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 stercoralis, Chagas disease (sometimes)

Recipient Screen

• Prednisone: TB/HBV/Strongyloides
• 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-α inhibitors: similar to prednisone

Post-Transplant Infections

Early Infections (≤30 days)

• Major risk factor is T-cell deficit, more than than B-cell deficit
• Surgical site infection
  • Bacterial
  • Fungal: Aspergillus and Mucorales
• 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)

• Major risk factor is T-cell deficit, more than B-cell deficit
• Occur as your withdraw prophylactic antimicrobials
• Reactivation infections
  • EBV/CMV/HSV/VZV
  • TB, PCP, invasive fungal infections

Very Late Infections (>6 months)

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