Search

Background/Purpose: Transplant recipients are vulnerable to life-threatening community-acquired respiratory viruses (CA-RVs) infection (CA-RVI). Even if non-transplant critically ill patients in intensive care unit (ICU) have serious CA-RVI, comparison between these groups remains unclear. We aimed to evaluate clinical characteristics and mortality of CA-RVI except seasonal influenza A/B in transplant recipients and non-transplant critically ill patients in ICU. Methods: We collected 37,777 CA-RVs multiplex real-time reverse transcription-polymerase chain reaction test results of individuals aged ≥18 years from November 2012 to November 2017. The CA-RVs tests included adenovirus, coronavirus 229E/NL63/OC43, human bocavirus, human metapneumovirus, parainfluenza virus 1/2/3, rhinovirus, and respiratory syncytial virus A/B. Results: We found 286 CA-RVI cases, including 85 solid organ transplantation recipients (G1), 61 hematopoietic stem cell transplantation recipients (G2), and 140 non-transplant critically ill patients in ICU (G3), excluding those with repeated isolation within 30 days. Adenovirus positive rate and infection cases were most prominent in G2 (p

Background: In addition to the conventional opportunistic infections in solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) recipients, cytomegalovirus (CMV) infection is associated with various chronic inflammatory diseases or poor outcomes in non-immunocompromised critically ill patients. To evaluate the burden or outcome of CMV replication in non-transplant individuals, we compared the incidence rates (IRs) for CMV disease and all-cause mortality between SOT recipients, HSCT recipients, and non-transplant population. Methods: The SOT (N=16,368) and HSCT (N=10,206) cohorts between 2010 and 2015 were established using the WHO ICD-10 from the whole population-based large database of the Health Insurance Review & Assessment Service (HIRA). CMV cases, defined as symptomatic disease with isolation of virus, DNA, pp65 antigen, and pathology except CMV syndrome, were extracted with the unique codes for relief of medical costs of HIRA in the same dataset. Cox's proportional hazard regression analyses and log-rank test in the Kaplan-Meier curves were performed to compare all-cause mortality between the three groups. Results: The CMV IRs adjusted by age and sex were significantly higher in the SOT (adjusted IR [95% confidence intervals], 33.1 [28.8-38.0] per 1,000 person-years) and HSCT recipients (5.1 [4.6-6.1] per 1,000 person-years) than in the whole population (0.58 [0.49-0.67] per 100,000 person-years). However, SOT recipients with CMV (18/283, 6.4%) had significantly lower all-cause mortality than non-transplant individuals with CMV (207/1,258, 16.5%) (adjusted hazard ratio [95% CI], 0.42 [0.25-0.67], log-rank P < 0.001). Conclusion: These data suggest that CMV disease in patients without transplants is associated with poor outcomes.

The growth ofThis study was a retrospective review of patients with airwayA total of 148 patients were enrolled in the study. In a multivariate analysis model,This study revealed that

BACKGROUND Multidrug-resistant (MDR) bacteria in the lower respiratory tracts of allografts may be risk factors for early posttransplant pneumonia (PTP) that causes detrimental outcomes in lung transplant recipients (LTRs). We evaluated the effects of immediate changes in MDR bacteria in allografts on early PTP and mortality rates in LTRs. METHODS We reviewed 90 adult bilateral LTRs without pretransplant infections who underwent lung transplantation between October 2012 and May 2018. Quantitative cultures were performed with the bronchoalveolar lavage fluids of the allografts preanastomosis and within 3 days posttransplant. The International Society for Heart and Lung Transplantation consensus defines early PTP as pneumonia acquired within 30 days posttransplant and not associated with acute rejection. RESULTS MDR Acinetobacter baumannii (11/34, 32.4%) and Staphylococcus aureus (9/34, 26.5%) were identified in 24.4% (22/90) of the preanastomosis allografts. Four LTRs had the same MDR bacteria in allografts preanastomosis and posttransplant. Allograft MDR bacteria disappeared in 50% of the LTRs within 3 days posttransplant. Early PTP and all-cause in-hospital mortality rates were not different between LTRs with and without preanastomosis MDR bacteria (P = 0.75 and 0.93, respectively). MDR bacteria ≥10 CFU/mL in the lungs within 3 days posttransplant was associated with early PTP (odds ratio, 5.8; 95% confidence interval, 1.3-27.0; P = 0.03). CONCLUSIONS High levels of preexisting MDR bacteria in allografts did not increase early PTP and mortality rates in LTRs. Despite the small and highly selective study population, lung allografts with MDR bacteria may be safely transplanted with appropriate posttransplant antibiotic therapy.

BACKGROUND The management of active tuberculosis (TB) in solid organ transplantation (SOT) recipients is challenging given the pharmacological interaction and the potential delays in diagnosis due to atypical presentation. The incidence rates (IRs) of post-SOT TB from whole recipients' cohort in high-endemic country have not been evaluated. METHODS We established SOT cohort (n = 15,598) and confirmed cases of TB between 2011 and 2015 from the Korean National Health Insurance Database using ICD-10 codes. After excluding 1,302 and 180 SOT-recipients due to age (< 18 years) and presence of pre-SOT TB and/or treatment for latent TB during wash-out period between 2006 and cohort entry, we analyzed 14,116 SOT recipients and 70,580 individuals with no history of SOT matched by age and sex. The hazard ratios (HRs) of IRs were adjusted for age, sex, low-income status, diabetes mellitus, chronic co-morbidities, and anti-TNF-α therapy. RESULTS The IR of TB was significantly higher (adjusted HR [aHR]: 6.1, 95% confidence interval [CI]: 4.5-7.6) in SOT recipients (4.9/1,000 person-years) than in non-SOT individuals (0.8/1,000 person-years). Of the transplanted organs, pancreas (pancreas alone and simultaneous pancreas-kidney) and lung had the highest IR (aHR: 16.3 [6.1-42.2] and 16.1 [5.9-43.8], respectively). The use of anti-thymocyte globulin and azathioprine was associated with a higher IR (aHR: 1.53 [1.01-2.43] and 3.92 [1.21-12.47], respectively), but basiliximab was associated with a lower IR (aHR: 0.67 [0.48-0.98]). CONCLUSION The IR of TB in SOT recipients, especially in pancreas and lung, was significantly higher than that in non-SOT population. This article is protected by copyright. All rights reserved.

BACKGROUND Chronic immunosuppressive therapy in solid organ transplant (SOT) recipients can trigger latent varicella zoster virus reactivation even in those with stable graft function. The inactivated herpes zoster (HZ) vaccine can be effective in preventing post-transplant HZ, which can cause severe neuralgia or disseminated disease. This meta-analysis aims to assess the incidences of HZ across transplant organs in SOT recipients. METHODS We included 12 observational studies (6560 recipients) from a PubMed and EMBASE search of articles through October 2019 and collected data from single-center dating from January 2001 to December 2017 (3498 recipients). The pooled HZ incidence and its differences between subgroups were obtained from random-effect models and meta-analysis of variance tests using R package. RESULTS The overall pooled crude incidence was 9.1% (95% confidence interval [CI], 7.6%-10.8%). The pooled incidence was similar between sexes but significantly different between transplanted organs (P

Background Cytomegalovirus (CMV) can cause tissue-invasive diseases in various organs after primary infection or through reactivation of latent-to-lytic switch over a lifetime. The number of individuals who are at risk of CMV diseases, such as elderly or immunocompromised patients, is constantly increasing; however, recent epidemiological changes associated with CMV disease have not been fully evaluated. Methods We used claims data of about 50 million individuals between 2010 and 2015 from the Korean Health Insurance Review and Assessment Service nationwide database. The code for CMV end-organ diseases in the ‘Relieved Co-payment Policy’ program matches the ICD-10 code of B25, except for congenital CMV infection and mononucleosis. A 628 cases of CMV and 3140 controls (without CMV disease), matched for age and sex, were selected from this dataset in order to evaluate the effect of adult CMV diseases on all-cause death. Results The overall unadjusted incidence rate (IR) of CMV end-organ diseases was 0.52/100,000 individuals. The standardized IR, adjusted for age and sex, have continuously increased from 0.32/100,000 in 2010 to 0.75/100,000 in 2015. The overall unadjusted IR in adult population was highest in 70–79 years for six years (0.96/100,000). In the model adjusted for age, sex, immunocompromised status including solid-organ or hematopoietic stem cell transplant recipients, hematologic malignancies, and human immunodeficiency virus diseases, the hazard ratio of case group was 5.2 (95% confidence interval, 3.6–7.4) for all-cause mortality. Conclusion Nationwide data indicates that CMV end-organ disease has steadily increased in the past six years and is associated with higher mortality.

Background The association between cytomegalovirus (CMV) and dementia remains controversial. Previous studies have suggested that CMV serostatus, as assessed by serum immunoglobulin G, plays a role in neurodegeneration with cognitive impairment. We aimed to evaluate the association between CMV tissue-invasive end-organ diseases and moderate-to-severe dementia. Methods The ICD 10th revision codes from the National Health Insurance Database covering the entire population of the Republic of Korea were used to classify patients into exposed (n = 687, age ≥ 40 years, with CMV disease) and unexposed (n = 3435, without CMV disease) groups, matched by age and sex at a 1:5 ratio of exposed: unexposed. All non-HIV-1-infected subjects selected during 2010–2014 with a washout period of the previous 4 years were followed up until December 2016 to identify newly diagnosed cases of moderate-to-severe dementia. Results Multivariate regression model (M3) adjusted for age, sex, low income, body mass index, transplantation status, malignant neoplasms, end-stage renal disease on dialysis, type 2 diabetes mellitus, hypertension, and dyslipidaemia showed a significantly higher incidence of dementia (odds ratio: 1.9; 95% confidence interval: 1.2–2.8) in the exposed group than that in the unexposed group. The risk of vascular dementia (2.9, 1.1–7.5) was higher than that of Alzheimer’s disease (1.6, 1.0–2.6) in the exposed group in M3. In M3, patients aged 40–59 years with CMV diseases had a significantly higher risk of all kinds of dementia than those aged 60–79 and ≥ 80 years (11.7, 2.5–49.4 vs. 1.8, 1.1–3.2 vs. 1.3, 0.5–2.8; P = 0.025). Conclusions CMV diseases may be associated with the risk of moderate-to-severe dementia.

Additional file 1: Table S1. Disease-related categories and the linked ICD-10 and unique codes for rare intractable diseases for Alzheimer’s disease, vascular dementia, and other dementia used in this cohort.

Background The association between human cytomegalovirus (CMV) and dementia remains controversial. Previous studies have suggested that CMV serostatus assessed by serum immunoglobulin G plays a role in neurodegeneration with cognitive impairment. We aimed to evaluate the association between CMV tissue-invasive diseases and vascular dementia (VD) and Alzheimer’s disease (AD).MethodsThe International Classification of Diseases (ICD) 10th revision codes from the National Health Insurance Database covering entire people in Republic of Korea were used to classify patients: case group (n = 687), age ≥40 years with CMV tissue-invasive end-organ disease and control group (n = 3,435), without CMV disease, matched by age and sex (ratio, 1:5). The case and control subjects selected during 2010–2014 with a washout period of the previous 4 years were followed-up until December 2016.ResultsThe multivariate regression model adjusted for age and sex showed a significantly higher incidence of dementia (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5–3.1) in the case group. The risk of VD (OR, 3.3; 95% CI, 1.3–8.4) was higher than that of AD (OR, 1.7; 95% CI, 1.1–2.8) in the case group. In age subgroup analysis adjusted for sex, patients aged 40–59 years with CMV disease had a significantly higher risk of all kinds of dementia than those aged 60-79 and ≥80 years (OR, 12.6; 95% CI, 3.3–48.8 vs. OR, 2.1; 95% CI, 1.3–3.4 vs. OR, 1.4; 95% CI, 0.7–2.9; P=0.021).Conclusions CMV disease may be associated with the risk of VD.

Background Human cytomegalovirus (HCMV) can cause poor outcomes in solid organ transplant (SOT) recipients; moreover, it is associated with cardiovascular diseases (CVD) in the general population. Accordingly, anti-HCMV immunoglobulin G (IgG) seroepidemiology may be useful in identifying the risk of post-SOT HCMV infection or disease as well as immunosenescence or CVD. However, HCMV seroprevalence and titre have not been fully evaluated with regard to age distribution or compared between SOT recipients and healthy individuals in South Korea. Methods We retrospectively retrieved all unduplicated anti-HCMV IgG results of individuals aged > 1 year evaluated between July 2006 and November 2017 at Severance Hospital in Seoul. The cohort, excluding haematopoietic stem cell transplant recipients and subjects with equivocal values, included 2184 SOT recipients and 3015 healthy transplant donors. All IgG results in the SOT recipients were measured during the pre-transplant period. Results The overall IgG seroprevalence and titres were significantly higher among SOT recipients than among healthy donors (98.7% vs. 88.6%, p p p p p Conclusions HCMV seropositivity was the lowest among school-aged children and adolescents. IgG testing revealed an intermediate serostatus risk of post-transplant HCMV infection and disease for most adult SOT recipients in South Korea.

Background: Cytomegalovirus (CMV) can cause poor outcomes in solid organ transplant (SOT) recipients and have relation to cardiovascular diseases (CVD) in general population. The anti-CMV immunoglobulin G (IgG) seroepidemiology is useful for identifying the risk of post-SOT CMV infection or disease as well as immunosenescence or CVD. However, recent CMV seroprevalence and titre have not been fully evaluated with respect to age distribution and comparison between SOT recipients and non-transplant individuals. Methods: We retrospectively retrieved all anti-CMV IgG results from 12658 individuals aged of > one years screened between July 2006 and Nov. 2017 at the Severance Hospital at Seoul. The cohort excluding hematopoietic stem cell transplant recipients and subjects with equivocal values included 2184 SOT recipients and 9738 non-transplant individuals. All IgG results in SOT recipients were measured at pre-transplant period, and only first values among subjects with repeated tests were included in the analyses. Results: The overall IgG seroprevalence and titres were significantly higher among SOT recipients relative to non-transplant individuals (98.7% vs. 94.8%, p < 0.001 and 64.7 ± 44.3 vs. 54.7 ± 38.9 arbitrary units [aU]/mL, p < 0.001, respectively). The lowest seropositive rates were observed among both SOT recipients and non-transplant individuals aged 11–15 years (70.6% and 70.2%, respectively). The frequency of seropositivity among adults aged ≥ 41 years increased to ≥ 99% in both groups. Age and SOT group were independently associated factors with higher CMV seroprevalence (OR, 1.12, 95% CI, 1.11-1.12, p < 0.001 and OR 2.43, 95% CI, 1.65-3.59, p < 0.001, respectively). Although liver (99.7%, 80.1 ± 54.5 aU/mL) and lung (100%, 84.3 ± 68.3 aU/mL) transplants had significantly higher seropositive rates and titres compared to kidney (98.3%, 59.4 ± 36.1 aU/mL) and heart (97.0%, 58.1 ± 46.9 aU/mL) transplant (overall p = 0.024 and < 0.001, respectively), the different transplant organs did not affect the seroprevalence in multivariate regression analysis. Conclusions: CMV seropositivity was lowest among school-aged children. IgG testing revealed that most adult SOT recipients in South Korea faced an intermediate serostatus risk of post-transplant CMV infection and disease.

Background Cytomegalovirus (CMV) can lead to severe morbidities and mortalities including pneumonia in particular as well as graft dysfunction through indirect immunomodulation in solid-organ transplantation recipients. High degree of HLA mismatch is a well-known risk factor of post-transplant (Tx) CMV reactivation. Recent laboratory advances for evaluating HLA mismatch can measure existence of donor-specific antibodies for single HLA allele; however, there was little evidence whether single panel reactive Ab (PRA) assay could predict CMV reactivation in SOT recipients. Methods We retrospectively analyzed pre-Tx HLA mismatch tests in total 300 of SOT recipients. All of them were CMV seropositive in donor and recipients and received regular blood CMV VL monitoring during ≥6 months after SOT. Lung (N = 83) and heart (N = 76) recipients received universal prophylaxis for 3 months, and kidney (N = 63) and liver (N = 78) received pre-emptive CMV therapy. The single PRA test for HLA class I/II was performed by bead-based immunoassay. The percentage of PRA was calculated by following formula: (the number of positive bead reaction/the number of beads in the assay) × 100. We categorized HLA-Ab specificity into two groups according to median fluorescent intensity (MFI) of bead; (1) strong with ≥10,000 of MFI, (2) not strong with

Background: A latent cytomegalovirus (CMV) cause chronic inflammation through undesirable inflation of cell-mediated im mune response. CMV immunoglobulin G has been associated with cardiovascular disease and type 1 diabetes mellitus. We evalu ated impact of CMV diseases on new-onset type 2 diabetes mellitus (T2DM). Methods: From the Korean Health Insurance Review and Assessment Service claim database of entire population with 50 mil lion, we retrieved 576 adult case group with CMV diseases diagnosed with International Statistical Classification of Diseases and Related-Health Problems 10th Revision (ICD-10) B25 code between 2010 and 2014 after exclusion of patients with T2DM to 2006. The 2,880 control patients without T2DM from 2006 to cohort entry point were selected between 2010 and 2014 by age, sex matching with case group. The subjects without new-onset T2DM were followed until 2015. T2DM, hypertension (HTN), dyslip idemia (DYS), and end-stage renal disease (ESRD) were coded as ICD-10. Results: The frequency of new-onset T2DM in case group was significantly higher than that in control (5.6% vs. 2.2%, P

Background The cytomegalovirus (CMV) can cause tissue-invasive diseases in various organs through primary infection or reactivation of latent status over a lifetime. Even though individuals with risk of CMV diseases such as elderly or immunocompromised patients are constantly increasing, the recent epidemiologic change of it is not fully evaluated, especially on a grand scale. Methods We used the Korean Health Insurance Review and Assessment Service (HIRA) claim nationwide database of about 50 million individuals, nearly entire population, between 2010 and 2015. The South Korean National Health Insurance Service operates the “Relieved Co-payment Policy” program as out-of-pocket relief in patients with rare intractable diseases including CMV. The unique code of CMV end-organ diseases in the program is completely matched with ICD-10 B25 except congenital CMV infection and mononucleosis. By this process, the cohort of CMV diseases was established from the HIRA data warehouse. The 628 case (with CMV) and 3,140 control (without CMV disease) group matched with age and sex were selected in same dataset to evaluate the effect of CMV diseases on all-cause death. Results The standardized prevalence rates of CMV diseases adjusted with age and sex have continuously increased from 0.55/100,000 in 2010 to 1.41/100,000 individuals in 2015. The crude prevalence was the highest in youngest group of less than 9-year-old every year for 6 years (4.34/100,000 in 2015) and second highest in individuals with 60–69-year-old (2.28/100,000 in 2015). Male population had the higher crude and standardized prevalence than female in all age groups every year. The individuals in lowest income status had the highest standardized prevalence (7.1/100,000 in 2015). In model adjusted by age, sex, low income, diabetes, hypertension and dyslipidemia, case group had 4.8 of hazard ratio (95% CI, 3.3–7.0) to all-cause of death compared with control group. The Kaplan–Meier survival curve revealed the significantly higher rate of all-cause mortality in case group (P < 0.001). Conclusion The occurrence of CMV disease is steadily on rise during the past 6 years in nationwide data, especially in male infant and childhood as well as elderly individuals, with association of high mortality. Disclosures All authors: No reported disclosures.