Transplantation Direct - November 2021 Issue


The November issue of Transplantation Direct is ready for viewing. This issue includes reports on multiple topics, including articles in kidney transplantation relating to the use of sodium-glucose cotransporter 2 inhibitors in diabetic recipients, absolute versus relative ddcfDNA measurements to detect rejection, factors influencing de novo thrombotic microangiopathy in early transplant loss, and the use of belatacept in liver transplant recipients receiving a subsequent kidney transplant; experimentally, we have a report on delivery of renal organoids in pigs. Another article reports on pushing the age envelop in cases of simultaneous pancreas-kidney transplantation. In liver transplantation, for patients who do not accept blood transfusions, there is a case report on safely doing a transfusion-free re-transplant for post-transplant hepatic artery thrombosis. In the bone marrow transplant arena, predictive factors influencing immune reconstitution are examined after hematopoietic stem cell transplantation for leukemia. Organ donation is also featured, with a new model of informed consent for non-standard risk donors, and a report on factors associated with early graft loss in expanded criteria kidney transplants. On the topic of infectious diseases, the National COVID Cohort Collaborative (N3C) reports on factors related to COVID-19 diagnostics and outcomes; we also have a report on mechanistic investigations as to how CMV immunoglobulin prophylaxis prevents infections post-transplantation. All these articles, and more, are available via open access publishing at the Transplantation Direct website.


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TTS-ILTS Paired Transplant Centers Program

The TTS-ILTS Paired Transplant Centers Program is now accepting applications!

The TTS-ILTS Paired Transplant Centers Program is a collaboration between The Transplantation Society (TTS) and the International Liver Transplantation Society (ILTS) supporting new liver transplant programs in emerging economies.

Application Deadline: January 1st, 2022

An experienced transplant center in the developed world is paired with an emerging transplant center to facilitate vital multidisciplinary training and an exchange of knowledge and expertise.
The project aims to benefit both centers. The supporting center (SC) is involved in global health, and promotes ethical and competent transplantation in regions of the world with limited or no current access to transplantation. The emerging center (EC), connects with a multidisciplinary team of experts in transplantation from a world-leading center.
Progressive steps associated with increasing funding as the partnership between the EC and SC grows.
The ultimate goal is for Level 3 centers to graduate and become true local centers of excellence for regional training and support.

New Members added in October 2021

We wish a warm welcome to October's new TTS members and we look forward to making new connections together.

Maha Alamri
King Faisal Specialist Hospital & Research Centre
Riyadh, Saudi Arabia

Bronwyn Dearman
The Transplantation Society of Australia and New Zealand (TSANZ)

Rene Frydman
International Society of Uterus Transplantation (ISUTx)
Paris, France

Sophie Harmos
The Transplantation Society of Australia and New Zealand (TSANZ)

Anu Kaskinen
New Children's Hospital
Helsinki, Finland

Aamir Khan
Virginia Commonwealth University
Richmond, United States

Tina Marinelli
Royal Prince Alfred Hospital
Camperdown, Australia

Alessandro Mattina
IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT)
Palermo, Italy

Lungiswa Mtingi-Nkonzombi
Livingstone Hospital
Port Elizabeth, South Africa

Ahmet Bulent Oktay
Acıbadem Bursa Hospital
Bursa, Turkey

Dengke Pan
Sichuan Academy of Medical Sciences Sichuan People's Hospital
Chengdu, China

Ronald Parsons
Emory Transplant Center
Atlanta, United States

Adam Philipoff
The Transplantation Society of Australia and New Zealand (TSANZ)

Luis Carlos Rodriguez Sancho
Hospital Real San Jose Valle Real
Zapopan, Mexico

Luis Arturo Ruvalcaba Castellon
Instituto Mexicano de Infertilidad
Guadalajara, Mexico

Marcus Silva
Hospital Estadual Geral de Goiânia Dr. Alberto Rassi
Goiânia, Brazil

Pedro Felipe Undurraga
Clínica Las Condes - Universidad de Chile
Santiago, Chile

Luis Uribe
Fundación Cardiovascular de Colombia – FCV
Bucaramanga, Columbia

Francisca van der Schyff
Wits Donald Gordon Medical Centre
Johannesburg, South Africa

Jaideep Vazirani
The Transplantation Society of Australia and New Zealand (TSANZ)

Steven Wisel
Cedars-Sinai Comprehensive Transplant Center
Los Angeles, United States

Hot Off The Press


Articles this week reviewed by Dr. Enver Akalin

Early Treatment for Covid-19 with SARS-CoV-2 Neutralizing Antibody Sotrovimab

Anil Gupta et al.
N Engl J Med 2021 Oct 27. Doi: 10.1056/NEJMoa2107934.
PMID: 34706189

Coronavirus disease 2019 (Covid-19) disproportionately results in hospitalization or death in older patients and those with underlying conditions. Sotrovimab is a pan-sarbecovirus monoclonal antibody that was designed to prevent progression of Covid-19 in high-risk patients early in the course of disease.

This is a multicenter, double-blind, phase 3 trial that 583 non-hospitalized patients with symptomatic Covid-19 (≤5 days after the onset of symptoms) and at least one risk factor for disease progression received a single infusion of sotrovimab at a dose of 500 mg or placebo. 3 patients (1%) in the sotrovimab group, as compared with 21 patients (7%) in the placebo group, had disease progression leading to hospitalization or death (relative risk reduction, 85%; 97.24% confidence interval, 44 to 96; P = 0.002). In the placebo group, 5 patients were admitted to the intensive care unit, including 1 who died by day 29.

Immunogenicity Rates After SARS-CoV-2 Vaccination in People With End-stage Kidney Disease: A Systematic Review and Meta-analysis

Jia-Jin Chan et al.
JAMA Netw Open. 2021;4(10):e2131749. doi:10.1001/jamanetworkopen.2021.31749
PMID: 34709385

A meta-analysis of 32 studies documented that the immunogenicity rate among patients receiving dialysis was 41% after the first dose and 89% after the second dose. Diabetes might be a risk factor for nonresponse in the dialysis population. Patients receiving dialysis had a lower antibody response rate than did individuals not receiving dialysis, particularly after the first dose.

Adults receiving dialysis have a higher mortality risk when infected with SARS-CoV-2 than do adults not receiving dialysis.1,2 Because most clinical trials have not included people with end-stage kidney disease (ESKD),3,4 immunogenicity rates are instead assessed to determine the efficacy of SARS-CoV-2 vaccines in this population. Several studies have reported that antibody response rates vary depending on vaccination protocols, vaccine types, and populations. Old age or use of immunosuppression medication have been identified as risk factors for vaccine nonresponse.5-8 However, the immunogenicity rates of patients receiving dialysis have not yet been systematically reviewed, to our knowledge.

In this study, immunogenicity rates among people with ESKD after receiving SARS-CoV-2 vaccines were investigated, as were potential risk factors for vaccine nonresponse and significant differences in antibody response rates between adults receiving dialysis and those not receiving dialysis

BNT162b2 mRNA COVID-19 vaccination in immunocompromised patients: A prospective cohort study

Galia Rahav et al.
EClinicalMedicine 2021 Nov;41:101158. doi: 10.1016/j.eclinm.2021.101158.
PMID: 34693234

Trials of the Pfizer-BioNTech BNT162b2 mRNA vaccine showed 95% efficacy in preventing symptomatic disease; however, the trials excluded immunocompromised patients (ICPs). We aim at analyzing antibody response in ICPs.

RBD-IgG antibodies were detected in 154/156 (98.7%) of patients with HIV, 75/90 (83.3%) with solid malignancies, 149/187 (79.7%) with myeloma, 83/111 (74.8%) following hematopoietic stem cell transplants, 25/36 (69.4%) following liver transplantation, 26/43 (60.5%) with myelodysplastic syndrome, 96/188 (51.0%) with chronic lymphocytic leukemia/non-Hodgkin's lymphoma, 50/110 (45.5%) following kidney transplantation, 15/80 (18.8%) following heart transplantation, and 269/272 (98.9%) in controls. Multivariate logistic regression analysis showed that age > 65 years (OR 0.41,95%CI 0.30,0.57) and underlying immunosuppression (OR 0.02,95%CI 0.01,0.07) were significantly associated with a non-reactive response of IgG antibodies. HIV patients showed a similar immunological response as healthy adults. The vaccine was safe without any episodes of rejection, graft-versus-host disease or allergy.

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