Ban Hock Tan

Background.: Widely accessible education on organ donation and transplantation (ODT) is a tool to reduce waiting lists, as <10% of transplant needs are met (Global Observatory on Donation and Transplantation). We aimed to assess the current state of access to education on ODT worldwide. Methods.: We surveyed transplant physicians and surgeons worldwide. Respondents were classified according to the mean deceased donation (DD) rate per million population (PMP) of their countries from 2016 to 2021 (excluding 2020): Group (G) 1 (G1) no DD reported, or no data provided to Global Observatory on Donation and Transplantation; (G2) <10 DD PMP; (G3) 10–19.9; (G4) 20–29.9; and (G5) ≥30. We inquired about the availability of education on ODT in countries and regions. Results.: We analyzed 311 respondents. We observed that the availability of education on ODT was as follows: in postgraduate education (77.2% in countries, 70.4% in regions), in undergraduate medical school (52.8%, 50.6%), in elementary school (14.2%, 14.2%), in high school (24.6%, 25.7%), and for the public (58.8%, 57.2%). The highest challenges were observed mainly in countries with lower DD rates. Conclusions.: This worldwide survey suggests that there are areas for improvement at a global level in education on ODT, spanning from schoolchildren to the public and from undergraduate to postgraduate medical students. This is a “Call to Action” to close the global education gap.

Background.: Global organ shortage is well documented; yet systemic barriers constraining access to transplantation remain poorly defined. Our study aimed to identify and map these barriers. Methods.: A web-based survey was conducted from May 2022 to March 2023 among physicians and surgeons involved in organ donation and transplantation (ODT) from transplantation societies worldwide: (1) Hospital structure, legislation and policies, and financial barriers, addressed to program directors; (2) Questions on education on ODT directed to all participants, and questions about donor acceptance for transplant specialists; (3) Questions on donor identification for critical care specialists and questions about organ acceptance directed to transplant specialists; (4) Demographic questions for everyone. Respondents were grouped according to the mean deceased donation (DD) rate per million population from years 2016 to 2019 and 2021: Group (G) 1 (G1) No DD reported, or no data provided to global observatory on donation and transplantation; (G2) <10 DD per million population; (G3) 10–19.9; (G4) 20–29.9; (G5) ≥30. Results.: We present answers from program directors. There were 150 program directors from 438 respondents. Financial barriers ranked highest, negatively affecting access to transplantation worldwide. G1 indicated the highest percentage of challenges. Those from G4 and G5 provided the least amount of challenges; however, training programs remain areas for improvement. Responses from G2 and G3 were similar, positioned between those from G1, and G4 and G5. Conclusions.: The organ shortage emergency is exacerbated by parallel system-level deficiencies. This global survey identifies specific, actionable deficits that must be addressed to build equitable transplant systems worldwide.

Mould pneumonia can be life-threatening, and its incidence is increasing in Asia. Due to significant variability in diagnostic setups and the availability of antifungal agents, especially in resource-limited settings, the current treatment practices and recommendations for local clinicians are poorly described. This study aimed to develop a consensus statement on the clinical management of mould pneumonia in Asia, particularly within resource-limited settings. Clinicians and infectious disease experts from the Asia Fungal Working Group answered questions about the regional epidemiology as well as diagnostic and resource-limited treatment approaches of mould pneumonia. Guided by a literature review, 22 initial questions were generated and voted upon anonymously using a Delphi-based methodology with predefined consensus criteria. The study comprised two rounds: one to generate summary statements based on the panelists’ questionnaire responses, and the other to review, confirm and rate the level of agreement of the consensus statements using a five-point Likert scale. The panelists generated 21 summary statements on the epidemiology (5), diagnosis (8), and treatment (8) of mould pneumonia, 20 of which achieved ≥ 70% consensus. Through a consensus-building exercise, clinical experts from Asia developed a set of 21 consensus statements for the diagnosis and management of mould pneumonia in resource-limited settings.

Background: More data is required to contextualize disease burden attributable to respiratory-viral-infections (RVIs) in hematology/oncology patients; including vaccine-preventable RVIs (eg. influenza, respiratory-syncytial-virus[RSV]) and other RVIs for which vaccines/therapeutics are not presently available (eg. metapneumovirus[HMPV]/parainfluenza [HPIV]). Methods: Retrospective cohort study of all adult RVI hospitalizations diagnosed on multiplex PCR testing from 2018-2024 in a large Singaporean cancer center. Severity was defined as a composite of multiple individual severe events (oxygen usage; ICU/HD admission; all-cause mortality). Patients were followed-up from admission till discharge/up to 1-month. Comparative severity of RSV and other non-vaccine-preventable RVIs (eg. HMPV/HPIV), versus seasonal influenza, was evaluated using multivariate logistic regression. Results: 1,823 RVI hospitalizations were included; 24.0% had influenza (N=437); 12.9% had RSV (N=235), and the remainder had other RVIs (eg. HMPV: N=128; HPIV: N=204). A third (29.4%, 536/1823) had severe infection (required oxygen/ICU/mortality events); 26.9% (491/1823) required oxygen, 6.9% (126/1823) required ICU/HD and 14.8% (269/1823) died. Other RVIs (eg. RSV/HMPV/adenovirus) were more severe overall, versus influenza (RSV: adjusted-odds-ratio, aOR=1.94[95%CI=1.33-2.83]; HMPV: aOR=1.77[95%CI=1.12-2.80]; adenovirus: aOR=2.19[95%CI=1.33-3.63]). RSV hospitalizations had increased odds for ICU/HD admission (aOR=2.41[95%CI=1.22-4.77]) and all-cause mortality at 1 month (aOR=2.42 [95%CI=1.42-4.12]) versus seasonal influenza. Older age (aOR=1.30[95%CI=1.03-1.64]), comorbidities (aOR=1.50[95%CI=1.18-1.90]), co-infections (aOR=1.70[95%CI=1.21-2.38]) and nosocomial transmission (aOR=1.53[95%CI=1.20-1.94]) were associated with greater severity. Conclusions: RSV hospitalizations were more severe than influenza in cancer patients; but higher odds of severity were also observed for other RVIs (HMPV/adenovirus), underlining the need for new vaccines/therapeutics. Given significant morbidity/mortality of nosocomial RVI, infection-prevention is crucial in preventing outbreaks in this immunocompromised population.

Background: Vancomycin-resistant Enterococcus (VRE) has emerged as a major nosocomial pathogen. A recent surveillance of our hospital identified a concerning rise in VRE bacteremia since 2020, despite the stable use of broad-spectrum antibiotics. This trend, coupled with the increased use of daptomycin and linezolid for drug-resistant Gram-positive bacteremia (GPB), prompted an evaluation of their usage beyond approved hospital indications. Methods: A retrospective analysis was carried out from 1 February 2023 to 31 July 2023, during which 100 and 195 patients received linezolid and daptomycin, respectively. Patients’ data were extracted from the hospital’s electronic medical records, and the appropriateness of the antibiotics prescribed was assessed. The amount of daptomycin and linezolid utilization during the study period was also retrieved, as was the incidence of VRE bacteremia. Results: A total of 295 courses of VRE-active agents, linezolid (n = 100) and daptomycin (n = 195), were assessed for appropriateness in this study. Linezolid and daptomycin use were judged as inappropriate 5.0% and 9.2% of the time, respectively. The primary reason for inappropriate linezolid use was overly broad empirical therapy where first-line options like cefazolin and vancomycin could have been prescribed. Daptomycin was often used inappropriately in non-VRE infections, and surgical prophylaxis or use was extended unnecessarily without microbiological justification. Conclusions: Linezolid and daptomycin were prescribed appropriately. Nevertheless, our findings suggest the need to re-evaluate the empirical treatment strategies especially in VRE-colonized patients. Implementation of robust risk-based criteria as well as in-house hospital guidelines or protocols on the initiation of VRE-active agents may help support more judicious prescribing practices of these agents.

Cherie Le Si Gan, Shimin Jasmine Chung, Quan Yao Ho, Thuan Tong Tan, Ban Hock Tan, Ian Tatt Liew, Carolyn Shan-Yeu Tien, Sobhana Thangaraju, Terence Kee. Clin Transplant Res -0001;0:. https://doi.org/10.4285/ctr.24.0045

Background: Solid organ transplantation (SOT) has expanded significantly in Asia over past few decades. Donor‐derived infections (DDIs) remain a significant concern as they may adversely impact transplant outcomes. We aim to review the existing regulatory frameworks, screening protocols, and management practices for DDIs in Asia.Methods: We reached out to transplant infectious diseases experts in Asia to provide standardized data on annual SOT numbers, incidence of DDIs, regulatory frameworks, donor and recipient screening protocols, and DDI surveillance measures. We present the data from Singapore, Japan, and Thailand.Results: Donor screening for HIV, hepatitis B, hepatitis C, and syphilis is mandatory in all countries. Additionally, Japan screens for HTLV‐1 antibody due to its endemicity. We also reviewed the protocols for screening and prevention of endemic infections in Asia. Singapore is the only country implementing universal screening for all donors for dengue, Zika, and chikungunya via blood and urine RT‐PCR. Strongyloidiasis screening is not routinely done, although some transplant centers empirically give ivermectin prophylaxis to organ recipients. Tuberculosis screening with a donor questionnaire and chest radiograph is common for deceased donors, and some centers do Interferon Gamma Release Assay test for living donors. We also found a significant gap in the surveillance and reporting of potential DDIs in Asia and the overall incidence of DDIs in Asia is unknown and likely underreported.Conclusion: The experiences of Singapore, Japan, and Thailand offer valuable insights into current practices and the unmet needs regarding a DDI registry and call for coordinated efforts to address this critical issue in the region. image