Solid Organ Transplant Infections Quiz

Infections in Solid Organ Transplantation: Prophylaxis and Treatment

• Solid organ transplantation carries the risk of transmission of bacterial, viral, fungal, and parasitic infections.

• Donor-derived infections (DDIs) occur in less than 1% of all transplant procedures in the United States.

• The incidence of DDIs is low, but when transmission occurs, significant morbidity and mortality can result.

• Common viral infections in transplant patients include cytomegalovirus (CMV), BK virus, Epstein Bar virus (EBV), and varicella (herpes) zoster virus.

• Common bacterial infections in transplant patients include skin and soft tissue infections and urinary tract infections (UTIs).

• UTIs are the most prevalent primary source of bacterial infection over 6 months post-transplant, with common pathogens such as E. coli, Enterococcus faecium, Klebsiella species, S. aureus, Enterobacter species, and Enterococcus faecalis.

• Risk factors for UTI in transplant patients include age, diabetes, and long-term use of a urinary indwelling catheter.

• Prophylactic use of TMP/SMZ for the prevention of Pneumocystis jirovecii pneumonia as well as UTIs is common, but UTIs are considered less preventable due to increasing rates of TMP/SMZ resistance.

• Post-transplant bacterial infections are treated per guideline recommendation for that specific disease, with drug therapy streamlined when culture and sensitivity reports return.

• Prophylactic oral or topical antifungal agents may be indicated for mucocutaneous fungal infections in immunosuppressed transplant recipients.

• Liver, pancreas, and small bowel transplant recipients are at high risk for invasive fungal infections and should receive prophylaxis with fluconazole.

• Prophylaxis with inhaled LAMB, high-dose fluconazole, itraconazole, voriconazole, and echinocandins have all been reported, but data supporting either the general recommendation for prophylaxis or choice of specific agent are largely lacking with center-to-center variability.Antiviral Prophylaxis and Management in Solid Organ Transplantation

• Solid organ transplant recipients are at high risk for opportunistic infections, including toxoplasmosis, cytomegalovirus (CMV), BK virus, and Epstein Barr virus (EBV).

• Patients receiving trimethoprim-sulfamethoxazole for P. jiroveci prophylaxis are also protected against T. gondii and N. asteroides.

• Patients are advised to have their pets taken care of by others during the first 6 months to 1 year post-transplant to reduce the risk of toxoplasmosis.

• Prophylaxis with IV ganciclovir or oral valganciclovir is effective in reducing the incidence of both primary and reactivated CMV infection.

• Preemptive ganciclovir or valganciclovir, initiated after actual isolation of CMV from blood, urine, or other sites, is more effective than acyclovir in preventing CMV disease in liver transplant recipients.

• Whether prophylaxis or preemptive therapy is the best approach to preventing CMV disease is controversial, with concerns about prolonged exposure to drugs leading to viral resistance.

• Prophylactic therapy is recommended primarily in patients at highest risk of disease, while lower-risk patients are often recommended to receive only preemptive therapy.

• Prophylaxis is routinely recommended for all lung transplant recipients due to the high risk of CMV infection and disease.

• Oral valganciclovir is a suitable alternative to intravenous ganciclovir, with a comparable daily exposure of ganciclovir.

• BK virus infection in renal transplant recipients is associated with viruria, viremia, and polyomavirus-associated nephropathy, and there is no accepted treatment other than reduction in immunosuppression.

• Epstein Barr virus (EBV) is associated with greatly increased risk of post-transplant lymphoproliferative disorder (PTLD) in EBV seronegative individuals, with insufficient data to support routine use of antiviral prophylaxis.

• Valganciclovir is recommended for CMV prophylaxis in patients with a high risk of infection, such as those with a CMV mismatch (donor positive, recipient negative), while other medications should be adjusted based on the individual patient's needs.

Infections in Solid Organ Transplantation: Prophylaxis and Treatment

• Solid organ transplantation carries the risk of transmission of bacterial, viral, fungal, and parasitic infections.

• Donor-derived infections (DDIs) occur in less than 1% of all transplant procedures in the United States.

• The incidence of DDIs is low, but when transmission occurs, significant morbidity and mortality can result.

• Common viral infections in transplant patients include cytomegalovirus (CMV), BK virus, Epstein Bar virus (EBV), and varicella (herpes) zoster virus.

• Common bacterial infections in transplant patients include skin and soft tissue infections and urinary tract infections (UTIs).

• UTIs are the most prevalent primary source of bacterial infection over 6 months post-transplant, with common pathogens such as E. coli, Enterococcus faecium, Klebsiella species, S. aureus, Enterobacter species, and Enterococcus faecalis.

• Risk factors for UTI in transplant patients include age, diabetes, and long-term use of a urinary indwelling catheter.

• Prophylactic use of TMP/SMZ for the prevention of Pneumocystis jirovecii pneumonia as well as UTIs is common, but UTIs are considered less preventable due to increasing rates of TMP/SMZ resistance.

• Post-transplant bacterial infections are treated per guideline recommendation for that specific disease, with drug therapy streamlined when culture and sensitivity reports return.

• Prophylactic oral or topical antifungal agents may be indicated for mucocutaneous fungal infections in immunosuppressed transplant recipients.

• Liver, pancreas, and small bowel transplant recipients are at high risk for invasive fungal infections and should receive prophylaxis with fluconazole.

• Prophylaxis with inhaled LAMB, high-dose fluconazole, itraconazole, voriconazole, and echinocandins have all been reported, but data supporting either the general recommendation for prophylaxis or choice of specific agent are largely lacking with center-to-center variability.Antiviral Prophylaxis and Management in Solid Organ Transplantation

• Solid organ transplant recipients are at high risk for opportunistic infections, including toxoplasmosis, cytomegalovirus (CMV), BK virus, and Epstein Barr virus (EBV).

• Patients receiving trimethoprim-sulfamethoxazole for P. jiroveci prophylaxis are also protected against T. gondii and N. asteroides.

• Patients are advised to have their pets taken care of by others during the first 6 months to 1 year post-transplant to reduce the risk of toxoplasmosis.

• Prophylaxis with IV ganciclovir or oral valganciclovir is effective in reducing the incidence of both primary and reactivated CMV infection.

• Preemptive ganciclovir or valganciclovir, initiated after actual isolation of CMV from blood, urine, or other sites, is more effective than acyclovir in preventing CMV disease in liver transplant recipients.

• Whether prophylaxis or preemptive therapy is the best approach to preventing CMV disease is controversial, with concerns about prolonged exposure to drugs leading to viral resistance.

• Prophylactic therapy is recommended primarily in patients at highest risk of disease, while lower-risk patients are often recommended to receive only preemptive therapy.

• Prophylaxis is routinely recommended for all lung transplant recipients due to the high risk of CMV infection and disease.

• Oral valganciclovir is a suitable alternative to intravenous ganciclovir, with a comparable daily exposure of ganciclovir.

• BK virus infection in renal transplant recipients is associated with viruria, viremia, and polyomavirus-associated nephropathy, and there is no accepted treatment other than reduction in immunosuppression.

• Epstein Barr virus (EBV) is associated with greatly increased risk of post-transplant lymphoproliferative disorder (PTLD) in EBV seronegative individuals, with insufficient data to support routine use of antiviral prophylaxis.

• Valganciclovir is recommended for CMV prophylaxis in patients with a high risk of infection, such as those with a CMV mismatch (donor positive, recipient negative), while other medications should be adjusted based on the individual patient's needs.