Low Performance of Sinovac Vaccine Particularly With Belatacept Therapy in a Study With Different Types of COVID-19 Vaccines in Transplanted Patients.

The huge impact of SARS-CoV-2 infections on organ transplant recipients makes it necessary to optimize vaccine efficacy in this population. To effectively implement multiple strategies, it is crucial to understand the performance of each type of available vaccine. In our study, the antibody titer was measured, and the presence of antibodies against SARS-CoV-2 was evaluated after 90 days of immunization; furthermore, the differences between hybrid immunity, immunity by vaccination, and immunosuppressant type were identified. As a result, of the patients included in this study (n = 160), 53% showed antibodies against SARS-CoV-2 90 days after the first dose in patients who had completed the vaccination schedule. Antibody titers were higher in patients with hybrid immunity, and the proportion of nonresponsive patients was higher among those who received the immunosuppressant belatacept in their post-transplant regimen (P = .01). Only 15% of patients treated with this medicine seroconverted and patients vaccinated with CoronaVac and treated with belatacept showed no response. In conclusion, a reduced response to vaccines against SARS-CoV-2 was identified in the transplant population, and this response varied with the type of vaccine administered and the immunosuppressive treatment.

Seroprevalence of HTLV-1 and 2 in organ donors and kidney transplant recipients. Colombia 2010-2017

Abstract Since 2004, in Colombia, the detection of human T-cell lymphotropic virus type 1 and 2 (HTLV-1-2) has been recommended for organ donors and recipients. The prevention of HTLV-1 and 2 infection in recipients is important due to its relationship with lymphoproliferative and inflammatory diseases and opportunistic infections. The objective of this study was to describe the seroprevalence of HTLV-1 and 2 among organ donors and kidney transplant recipients between 2010 and 2017 in Colombia. Methods: this was a descriptive study which included 1979 organ donors and 3,311 kidney transplant recipients from the donation and transplant network from 2010 to 2017. The seroprevalence of HTLV-1 and 2 was calculated, and serological and demographic variables were described. Results: out of 1979 donors, detection of antibodies against HTLV-1 was performed in 92% (1820), with a seroprevalence of 0.2%; 50% of the cases were from the Pacific region (an endemic zone in Colombia). Ninety percent of the donors were examined for HTLV-2, with a seroprevalence of 0.2%. Of the 3311 kidney recipients between 2010 and 2017, only 44% were evaluated for HTLV-1 and 43% for HTLV-2. The seroprevalence for both viruses was 0.3%. Two of the HTLV-1 cases were positive for HLADRB1*01. Conclusions: the seroprevalence found in organ donors and kidney transplant recipients was similar to that previously reported in Colombia. Screening of all potential donors must be adhered to prevent transmission of this virus. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2001).

SARS-CoV2/COVID-19 Infection in Transplant Recipients and in Patients on the Organ Transplant Waiting List in Colombia.

To assess our determination to continue transplant activity in Colombia during the coronavirus disease 2019 (COVID-19) pandemic, this study seeks to describe the risk of infection and mortality of transplanted patients vs those on the waiting list. Therefore, a descriptive study of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)/COVID-19 infection in transplant recipients and patients on the waiting list was conducted. The data sources were the information systems of the Instituto Nacional de Salud of Colombia: National Donation and Transplant Information System, the National Public Health Surveillance System, and the National COVID-19 Data Repository. Characteristics of the patients who tested positive were analyzed, and the mortality rate was determined. An Real Time-PCR test for SARS-CoV-2/COVID-19 was performed in 7% of the transplant recipients included in this study, and 14.8% of those recipients tested positive. Among patients on the waiting list, 15.2% were tested, and 16.7% showed positive results. Overall, 1% (84/8108) of the transplant recipients and 2.5% (74/2926) of patients on the waiting list were infected with SARS-CoV-2/COVID-19. There were no differences in mortality between these groups (P = .8748). In conclusion, with the data obtained so far, the hospital availability, and the adoption of safety protocols in the institutions, our findings can support the continuity of the transplant activities in this country.

Supervivencia de receptores de trasplante renal en Colombia, 2008-2012 / Survival in renal transplant recipients in Colombia, 2008-2012

Resumen Introducción. La Red Nacional de Donación y Trasplantes del Instituto Nacional de Salud reportó que durante 2014 se realizaron en Colombia 1.059 trasplantes de órganos, de los cuales 761 fueron de riñón y, de estos, 643 (84,5 %) correspondieron a órganos provenientes de cadáveres. Objetivo. Describir las características sociodemográficas de los pacientes con trasplante renal y los resultados en términos de supervivencia. Materiales y métodos. Se hizo un estudio observacional y retrospectivo de cohorte mediante el análisis de la base nacional de datos de receptores de trasplante renal. Se estimó la supervivencia global con el método de Kaplan-Meier, se compararon las curvas según sexo, edad, tipo de donante, tipo de régimen de afiliación al sistema de salud y tiempo en lista de espera mediante la prueba de hipótesis de Mantel-Cox (log rank) y una regresión de Cox. Resultados. De los 3.980 pacientes incluidos en el estudio, 338 fallecieron según el Registro Único de Afiliados. Con una mediana de seguimiento de 49 meses, la supervivencia global fue de 6,35 años (IC95% 6,30-6,40), la supervivencia al año del trasplante fue de 97,2 %, a los tres años, de 93,2 %, y a los cinco años, de 90,8 %. La supervivencia fue mayor en los pacientes menores de 50 años receptores de trasplante con donante vivo y con menos de seis meses en lista de espera. Conclusiones. Los resultados reflejaron el panorama de los pacientes con trasplante renal en el país en términos de supervivencia, lo cual sirve de base para estudios prospectivos con seguimiento estricto.

Abstract Introduction: The Red Nacional de Donación y Trasplantes of the Colombian Instituto Nacional de Salud reported that in 2014, 1,059 organ transplants were performed, of which 761 were kidney transplants, and 643 (84.5%) of these were from cadaveric organ donors. Objective: To describe the socio-demographic characteristics of patients who received renal transplants, as well as their outcomes in terms of survival. Materials and methods: National kidney transplants were analyzed through an observational retrospective cohort study. Overall survival was estimated using the Kaplan-Meier method. The survival curves by sex, age, type of donor, type of insurance, and time on the waiting list were compared utilizing the log rank hypothesis and a Cox regression. Results: A total of 3,980 patients were included, of whom 338 died according to the Registry of Affiliates. The median follow-up time was 49 months, overall survival was 6.35 years (95% CI: 6.30 to 6.40), the one-year survival following transplantation was 97.2%, the three-year survival, 93.2%, and the five-year survival, 90.8%. The survival rate was higher in patients under 50 years of age, receptors of living donor transplants, and with less than six months on the waiting list. Conclusions: The results obtained serve as the basis for future studies with strict monitoring of survival among kidney transplant recipients in Colombia.

Determinación del polimorfismo de HLA-A, -B y -DRB1 en donantes de órganos con muerte encefálica representativos de la población general colombiana, 2007-2014 / Determination of HLA-A, -B and -DRB1 polymorphism in brain dead organ donors representative of the Colombian general population, 2007-2014

Resumen Introducción. Los genes que codifican para el sistema de antígenos leucocitarios humanos (Human Leukocyte Antigen, HLA) son muy polimorfos y de gran importancia en procedimientos de trasplante de órganos, ya que la determinación de las frecuencias alélicas en poblaciones específicas se tiene en cuenta entre los criterios científicos para la asignación de órganos. Objetivo. Establecer las frecuencias antigénicas y haplotípicas de HLA-A, -B y -DRB1 en donantes de órganos con muerte encefálica, representativos de la población colombiana. Materiales y métodos. En este estudio descriptivo retrospectivo de 2.506 donantes cadavéricos de órganos, se hizo un análisis alélico y de haplotipos de HLA-A, -B y -DRB1, y se determinó el equilibrio de Hardy-Weinberg. Resultados. Se encontraron 21, 43 y 15 grupos alélicos para los loci A*, B* y DRB1*, respectivamente. Se detectaron 1.268 haplotipos HLA-A, -B y -DR, 409 haplotipos HLA A-B, 383 haplotipos HLA-B-DR y 218 haplotipos HLA-A-DR. Los tres loci se encontraban en equilibrio de Hardy-Weinberg entre el número de heterocigóticos observados y el esperado, con valores de p<0,05. Conclusiones. En este estudio se proporciona información sobre la distribución de los alelos HLA de clase I y II en la población de donantes de órganos provenientes de las seis regionales en las que está dividido el país para la prestación de servicios de trasplante.

Abstract Introduction: Genes encoding for human leukocyte antigens (HLA) are highly polymorphic and of great importance in organ transplantation procedures, as determining allelic frequencies in defined populations is taken into account among the scientific criteria for organ allocation. Objective: The objective of this study was to establish the antigen HLA-A, -B, and -DRB1 haplotype frequencies in organ donors representative of the Colombian population after brain death. Materials and methods: We conducted a descriptive retrospective study involving 2,506 cadaveric organ donors including an allelic and haplotype analysis of HLA-A, -B and -DRB1; we also determined the Hardy-Weinberg equilibrium. Results: We identified 21, 43 and 15 allelic loci for groups A*, B* and DRB1*, respectively. We detected 1,268 HLA-A, -B and -DR, 409 HLA-A-B, 383 HLA-DR-B, and 218 HLA-A-DR haplotypes. The three loci were found to be in Hardy-Weinberg equilibrium between the number of heterozygotes observed and the expected number, with p values of <0.05. Conclusions: This study provides information on the allelic distribution of HLA class I and II in organ donors from the six regions in which Colombia is structurally divided to provide transplant services.

[Survival in renal transplant recipients in Colombia, 2008-2012].

INTRODUCTION: The Red Nacional de Donación y Trasplantes of the Colombian Instituto Nacional de Salud reported that in 2014, 1,059 organ transplants were performed, of which 761 were kidney transplants, and 643 (84.5%) of these were from cadaveric organ donors. OBJECTIVE: To describe the socio-demographic characteristics of patients who received renal transplants, as well as their outcomes in terms of survival. MATERIALS AND METHODS: National kidney transplants were analyzed through an observational retrospective cohort study. Overall survival was estimated using the Kaplan-Meier method. The survival curves by sex, age, type of donor, type of insurance, and time on the waiting list were compared utilizing the log rank hypothesis and a Cox regression. RESULTS: A total of 3,980 patients were included, of whom 338 died according to the Registry of Affiliates. The median follow-up time was 49 months, overall survival was 6.35 years (95% CI: 6.30 to 6.40), the one-year survival following transplantation was 97.2%, the three-year survival, 93.2%, and the five-year survival, 90.8%. The survival rate was higher in patients under 50 years of age, receptors of living donor transplants, and with less than six months on the waiting list. CONCLUSIONS: The results obtained serve as the basis for future studies with strict monitoring of survival among kidney transplant recipients in Colombia.

Cytomegalovirus seroprevalence in organ donors and kidney transplant recipients, Colombia, 2010-2014.

INTRODUCTION: Cytomegalovirus infections have gained high importance for individuals that have received organ transplants given the clinical implications this may have in immunocompromised patients.  OBJECTIVE: To describe the seroprevalence of cytomegalovirus in organ donors and recipients of kidney transplants nationwide from the six regions established by the Red Nacional de Donación y Trasplante.  MATERIALS AND METHODS: We conducted a descriptive retrospective study that included 1,813 organ donors and 3,313 recipients of kidney transplants, and we calculated IgM and IgG seroprevalence for cytomegalovirus. IgG prevalence was stratified according to sex, age group, and region, and the results were analyzed in each donor-recipient pair and classified according to the risk. Statistical packages IBM SPSS®, Statistics 22, and Epi Info 7 were utilized.  RESULTS: IgG prevalence for cytomegalivirus was 86.8% in donors and 91.0% in kidney transplant recipients with statistical significance observed for age, geographical location, and between donors and recipients. We analyzed 1,764 pairs of donors and recipients, of which 91.4% were categorized as having intermediate risk.  CONCLUSIONS: The results of this study showed high cytomegalovirus infection rates in Colombia. Given the risk, categorization of patients undergoing transplants, measures should be adopted by medical teams to minimize risks.

Seroprevalencia de citomegalovirus en donantes de órganos y receptores de trasplante renal, Colombia, 2010-2014 / Cytomegalovirus seroprevalence in organ donors and kidney transplant recipients, Colombia, 2010-2014

Introducción. La infección por citomegalovirus ha cobrado gran importancia en los receptores de trasplantes debido a las implicaciones clínicas que puede tener en pacientes inmunocomprometidos. Objetivo. Describir la seroprevalencia del citomegalovirus en donantes de órganos y receptores de trasplante renal a nivel nacional seleccionados de las seis regionales en que está dividido el país según las áreas de actuación de la Red Nacional de Donación y Trasplante. Materiales y métodos. Se hizo un estudio descriptivo y retrospectivo que incluyó 1.813 donantes de órganos y 3.313 personas receptoras de trasplante renal, y se calculó la seroprevalencia general de IgM e IgG para citomegalovirus. La prevalencia de IgG se estratificó por sexo, grupos de edad y regional, se analizó el resultado en cada pareja de donante y receptor, y se estratificó el riesgo. Se utilizaron los paquetes estadísticos IBM SPSS ® , Statistics 22, y Epi-Info 7. Resultados. La prevalencia de IgG para citomegalovirus fue de 86,2 % en donantes y de 91,0 % en receptores de trasplante renal, con diferencias estadísticamente significativas por edad, por criterio geográfico y según su calidad de donantes o receptores. Se analizaron 1.764 parejas de donante y receptor, de las cuales 91,4 % se clasificó como de riesgo intermedio. Conclusiones. Los resultados del presente estudio evidenciaron que las tasas de infección por citomegalovirus fueron altas y que la categorización del riesgo de los receptores de trasplante señala la necesidad de que los equipos médicos tratantes tomen medidas para minimizar los riesgos.

Introduction: Cytomegalovirus infections have gained high importance for individuals that have received organ transplants given the clinical implications this may have in immunocompromised patients. Objective: To describe the seroprevalence of cytomegalovirus in organ donors and recipients of kidney transplants nationwide from the six regions established by the Red Nacional de Donación y Trasplante . Materials and methods: We conducted a descriptive retrospective study that included 1,813 organ donors and 3,313 recipients of kidney transplants, and we calculated IgM and IgG seroprevalence for cytomegalovirus. IgG prevalence was stratified according to sex, age group, and region, and the results were analyzed in each donor-recipient pair and classified according to the risk. Statistical packages IBM SPSS ® , Statistics 22, and Epi Info 7 were utilized. Results: IgG prevalence for cytomegalivirus was 86.8% in donors and 91.0% in kidney transplant recipients with statistical significance observed for age, geographical location, and between donors and recipients. We analyzed 1,764 pairs of donors and recipients, of which 91.4% were categorized as having intermediate risk. Conclusions: The results of this study showed high cytomegalovirus infection rates in Colombia. Given the risk, categorization of patients undergoing transplants, measures should be adopted by medical teams to minimize risks.

Analysis of HLA-A, HLA-B, HLA-DRB1 allelic, genotypic, and haplotypic frequencies in Colombian population / Análisis de frecuencias alélicas, genotípicas y haplotípicas HLA -A, HLA-B, HLA-DRB1 en población colombiana

Introduction: The high polymorphism of the HLA system allows its typification to be used as valuable tool in establishing association to various illnesses, immune and genetic profiles; it also provides a guide to identifying compatibility among donors and receptors of organs transplants. Objective: To establish HLA-A, HLA-B, and HLA.DRB1 allele, genotype and haplotype frequencies among patients treated at Clinica Colsanitas SA. Methods: 561 patients coming from different regions in Colombia, who were attended in 8 centers of the clinical laboratory of the Clinica Colsanitas in different cities of the country from January 2004 to August 2008, were included in this study. All were HLA-A,-B, and -DRB1 typified via SSP PCR. Allele, genotype and haplotype frequencies were estimated with STATA Software Version 9.0 and the GENEPOP genetic analysis package. Results: 19, 28, and 15 different alleles were identified for loci HLA-A,-B and -DRB1, respectively. Alleles found most frequently were A*24 (26.2%), A*02 (26%), B*35(22.7%), and DRB1*04 (24%). The most frequent genotypes were A*02,24 (14.2%), B*07,35 (5.5%), DRB1*01,04, and DRB1*04,04 (6.9%); while most the frequent haplotypes were HLA A*24, B*35 (9.2%), A*24, DRB1*04 (8.1%); B*35, DRB1*04 (7.8%), A*2 DRB1*04 (7.4%). Conclusion: The results obtained provide a useful reference framework for the population studied, allowing compatibility probability calculations to be performed for organ transplants.

Introducción: El alto polimorfismo del sistema HLA, hace que su tipificación sea una herramienta de gran valor al establecer asociación con diferentes enfermedades, patrones inmunológicos, antropogenéticos, así como para establecer probabilidades de encontrar donantes compatibles con receptores de diferentes tipos de trasplante de órganos. Objetivo: Establecer las frecuencias alélicas, genotípicas y haplotípicas en pacientes atendidos en la Clínica Colsanitas SA. Metodología: Se incluyeron un total de 561 pacientes atendidos en el Laboratorio Clínico de La Clínica Colsanitas SA, en 8 sedes en diferentes ciudades del Colombia, durante el período comprendido entre enero de 2004 a agosto de 2008. Se realizó tipificación de HLA -A,-B,-DRB1 por PCR SSP. Las frecuencias alélicas, genotípicas y haplotípicas fueron estimadas mediante el paquete estadístico Stata y el paquete de análisis genético Genepop. Resultados: Fue posible la identificación de 19, 28 y 15 alelos de los loci HLA A-B-DRB1 respectivamente, de los cuales los más frecuentes fueron A*24 (26.2%), A*02 (26%), B*35 (22.7%), DRB1*04 (24%). Los genotipos más frecuentes encontrados fueron A*02,24 (14.2%), B*07,35 (5.5%), DRB1*01,04 y DRB1*04,04 (6.9%). Los haplotipos más frecuentes fueron: HLA A*24, B*35 (9.2%), A*24, DRB1*04 (8.1%); B* 35, DRB1*04 (7.8%), A*2 DRB1*04 (7.4%). Conclusión: Los resultados obtenidos permiten tener referencia para aplicaciones en la población estudiada, así como para establecer probabilidades de compatibilidad en la creciente área de trasplante de órganos.

Genotipificación del virus de papiloma humano en mujeres con hallazgo citológico de lesión escamosa intraepitelial de bajo grado (lsil) o de significado indeterminado (asc-us) en Bogotá, Colombia / Genotiping human papillomavirus in patients with low-grade squamous intraepithelial lesion or atipycal squamous cells of uncertain significance (asc-us) in Bogotá, Colombia

El virus de papiloma humano (vph) es el principal factor de riesgo asociado al cáncer cervical, y es la causa de muerte más común por cáncer entre las mujeres en Colombia. Por tanto, crece el interés a nivel mundial y nacional por mejorar las estrategias de control y diagnóstico de la infección; incluyendo técnicas de diagnóstico molecular que identifiquen y diferencien tipos virales específicos para así tener mejor entendimiento de la dinámica del virus en la historia natural de la infección por vph. En el presente trabajo se detectó el vph en 363 pacientes diagnosticadas con lesiones asc-us o lsil en su citología, pertenecientes al programa de tamizaje de cáncer de cérvix de la eps Sanitas. Sólo a 302 de estas muestras se les pudo realizar genotipificación por Reverse Line Blot, de éstas el 20,5% (62/302 pacientes) fueron positivas para vph; los tipos virales de alto riesgo estuvieron presentes en el 82,2% y los de bajo riesgo, en el 17,8%. Por primera vez se realiza un acercamiento a la descripción de tipos virales específicos, encontrados en muestras con diagnóstico citológico de asc-us o lsil en Bogotá.

Human papillomavirus (hpv) is the principal risk factor associated with cervical cancer, the most common malignancy among women in Colombia. Therefore, a growing concern globally and nationally to improve strategies to control and diagnosis of infection, including molecular diagnostic techniques to identify and differentiate specific hpv types thus have a better understanding of the dynamics of the virus in history natural infection. In the present work was performed hpv detection and genotyping in 302 of 363 patients who normally attended the screening program of the eps Sanitas, and were subsequently diagnosed with asc-us lesions. We found hpv in 20.5% (62/302 patients) divided into 82.2% for high-risk viral types and 17.8% for low risk. For the first time was a description of specific viral types found in samples of asc-us in Bogotá.