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Infectious Diseases: Vaccines, Immune Monitoring and Potential New Biomarkers at the 34th Annual Meeting and Scientific Sessions

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Javier Carbone, MD, PhD
ISHLT Links International Correspondents Board
Transplant Immunology Group, Hospital General Universitario Gregorio Marañon
Madrid, Spain

Heart and lung transplant candidates and recipients are at significant risk for infection and efforts should be optimized to limit these risks. Vaccine-preventable diseases continue to affect solid organ transplant recipients and can be minimized with proper vaccination. E. Stimpson (abstract 733)* evaluated the effect of hepatitis B vaccination on patients who are awaiting a heart transplant. Those patients who were hepatitis B surface antibody positive after vaccination were transplanted at a higher rate compared to those who were hepatitis B surface antibody negative. K Gould (abstract 477)* presented data on a high influenza vaccination rate amongst cardiothoracic transplant patients (Season 2012/2013, Heart 86%, Lung 95%). E. Sarmiento (abstract 36)* suggested that a lower antibody response (low anti-PnPS antibody titers) to the 23-valent pneumococcal polysaccharide vaccine was associated with a significant risk of bacterial infection in heart recipients.

In the Sunrise Symposium CMV Infection in Lung Transplant Recipients: Are We Ready for Personalized Medicine?, J McDyer spoke about T cell Function (low CD107 expression on CD8+ T-cells, CD4+ pp65 responses and CMV-specific CD4+ memory T cells with multifunctional cytokine production) and relapses of CMV infection in high-risk lung transplant recipients. Following on, G Westall discussed about prediction of CMV reactivation risk by evaluating specific anti-CMV CD8+ responses in lung transplant recipients. Prolonged antiviral therapy can be guided by results of these responses. In the Sunday Plenary Session, L Potena (featured abstract 406)* presented interesting data on immune monitoring of specific anti-CMV T-cell responses as a guide to anti-CMV prophylaxis in a prospective randomized study. He concluded that a lack of CMV-specific immune reconstitution after heart transplantation was associated with increased risk of CMV infection and identified patients likely to benefit of specific anti-CMV approaches.

D Ruttens (abstract 61)* discussed the role of genetic variation in immunoglobulin G receptor on survival after lung transplantation. Multivariate analysis showed that carriers of the TT variant had worse survival compared to the CC genotype. The TT genotype demonstrated more respiratory infections compared to the other genotypes. E Sarmiento (abstract 33)* showed that a combination of post transplant IgG hypogammaglobulinemia with lower complement C3 levels identified CMV-seropositive heart recipients at risk of CMV disease in a prospective multicenter study. Screening for IgG deficiency and supplementation with intravenous immunoglobulin was associated with comparable survival as compared to patients with sufficient IgG levels in a cohort of post transplant IgG hypogammaglobulinemic lung recipients presented by WM Tsuang (abstract 173)*.

Although this is not related with infections, as I was born in Peru I have to write that I was fortunate to attend the Concurrent Symposium 27: Heart Transplantation and Mechanical Circulatory Support in Latin America. Interesting presentations about long term results from patients with heart transplantation and MCS demonstrated that this is a growing field in Latin America. There is a clear and evident need for mutual learning in this area.

Disclosure Statement: the author has no conflicts of interest to report.

*All of these abstracts are available to view using any of the digital media available on the ISHLT website at http://www.ishlt.org/meetings/annualMeeting.asp.

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