Zoonoses represent a problem of rising importance in the transplant population.A close relationship and changes between human,animal and environmental health(“One Health”concept)significantly influence the transmiss...Zoonoses represent a problem of rising importance in the transplant population.A close relationship and changes between human,animal and environmental health(“One Health”concept)significantly influence the transmission and distribution of zoonotic diseases.The aim of this manuscript is to perform a narrative review of the published literature on emerging and neglected zoonoses in the transplant population.Many reports on donor-derived or naturally acquired(re-)emerging arboviral infections such as dengue,chikungunya,West Nile,tick-borne encephalitis and Zika virus infection have demonstrated atypical or more complicated clinical course in immunocompromised hosts.Hepatitis E virus has emerged as a serious problem after solid organ transplantation(SOT),leading to diverse extrahepatic manifestations and chronic hepatitis with unfavorable outcomes.Some neglected pathogens such as lymphocytic choriomeningitis virus can cause severe infection with multi-organ failure and high mortality.In addition,ehrlichiosis may be more severe with higher casefatality rates in SOT recipients.Some unusual or severe presentations of borreliosis,anaplasmosis and rickettsioses were also reported among transplant patients.Moreover,toxoplasmosis as infectious complication is a well-recognized zoonosis in this population.Although rabies transmission through SOT transplantation has rarely been reported,it has become a notable problem in some countries.Since the spreading trends of zoonoses are likely to continue,the awareness,recognition and treatment of zoonotic infections among transplant professionals should be imperative.展开更多
Combined liver and kidney transplantation(CLKT)is indicated in patients with failure of both organs,or for the treatment of end-stage chronic kidney disease(ESKD)caused by a genetic defect in the liver.The aim of the ...Combined liver and kidney transplantation(CLKT)is indicated in patients with failure of both organs,or for the treatment of end-stage chronic kidney disease(ESKD)caused by a genetic defect in the liver.The aim of the present review is to provide the most up-to-date overview of the rare conditions as indications for CLKT.They are major indications for CLKT in children.However,in some of them(e.g.,atypical hemolytic uremic syndrome or primary hyperoxaluria),CLKT may be required in adults as well.Primary hyperoxaluria is divided into three types,of which type 1 and 2 lead to ESKD.CLKT has been proven effective in renal function replacement,at the same time preventing recurrence of the disease.Nephronophthisis is associated with liver fibrosis in 5%of cases and these patients are candidates for CLKT.In alpha 1-antitrypsin deficiency,hereditary C3 deficiency,lecithin cholesterol acyltransferase deficiency and glycogen storage diseases,glomerular or tubulointerstitial disease can lead to chronic kidney disease.Liver transplantation as a part of CLKT corrects underlying genetic and consequent metabolic abnormality.In atypical hemolytic uremic syndrome caused by mutations in the genes for factor H,successful CLKT has been reported in a small number of patients.However,for this indication,CLKT has been largely replaced by eculizumab,an anti-C5 antibody.CLKT has been well established to provide immune protection of the transplanted kidney against donor-specific antibodies against class I HLA,facilitating transplantation in a highly sensitized recipient.展开更多
基金This study was supported in part by the Croatian Science Foundation,project No.IP 2016-06-7456:Prevalence and molecular epidemiology of emerging and re-emerging neuroinvasive arboviral infections in CroatiaCRONEUROARBO(to TVC).
文摘Zoonoses represent a problem of rising importance in the transplant population.A close relationship and changes between human,animal and environmental health(“One Health”concept)significantly influence the transmission and distribution of zoonotic diseases.The aim of this manuscript is to perform a narrative review of the published literature on emerging and neglected zoonoses in the transplant population.Many reports on donor-derived or naturally acquired(re-)emerging arboviral infections such as dengue,chikungunya,West Nile,tick-borne encephalitis and Zika virus infection have demonstrated atypical or more complicated clinical course in immunocompromised hosts.Hepatitis E virus has emerged as a serious problem after solid organ transplantation(SOT),leading to diverse extrahepatic manifestations and chronic hepatitis with unfavorable outcomes.Some neglected pathogens such as lymphocytic choriomeningitis virus can cause severe infection with multi-organ failure and high mortality.In addition,ehrlichiosis may be more severe with higher casefatality rates in SOT recipients.Some unusual or severe presentations of borreliosis,anaplasmosis and rickettsioses were also reported among transplant patients.Moreover,toxoplasmosis as infectious complication is a well-recognized zoonosis in this population.Although rabies transmission through SOT transplantation has rarely been reported,it has become a notable problem in some countries.Since the spreading trends of zoonoses are likely to continue,the awareness,recognition and treatment of zoonotic infections among transplant professionals should be imperative.
文摘Combined liver and kidney transplantation(CLKT)is indicated in patients with failure of both organs,or for the treatment of end-stage chronic kidney disease(ESKD)caused by a genetic defect in the liver.The aim of the present review is to provide the most up-to-date overview of the rare conditions as indications for CLKT.They are major indications for CLKT in children.However,in some of them(e.g.,atypical hemolytic uremic syndrome or primary hyperoxaluria),CLKT may be required in adults as well.Primary hyperoxaluria is divided into three types,of which type 1 and 2 lead to ESKD.CLKT has been proven effective in renal function replacement,at the same time preventing recurrence of the disease.Nephronophthisis is associated with liver fibrosis in 5%of cases and these patients are candidates for CLKT.In alpha 1-antitrypsin deficiency,hereditary C3 deficiency,lecithin cholesterol acyltransferase deficiency and glycogen storage diseases,glomerular or tubulointerstitial disease can lead to chronic kidney disease.Liver transplantation as a part of CLKT corrects underlying genetic and consequent metabolic abnormality.In atypical hemolytic uremic syndrome caused by mutations in the genes for factor H,successful CLKT has been reported in a small number of patients.However,for this indication,CLKT has been largely replaced by eculizumab,an anti-C5 antibody.CLKT has been well established to provide immune protection of the transplanted kidney against donor-specific antibodies against class I HLA,facilitating transplantation in a highly sensitized recipient.
