Infectious diseases are important causes of morbidity and mortality in patients with cancer. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Prevention and Treatment of Cancer-Related Infections characterize the major pathogens to which patients with cancer are susceptible, with a focus on the prevention, diagnosis, and treatment of major common and opportunistic infections. This portion of the guidelines highlights the sections on antifungal and antiviral prophylaxis. Antifungal and antiviral prophylaxis recommendations have expanded over the past few years. New agents for the treatment of fungal infections and incorporation of therapeutic drug monitoring are presented. Antiviral prophylaxis for hepatitis B and management considerations for hepatitis C and HIV have been further developed.

Although late cases occur, the first year after SOT is the period of highest risk for histoplasmosis. In patients who survive the first month after diagnosis, treatment with an amphotericin formulation followed by an azole for 12 months is usually successful, with only rare relapse.

COVID-19 coronavirus disease 2019 SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 CLD chronic liver disease EUA emergency use authorization FDA Food and Drug Administration VE vaccine efficacy BNT162b2 Pfizer-BioNTech mRNA vaccine mRNA-1273 Moderna mRNA vaccine VAERS Vaccine Adverse Event Reporting System CDC Centers for Disease Control and Prevention SOT solid organ transplant ACR acute cellular rejection

Background While sarcopenia (muscle loss) is associated with increased mortality after liver transplant, its influence on other complications is less well understood. We examined the association between sarcopenia and the risk of severe post-transplant infections among adult liver transplant recipients. Methods We assessed sarcopenia among 207 liver transplant recipients by calculating total psoas area (TPA) on preoperative computed tomography scans. The presence or absence of severe post-transplant infection was determined by review of the medical chart. The influence of post-transplant infection on overall survival was also assessed. Results We identified 196 episodes of severe infections among 111 patients. Fifty-six patients had more than one infection. The median time to development of infection was 27 days (range 13–62). When grouped by tertiles, patients in the lowest tertile had a more than four-fold higher odds of developing severe infection compared to patients in the highest tertile; OR 4.6, CI 95 2.3–9.5). In multivariable analysis, recipient age (hazard ratio 1.04, p=0.02), pre-transplant TPA (hazard ratio 0.38, p<0.01) and pre-transplant total bilirubin level (hazard ratio 1.05, p=0.02) were independently associated with the risk of developing severe infections. Patients with severe post-transplant infections had worse 1-year survival compared to patients without infection (76% vs. 92%, p=0.003). Conclusions Among patients undergoing liver transplantation, lower TPA was associated with heightened risk for post-transplant infectious complications and mortality. Future efforts should focus on approaches to assess and mitigate vulnerability among patients undergoing transplantation.

NCT00817908.