Infections in transplant recipients

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

Organ transplant recipients are susceptible to infections due to their generalized immunosuppressed state. Furthermore, the allograft organ (e.g., lung) has increased susceptibility due to its direct communication with the environment.

Pathophysiology

The immunosuppressive therapy related to the transplantation depresses the cell mediated immunity and blunt the antibody response making them more susceptible to the infections.
The presence of metabolic abnormalities, damage to muco-cutaneous membranes and devices like catheters and IV lines make the patient more prone to infections.
They are most prone during the early post transplantation period and less immunosuppressed at the later stage when the immunotherapy is withdrawn.
Post transplantation period is classified to three time frames namely first month, second through six months and beyond six months (late post transplant period). The patient is most susceptible to specific type of infections in each period. The type of infections is mainly influenced by environmental factors, level of immunosupression and surgical factors.

During the first month, most infections are due to complications of surgery such as urinary tract infections, sepsis, pneumonia, herpes simplex virus infection reactivation and wound infections. It includes bacterial, viral and fungal infections. The other major complications specific to the organ include the following.

Renal and pancreatic transplantation- Lymphoceles and perigraft hematoma
Liver transplantation- Infected biloma, hepatic vein occlusion, biliary stricture formation, hepatic artery thrombosis and portal vein thrombosis.
Heart transplantation- Acute mediastinitis, mycotic aneurysm.
Lung transplantation- Bronchial anastomosis.

During the second to six months post transplantation, opportunistic infections manifest. The major opportunistic pathogens are Pneumocystis carinii, Nocardia, Aspergillus, CMV, Toxoplasma gondii and Listeria monocytogenes. Reactivation of Mycobacterium tuberculosis can occur during this period.
During the late post transplant period after 6 months, the immune status of the patient is improved and patient is more prone to community based infections such as influenza virus infections, pneumococcal pneumonia and urinary tract infections. ^[1]

Treatment

Antimicrobial Therapy

Post Transplant Infected Biloma

Preferred regimen: Linezolid 600 mg IV bid AND Ciprofloxacin 400 mg IV q12h AND Fluconazole 400 mg IV q24h ^[2]

Alternative regimen: Daptomycin 6mg/kg per day AND Levofloxacin 750 mg IV q24h AND Fluconazole 400 mg IV q24h ^[3]

Prevention

Evaluation of pretransplantation infection and counseling to prevent post transplant infections are done as a routine before any transplantation.

References

↑ Patel R, Paya CV (1997). "Infections in solid-organ transplant recipients". Clin Microbiol Rev. 10 (1): 86–124. PMC 172945. PMID 8993860.CS1 maint: PMC format (link)
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

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[pmid8993860-1] Patel R, Paya CV (1997). "Infections in solid-organ transplant recipients". Clin Microbiol Rev. 10 (1): 86–124. PMC 172945. PMID 8993860.CS1 maint: PMC format (link)

[2] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[3] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

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