Infections in solid-organ transplantation

Infections in solid-organ transplantation

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

Early

≤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

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

• More than 6 months
• B-cell deficits and variable T-cell deficits
• Usually regular community-acquired infections, but more severe