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In recent years, extensive research and newer therapeutic strategies have remarkably reduced the number of acute and chronic rejections and graft-versus-host disease (GVHD) and have significantly improved the survival of transplant recipients. On the other hand, transplant recipients are more vulnerable to a wide range of infections as immunosuppressive therapies not only suppress host T-cell response but also destroy other rapidly dividing cells resulting in neutropenia and...

Half a century has passed since the first orthotopic heart transplant took place. Surgical innovations allowed for heart, lung, and heart-lung transplantation to save lives of patients with incurable chronic cardiopulmonary conditions. The complexity of the surgical interventions, chronic host health conditions, and antirejection immunosuppressive medications makes infectious complications common. Infections have remained one of the main barriers for successful transplantation and a source...

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...

Invasive fungal infections are an important problem in the management of both solid organ and hematopoietic stem cell transplant recipients. This chapter summarizes the evidence and recommendations for preventing invasive fungal infections in transplant recipients. A summary of recommendations are presented in Table 64.1.

Infections are major complications in pediatric patients undergoing hematopoietic stem cell or solid organ transplantation. They also represent the most significant barrier to short- and long-term survival of the transplanted allograft. The achievements and advances during the past 30 years have resulted in remarkably improved outcome for pediatric patients undergoing transplantation. These advances in pediatric infectious disease supportive care have contributed substantially to the...

Infectious complications are a major cause of morbidity and mortality in patients undergoing solid organ or stem cell transplantation. Over the past years, advances in immunology and molecular biology have greatly contributed to a better understanding of the pathogenesis of opportunistic infections in the immunocompromised host. The lifelong immunosuppression required by the transplant recipients together with the limitations of the current anti-infective agents makes strategies able to...

The differential diagnosis of lung infiltrates in transplant patients includes non-infectious processes that may mimic pneumonia. Hydrostatic and non-cardiogenic pulmonary edema, as well as transfusion-related lung injury, may cause bilateral airspace opacification that may be confused with an infectious process. Chemotherapeutic agents, whether administered for treatment of an underlying hematologic malignancy, for induction prior to transplant, or for the treatment of GVHD or graft...

As organ transplant recipients live longer and healthier lives after transplant, they increasingly partake in foreign travel, for leisure, adventure, work, or to visit friends or relatives. A review of cohorts of transplant recipients shows that they tend to have minimal or suboptimal preparation prior to travel, with limited pre-travel vaccination, medications, and education, and overall poses greatly increased risk of travel-related infections and complications. Enhancing the knowledge of...

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...

Ocular infections in transplant patients can be rapidly progressive and result in significant vision loss and morbidity. Approximately 2% of transplant patients in several large series developed serious eye infections, and the most common were viral retinitis and fungal endophthalmitis. Viral retinitis is due to cytomegalovirus, herpes simplex, or herpes zoster. A particularly fulminant form of viral retinitis, progressive outer retinal necrosis, may occur and result in blindness within 1 to...

Infections of the central nervous system (ICNS) contribute significantly to morbidity and mortality in patients receiving solid organ and stem cell transplants. The risk for ICNS is influenced by multiple factors, including the organ transplanted, type and degree of immunosuppression, post-transplant adverse events, as well as donor characteristics. These infections may be classified by anatomic location – intracranial, spinal, and paraspinal – as well as by time of onset. The early...

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...

Infections involving the hepatobiliary tract contribute to significant morbidity and mortality in solid-organ transplant recipients, particularly recipients of a hepatic allograft. Bacteria within the gastrointestinal tract may colonize a dysfunctional biliary system, thereby increasing the risk for ascending cholangitis. Additionally, infections such as cytomegalovirus or Epstein-Barr virus may trigger life-threatening acute illness and foster risk for other opportunistic infections and...

Transplant-related immunosuppression is an important risk factor for the development of infectious diseases. The skin, as barrier to the outside world and the body’s largest organ, is particularly susceptible to both primary and disseminated infection. For the astute and thorough clinician, the skin is a useful marker of the health of the patient. It may provide clues to systemic disease and offers a chance at early diagnosis and prompt intervention.

Solid organ and hematopoietic stem cell transplant recipients are at increased risk of upper and lower respiratory tract infections. While these infections are frequently encountered in the general population, the spectrum of their clinical presentation including morbidity and mortality is increased in patients undergoing transplantation procedures. Impaired innate and adaptive immunity, potential anatomical abnormalities resulting from extensive surgical procedures, presences of indwelling...

Liver transplantation has become an important treatment modality for patients with end-stage liver disease/cirrhosis, acute liver failure, and hepatocellular carcinoma. Although surgical techniques and immunosuppressive regimens for liver transplantation have improved significantly over the past 20 years, infectious complications continue to contribute to the morbidity and mortality in this patient population. The use of standardized screening protocols for both donors and recipients,...

The optimal treatment for patients with chronic kidney disease (CKD) requiring renal replacement therapy/dialysis is kidney transplantation. Additionally, pancreas transplantation alone or simultaneous pancreas-kidney transplantation offers improved quality of life as well as reversion or prevention of complications seen in patients with type 1 diabetes mellitus. Patients with CKD on dialysis are at increased risk for bacterial and blood-borne viral pathogens. During the initial first month...

Febrile neutropenic patients are at increased risk of developing infections. During the initial stages of neutropenia, most of these infections are bacterial. The spectrum of bacterial infections depends to some extent on whether or not patients receive antimicrobial prophylaxis when neutropenic. Since most transplant recipients do, Gram-positive organisms predominate, due to the fact prophylaxis is directed primarily against Gram-negative organisms. Staphylococcus species (often...

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has become a widely used modality of therapy for a variety of malignant and nonmalignant diseases. Despite advances in pharmacotherapy and transplantation techniques, infection remains one of the most severe and frequently encountered complications of allo-HSCT.

Mycobacterial disease is commonly encountered during transplant evaluations and can be a major source of morbidity and mortality among transplant recipients. The impact of TB and NTM around the world has gained increased awareness, and the global impact of disease varies from country to country thus making mycobacterial epidemiology an important aspect of disease management. Risk factors for both tuberculosis (TB) and nontuberculous mycobacteria (NTM) must be assessed by transplant...