周一“星”视角|肺移植术后早期医院呼吸机相关性肺炎：一项前瞻性研究；肺移植受者SARS-CoV-2体液和细胞免疫的持续性缺陷

01

Laura N. Walti1,2, Chun Fai Ng1, Qasim Mohiuddin3, Roin Bitterman1, Mohammed Alsaeed1,4, Wiliam Klement5, Tereza Matinu6,7, Aman Sidhu6,7, Tony Mazzulli8, Laura Donahoe9, Shaf Keshavjee9, Lorenzo Del Sorbo10, Shahid Husain1

1 Transplant Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada.

2 Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

3 Infection Prevention and Control, University Health Network, University of Toronto, Toronto, Ontario, Canada.

4 Department of Medicine, Infectious Disease Division, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

5 Department of Surgery, Division of Thoracic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

6 Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada. 

7 Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

8 Department of Microbiology, University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada. 

9 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

10 Interdepartmental Division of Critical Care Medicine Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Background: 

Hospital-acquired (HAP) and ventilator-associated pneumonia (VAP) are important complications early (<30 days) after lung transplantation (LT). However, current incidence, associated factors, and outcomes are not well reported.

Methods: 

LT recipients transplanted at our institution (July 2019-January 2020 and October 2021-November 2022) were prospectively included. We assessed incidence and presentation of pneumonia and evaluated the impact of associated factors using regression models. We also evaluated molecular relatedness of respiratory pathogens collected peri-transplant and at pneumonia occurrence using pulsed-field gel electrophoresis (PFGE).

Results: 

In the first 30 days post-LT, 25/270 (9.3%) recipients were diagnosed with pneumonia (68% [17/25] VAP; 32% [8/25] HAP). Median time to pneumonia was 11 days (IQR, 7-13); 49% (132/270) of donor and 16% (44/270) of recipient respiratory peri-transplant cultures were positive. However, pathogens associated with pneumonia were not genetically related to either donor or recipient cultures at transplant, as determined by PFGE. Diagnosed pulmonary hypertension (HR, 4.42; 95% CI, 1.62-12.08) and immunosuppression use (HR, 2.87; 95% CI, 1.30-6.56) were pre-transplant factors associated with pneumonia. Pneumonia occurrence was associated with longer hospital stay (HR, 5.44; 95% CI, 2.22-13.37) and VAP with longer ICU stay (HR, 4.31; 95% CI, 1.73-10.75) within the first 30 days post-transplantation; 30- and 90-day mortality were similar.

Conclusion: 

Prospectively assessed early pneumonia incidence occurred in ~10% of LT. Populations at increased risk for pneumonia occurrence include LT with pre-transplant pulmonary hypertension and pre-transplant immunosuppression. Pneumonia was associated with increased healthcare use, highlighting the need for further improvements by preferentially targeting higher-risk patients.

[CITATION]: Walti LN, Ng CF, Mohiuddin Q et al. Hospital- and Ventilator-associated Pneumonia early after Lung Transplantation: a prospective Study on Incidence, Pathogen Origin and Outcome. Clin Infect Dis. 2024 Aug 6:ciae399. 

[DOI]: 10.1093/cid/ciae399.

[IF]: 8.2

02

Isabelle Etienne1,2, Delphine Kemlin2,3, Nicolas Gemander2,3, Véronique Olislagers2, Alexandra Waegemans2, Emilie Dhondt4, Leo Heyndrickx4, Stéphanie Depickère5, Alexia Charles⁵, Maria Goossens⁵, Leen Vandermosten⁶, Isabelle Desombere⁶, Kevin K. Ariën⁴, Pieter Pannus², Christiane Knoop¹, Arnaud Marchant²

1 Chest Department, Hôpital Universitaire de Bruxelles Erasme, Université libre de Bruxelles, Brussels, Belgium 

2 European Plotkin Institute for Vaccinology, Université libre de Bruxelles, Brussels, Belgium 

3 Department of Nephrology, Dialysis and Transplantation, Hôpital Universitaire de Bruxelles Erasme, Université libre de Bruxelles, Brussels, Belgium 

4 Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium 

5 Plateform interventional studies, Scientific Direction Infectious Diseases in Humans, Sciensano, 

Brussels, Belgium 

6 Laboratory of Immune Response, Scientific Direction Infectious Diseases in Humans, Sciensano, Brussels, Belgium 

Background: 

Lung transplant recipients (LTR) are susceptible to severe COVID-19 and had lower immune responses to primary SARS-CoV-2 vaccination as compared to the general population and to other solid organ transplant recipients. As immunity induced by booster vaccination and natural infection has increased since the beginning of the pandemic in the general population, immunity acquired by LTR is not well documented. 

Method: 

Humoral and cellular immunity to SARS-CoV-2 was monitored in February and May 2023 in 30 LTR and compared to that of health care workers (HCW) and nursing home residents (NHR). 

Results: 

LTR had significantly lower levels of SARS-CoV-2 binding and neutralizing antibodies and lower IFN-γ responses to Wuhan, Delta and XBB1.5 variants as compared to HCW and NHR. Humoral immunity decreased between the two visits whereas cellular immunity remained more stable. 

Conclusions: 

The persistent defect in SARS-CoV-2 immunity in LTR should encourage continued monitoring and preventive measures for this vulnerable population. 

[CITATION]:Isabelle Etienne, Delphine Kemlin, Nicolas Gemander, et al.Persistent defect in SARS-CoV-2 humoral and cellular immunity in lung transplant recipients. J Heart Lung Transplant. 2024 Aug 10:S1053-2498(24)01792-3.

[DOI]: https://doi.org/10.1016/j.healun.2024.08.002 

[IF]: 6.4