Infections in solid-organ transplantation: Difference between revisions
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== Pretransplant Screening == |
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* Bacterial: syphilis, urine and blood cultures, bronchoalveolar lavage |
* Bacterial: syphilis, urine and blood cultures, bronchoalveolar lavage |
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* Other: Strongyloides, Chagas (sometimes) |
* Other: Strongyloides, Chagas (sometimes) |
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= Recipient Screen = |
=== Recipient Screen === |
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* Prednisone: TB/HBV/Strongy |
* Prednisone: TB/HBV/Strongy |
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* TNF-alpha inhibitors: like prednisone |
* TNF-alpha inhibitors: like prednisone |
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== Post-Transplant Infections == |
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=== Early Infections (≤30 days) === |
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* ≤30 days |
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* T-cell deficit greater than B-cell |
* T-cell deficit greater than B-cell |
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* Anastomotic infection, including fungal Liver: anastamotic leak, including VRE peritonitis Hospital-acquired: central line infections and resistant organisms Donor-derived bacterial infections, including syphilis |
* Anastomotic infection, including fungal Liver: anastamotic leak, including VRE peritonitis Hospital-acquired: central line infections and resistant organisms Donor-derived bacterial infections, including syphilis |
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= Late Infections = |
=== Late Infections (30 days to 3-6 months) === |
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* 30 days to 3-6 months |
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* T-cell deficit greater than B-cell |
* T-cell deficit greater than B-cell |
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* TB, PCP, invasive fungal infections Occur as your withdraw prophylactic antimicrobials |
* TB, PCP, invasive fungal infections Occur as your withdraw prophylactic antimicrobials |
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= Very Late Infections = |
=== Very Late Infections (>6 months) === |
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* More than 6 months |
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* B-cell deficits and variable T-cell deficits |
* B-cell deficits and variable T-cell deficits |
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* Usually regular community-acquired infections, but more severe |
* Usually regular community-acquired infections, but more severe |
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Revision as of 19:44, 15 August 2019
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
