South Asian Transplant Infectious Disease Guidelines for Solid Organ Transplant Candidates, Recipients, and Donors

Abstract

These guidelines discuss the epidemiology, screening, diagnosis, posttransplant prophylaxis, monitoring, and management of endemic infections in solid organ transplant (SOT) candidates, recipients, and donors in South Asia. The guidelines also provide recommendations for SOT recipients traveling to this region. These guidelines are based on literature review and expert opinion by transplant physicians, surgeons, and infectious diseases specialists, mostly from South Asian countries (India, Pakistan, Bangladesh, Nepal, and Sri Lanka) as well as transplant experts from other countries. These guidelines cover relevant endemic bacterial infections (tuberculosis, leptospirosis, melioidosis, typhoid, scrub typhus), viral infections (hepatitis A, B, C, D, and E; rabies; and the arboviruses including dengue, chikungunya, Zika, Japanese encephalitis), endemic fungal infections (mucormycosis, histoplasmosis, talaromycosis, sporotrichosis), and endemic parasitic infections (malaria, leishmaniasis, toxoplasmosis, cryptosporidiosis, strongyloidiasis, and filariasis) as well as travelers’ diarrhea and vaccination for SOT candidates and recipients including travelers visiting this region. These guidelines are intended to be an overview of each topic; more detailed reviews are being published as a special supplement in the Indian Journal of Transplantation.

Donor-derived infections in solid organ transplant recipients

“…Due to variable clinical presentation and underdiagnosis with therapeutic delays, DDIs due to S. stercoralis have been associated in most series with unfavorable outcomes [1,40 && ]. Previous screening recommendations have focused on preventing reactivation by testing for chronic infection in at-risk recipients, but current guidelines recommend screening program for S. stercoralis to be strongly considered also in donors with epidemiologic risk factors (based on country of origin and travel history) or unexplained eosinophilia [41,42]. Areas with high endemicity include Southeast Asia, Central and South America, Africa, Bangladesh, and Pakistan (estimated 10-60% incidence).…”