods: Heart transplant recipients (251) and available corresponding donors (196) samples were genotyped for polymorphisms and the association of polymorphisms to outcome was evaluated with parametric hazard regression models., Results: Risk of cancer was 22% at 10years post-transplantation. The mean follow-up was of 4.9±3.6years. In a multivariable analysis, donor-recipient SNP 3187 matching was identified as a protective factor for cancer (hazard ratio 0.43; 95% confidence interval 0.19-0.93; p=0.03). While coding region allele (haplotype 6) was identified as an independent risk factor (hazard ratio 3.7; 95% confidence interval 1.36-10.06; p=0.01)., Conclusion: In this investigation, we identified an association between cancer post-transplantation and HLA-G polymorphisms, which may reveal a pathway for potential diagnostic and therapeutic strategies for cancer post-transplantation., (Copyright © 2016 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.)

Non-ischemic dilated cardiomyopathies (DCM) are important causes of heart transplant worldwide. Previous international data suggest that familial etiology for heart failure may be frequently overlooked among patients undergoing heart transplant. A structured screening instrument may help to identify patients who would benefit from genetic testing. Fifty-nine heart transplanted patients from a single transplant center in South of Brazil were reviewed between 2015-2019; those with hypertrophic cardiomyopathies or confirmed ischemic DCM were excluded. Patients with non-ischemic CMP answered a structured screening questionnaire (Kushner et al., 2006), and familial etiology was classified in confirmed, probable, possible familial or non-familial DCM. Thirty-four heart transplant recipients were included (53% male, 85% Caucacian, 50±14 years). Etiologic classification pre and post structured screening is depicted in Figures 1A and 1B. There was a difference in suspected familial etiology pre and post structured screening (15% versus 32%; p = 0.037). These findings suggest that familial DCM is frequently overlooked by the time of heart transplant. Our prevalence of familial DCM is similar to international reports. Applying a structured, low-cost, screening tool may contribute to counseling patients and their relatives regarding special attention to cardiovascular conditions and proper indication of genetic testing in a resource-limited scenario. [ABSTRACT FROM AUTHOR]