Infection in Organ Transplantation

Abstract

The prevention, diagnosis, and management of infectious disease in transplantation are major contributors to improved outcomes in organ transplantation. The risk of serious infections in organ recipients is determined by interactions between the patient's epidemiological exposures and net state of immune suppression. In organ recipients, there is a significant incidence of drug toxicity and a propensity for drug interactions with immunosuppressive agents used to maintain graft function. Thus, every effort must be made to establish specific microbiologic diagnoses to optimize therapy. A timeline can be created to develop a differential diagnosis of infection in transplantation based on common patterns of infectious exposures, immunosuppressive management, and antimicrobial prophylaxis. Application of quantitative molecular microbial assays and advanced antimicrobial therapies have advanced care. Pathogen-specific immunity, genetic polymorphisms in immune responses, and dynamic interactions between the microbiome and the risk of infection are beginning to be explored. The role of infection in the stimulation of alloimmune responses awaits further definition. Major hurdles include the shifting worldwide epidemiology of infections, increasing antimicrobial resistance, suboptimal assays for the microbiologic screening of organ donors, and virus-associated malignancies. Transplant infectious disease remains a key to the clinical and scientific investigation of organ transplantation.

Transplant associated infections—The role of the gastrointestinal microbiota and potential therapeutic options

“…Infectious complications following kidney transplantation cause significant morbidity and mortality . In Australia, infections account for approximately 22% of deaths in the kidney transplant population, and 75% of these deaths occur in individuals with a functioning graft .…”

BK polyomavirus genotypes in renal transplant recipients in the United States: A meta‐analysis

“…Development of Donor specific antibodies leading to sequela of acute rejection seems to be a major consequence from reduction of immunosuppression for among patients with BKV infection with no available effective treatment options at this time . Thus, findings from our study on epidemiology of BKV genotypes may serve as a resource for development of vaccines against BKV in United States .…”

“…Despite advances in KTx in the past decades, there is still no effective BKV‐specific antiviral treatment and reduction of immunosuppression remains the mainstay treatment of BK viremia/nephropathy . Thus, both identification of those at higher risk for BK infection and BKV screening after KTx are crucial for prevention and early management of BK infection .…”

Infectious disease risks in xenotransplantation

“…2 Guidance documents from regulatory authorities and societies exist for clinical trials. Infection is included in the differential diagnosis of graft dysfunction in both allo-and xenotransplantation.…”

“…1,2 The transmission of infection with viable cells and tissues is efficient, notably for intracellular organisms and latent viruses, and is enhanced by the immunosuppression required to prevent graft rejection. 1,2 The transmission of infection with viable cells and tissues is efficient, notably for intracellular organisms and latent viruses, and is enhanced by the immunosuppression required to prevent graft rejection.…”