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TRANSPLANT INFECTIONS
Apex Physicians partners with our solid organ (face, heart, lung, liver, kidney, intestine, multi-visceral, pancreas, and uterus) and our stem cell transplant programs to facilitate care and prevent infection for
these at-risk patients.
INCIDENCE OF INFECTION
Following solid-organ transplantation varies because of several factors. The type of organ transplanted, the degree of immunosuppression, the need for additional antirejection therapy, and the occurrence of technical or surgical complications all affect the incidence of infection after transplantation. The anatomical
region of the transplant dictates to a great extent the type of infection
that may occur.
Furthermore, investigators have demonstrated that viral
infections, such as cytomegalovirus (CMV) and
hepatitis C (HCV), influence the likelihood of opportunistic
infections occurring, whether bacterial or fungal.
These infections contribute to the net state of immunosuppression and weaken host defenses. In addition, antirejection therapy also contributes to the increase in infectious complications. The other major factor in the development of infection is exposure to a donor pathogen when a recipient is at risk for primary infection (i.e., absence of preexisting immunity). The most common manifestation of these risk strata is primary CMV infection and disease, in which this subset has the highest risk of disease and complications, regardless of the type of organ transplanted.
INFECTION TIMELINES
Most infections during the first month (early perioperative period) after transplantation are related to surgical complications. They include bacterial and candida wound infections, pneumonia, urinary tract infection, intravascular catheter sepsis, infections of the biliary, chest, and other drainage catheters, and C. difficile.
The period from the second to the sixth month after transplantation is the time during which infections “classically” associated with transplantation become manifest. Opportunistic pathogens such as CMV, Pneumocystis carinii, Aspergillus species, Nocardia species, Toxoplasma gondii, and Listeria monocytogenes typically occur in this time frame.
From 6 months (late posttransplant period) after transplantation onward, most transplant recipients do well, suffering from the same infections seen in the general community. These include influenza virus infection, urinary tract infection, and pneumococcal pneumonia. The only opportunistic viral infection commonly seen during this period is reactivated varicella-zoster virus infection manifesting as herpes zoster.
It should be noted that the epidemiology of infections after transplantation is changing dramatically because of improved surgical techniques, improved types of immunosuppressive agents, and improved diagnostic capabilities.
RISK FACTORS FOR INFECTION
Transplant recipients are at increased risk for infections due to the use of anti-rejection medications that impair the immune response. Microbes that our body controls quite easily before transplantation can cause serious infection after transplantation. Depending on the transplant type, 10-75% of transplant recipients can expect infection in the first year after transplantation.
TRANSPLANTATION INFECTION PREVENTION
Apex Physicians provide vaccinations, anti-microbial medications, and educational strategies to prevent infections after transplant. Some serious infections are acquired during daily activities, including gardening and spending time with young children. Learning how to live safely after transplantation is important to the success of transplantation.
TRANSPLANTATION INFECTION TREATMENT
We aim to recognize early signs of infection and treat them expeditiously. Once recognized we use a variety of modalities to treat infection, including antibiotics, immunologic tools, and surgical/interventional radiologic techniques.