Infections in solid-organ transplantation

Pretransplant Screening

Donor screen

• Bacterial: syphilis, urine and blood cultures, bronchoalveolar lavage
• Viral: CMV, EBV, HIV HBV, HCV, HSV, VZV, HTLV-1
• Other: Strongyloides, Chagas (sometimes)

Recipient Screen

• Prednisone: TB/HBV/Strongy
• Fludarabine:
  • Lasts 6-12 months after last dose
  • Listeria, PCP, and Nocardia
• Rituximab: as well as B-cell, can allow HBV and PJP infections
• Adalimumab: T-cell deficiency for months after last dose
• TNF-alpha inhibitors: like prednisone

Post-Transplant Infections

Early Infections (≤30 days)

• T-cell deficit greater than B-cell

• Surgical site infection
  • Bacterial
  • Fungal: Aspergillus and Mucor Organ-specific Cardiac
• LVAD infection
• Mycobacterial infection (very late) Lungs
• Donor-derived VAP
• Anastomotic infection, including fungal Liver: anastamotic leak, including VRE peritonitis Hospital-acquired: central line infections and resistant organisms Donor-derived bacterial infections, including syphilis

Late Infections (30 days to 3-6 months)

• T-cell deficit greater than B-cell

• Reactivation infections
• EBV/CMV/HSV/VZV
• TB, PCP, invasive fungal infections Occur as your withdraw prophylactic antimicrobials

Very Late Infections (>6 months)

• B-cell deficits and variable T-cell deficits
• Usually regular community-acquired infections, but more severe