Infections in transplant

Bacterial Infection

• Risk highest during the 1st month
• Infections in the wound, respiratory tract and urinary tract
• Standard practice to give a broad-spectrum antibiotic to cover the peri-op period
• Risk of bacterial infection greatest in
  • Recipients who are critically ill before or after surgery
  • Who are in ICU with IDC and lines

Viral Infection

• Risk highest during the first 6 months
• Most common problem is CMV
• Herpes Simplex Virus (HSV)
• Herpes Zoster

CMV Infection

• May arise because of reactivation of latent infection
  • Or primary infection transmitted by an organ from a CMV-positive donor
• Recipients at most risk
  • CMV-seronegative who receive an organ from CMV-seropositive donor
  • Can match to avoid this but is not practicable
• Typically presents with high swinging fever, lethargy and leucopenia
  • Severity of disease variable and clinical picture depends on organ system most affected
• Can present as
  • Pneumonia
  • Gastrointestinal disease
  • Hepatitis
  • Retinitis
  • Encephalitis
  • Severe CMV disease is potentially fatal
• Prophylaxis
  • Passive immunization using hyperimmune immunoglobulin
  • More commonly: Anti-viral agents
    • Acyclovir, Valaciclovir, Ganciclovir or Valganciclovir
• Diagnosis:
  • Serology, detection of CMV antigen in serum, CMV culture, viral DNA PCR, histological examination of biopsy material
• Treatment - anti-viral agents
  • More effective when given pre-emptively

Human Herpesviruses

• Herpes Simplex Virus 1 and 2
  • Common
    • Usually due to reactivation of latent infection
    • Mucocutaneous lesions around mouth and genitalia
  • Treatment
    • Topical treatment with Acyclovir
    • Severe cases may need systemic anti-viral therapy
  • Disseminated HSV infection rare
• Herpes Zoster
  • Reactivation of latent Varicella Zoster virus
  • More frequent in transplant patients
  • Should be treated with systemic anti-viral therapy
  • Primary varicella zoster virus infection (chickenpox)
    • Potentially very serious in immunosuppressed patients
  • Relatively uncommon as most adults have acquired immunity

Protozoal Infection

• Pneumocystis carinii most important
• Occurs during the first few months
  • Presents with respiratory symptoms
• Diagnosis:
  • Bronchoalveolar lavage fluid
  • Lung biopsy
• Prophylaxis with Cotrimoxazole effective
• Continued for up to 6 months after transplantation

Fungal Infection

• Invasive fungal infections are uncommon in renal transplant recipients
• Infection with Candida or Aspergillus is more common after other types of solid organ transplantation
• Usually occurs in the first 3 months after transplantation
• Early diagnosis and aggressive treatment essential to avoid fatal infection