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Abstract. These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to t

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the management of transplantation in HIV-infected individuals. Transplantation has become the standard of care for patients with HIV and end-stage kidney or liver disease. Although less data exist for thoracic organ and pancreas transplantation, it is likely that transplantation is also safe and effective for these recipients as well. Despite what is typically a...

These guidelines from the American Society of Transplantation Infectious Diseases Community of Practice update the epidemiology and management of human papillomavirus (HPV) infections in organ transplant recipients. HPV is one of the most common sexually transmitted infections and is associated with cancers of the anogenital region. Increasing evidence suggests an association with head and neck cancers as well. Solid organ transplant recipients have a higher risk of HPV infection than the...

These updated guidelines of the AST IDCOP review vaccination of solid organ transplant candidates and recipients. General principles of vaccination as well as the use of specific vaccines in this population are discussed. Vaccination should be reviewed in the pre-transplant setting and appropriate vaccines updated. Both inactivated and live vaccines can be given pre-transplant. The timing of vaccination post-transplant should be taken into account. In the post-transplant setting, inactivated...

Clinical manifestations of human parvovirus B19 infection can vary widely and may be atypical in solid organ transplant (SOT) recipients. However, disease is apparent when there is destruction of erythrocyte progenitor cells leading to severe acute or chronic anemia with lack of an appropriate reticulocyte response in the setting of active parvovirus B19 infection. Serology may not reliably establish the diagnosis. High-level viremia is more likely to be associated with symptomatic disease....

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of adenovirus infections after solid organ transplantation. Adenovirus is an important cause of infectious complications in both stem cell transplant and SOT patients, causing a range of clinical syndromes including pneumonitis, colitis, and disseminated disease. The current update of the guidelines highlights that adenovirus...

Parvovirus B19 was discovered in 1975, and the first reports associating B19 with human disease came 6 years later, when B19 was linked to cases of aplastic crisis in patients with sickle cell disease. Since then, B19 infection has become a recognized infectious complication in the immunocompromised host, including persons infected with human immunodeficiency virus (HIV), as well as solid organ (SOT) and hematopoietic cell transplant (HCT) recipients. While typically a benign, self-limited...

The present AST-IDCOP guidelines update information on BK polyomavirus (BKPyV) infection, replication, and disease, which impact kidney transplantation (KT), but rarely non-kidney solid organ transplantation (SOT). As pretransplant risk factors in KT donors and recipients presently do not translate into clinically validated measures regarding organ allocation, antiviral prophylaxis, or screening, all KT recipients should be screened for BKPyV-DNAemia monthly until month 9, and then every 3...

West Nile virus (WNV) is an emerging pathogen endemic in Africa and Europe. Recent events demonstrate the speed with which a vector-borne disease like WNV can disseminate when introduced into a susceptible, pathogen-naïve population, where competent reservoir and vectors are present. Since the arrival of WNV to the North American continent in 1999, it is estimated that 2–4 million people have been infected in the USA alone. It has special relevance to the immunocompromised host populations...

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of HSV in the pre- and post-transplant period. A majority of transplant recipients are seropositive for HSV-1 or 2. Compared with immunocompetent persons, SOT recipients shed HSV more frequently, have more severe clinical manifestations, and are slower to respond to therapy. Most HSV infection is diagnosed on clinical grounds,...

Respiratory viral infections (RVIs) are common among the general population; however, these often mild viral illnesses can lead to serious morbidity and mortality among recipients of hematopoietic stem cell and solid organ transplantation. The disease spectrum ranges from asymptomatic or mild infections to life-threatening lower respiratory tract infection or long-term airflow obstruction syndromes. Progression to lower respiratory tract infection or to respiratory failure is determined by...

Viral hepatitis remains the leading cause of liver failure and is the primary indication for liver transplantation worldwide. Hepatitis viruses are categorized into five distinct subtypes that collectively render significant morbidity and mortality in transplanted patients. Each subtype has a distinct replication pattern, pathology, and treatment. While the primary pathology mediated by these viruses occurs within the liver, significant extrahepatic disease may be observed with particular...

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of HHV-6A, HHV-6B, HHV-7, and HHV-8 in the pre- and post-transplant period. The majority of HHV-6 (A and B) and HHV-7 infections in transplant recipients are asymptomatic; symptomatic disease is reported infrequently across organs. Routine screening for HHV-6 and 7 DNAemia is not recommended in asymptomatic patients, nor is...

These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the diagnosis, prevention, and management of varicella zoster virus (VZV) in the pre- and post-transplant period. Primary varicella is an uncommon complication post-solid-organ transplant (SOT), except among pediatric transplant patients and those seronegative for VZV. As the majority of SOT recipients are seropositive for VZV, herpes zoster (HZ) occurs frequently following...

Live-attenuated vaccines are currently contraindicated in solid-organ transplant recipients. However, the risk of vaccine-preventable infections is lifelong, and can be particularly severe after transplantation. In this prospective interventional national cohort study, 44 pediatric liver transplant recipients with measles IgG antibodies <150 IU/L (below seroprotection threshold) received measles-mumps-rubella vaccine (MMR) at a median of 6.3 years posttransplantation (interquartile range,...

Human herpes viruses are a family of double-stranded DNA viruses that cause opportunistic infections in solid organ and hematopoietic stem cell transplant recipients. Alpha-herpesviruses cause localized ulcerative mucosal and vesicular cutaneous lesions, with the tendency to disseminate if not treated early and aggressively. Beta-herpes viruses, discussed in this chapter such as human herpes viruses 6 and 7, may rarely cause a febrile illness and a skin rash; however, HHV6 in recipients of...

Cytomegalovirus (CMV) is one of the most common opportunistic infections that affect the outcome of solid organ transplantation. This updated guideline from the American Society of Transplantation Infectious Diseases Community of Practice provides evidence-based and expert recommendations for screening, diagnosis, prevention, and treatment of CMV in solid organ transplant recipients. CMV serology to detect immunoglobulin G remains as the standard method for pretransplant screening of donors...

In the general population, cytomegalovirus (CMV) is a common infection that is frequently acquired at a young age; one in three children in the United States are infected with CMV. In patients undergoing transplantation, CMV most frequently presents as reactivation of a remotely acquired infection, whereas primary CMV infection in seronegative (−) recipients transmitted via allografts harvested from CMV-seropositive (+) donors poses the greatest threat of infection and viral end-organ...

Viral infections account for a large proportion of emerging infectious diseases, and the agents included in this group consist of recently identified viruses as well as previously identified viruses with an apparent increase in disease incidence. In transplant recipients, this group can include viruses with no recognized pathogenicity in immunocompetent patients and those that result in atypical or more severe disease presentations in the immunocompromised host. In this chapter, we begin by...