The American Society of Transplantation Online Transplant Infectious Diseases Library

Following solid organ and hematopoietic stem cell transplantation, patients are at increased risk for community-acquired infections, opportunistic and uncommon pathogens, coinfections, and multidrug-resistant organisms. Given the increased predilection for serious infection in this population, diagnostics applicable to the practice of transplant infectious diseases are essential. In the last decade, diagnostic microbiology has witnessed a shift toward culture-independent methods such as...

Cryptococcosis is the third most common invasive fungal infection in solid organ transplant (SOT) recipients, but is rare among recipients of hematopoietic stem cell transplant (HSCT). Infection often occurs a year after transplantation; however early infections are common in HSCT. Among SOT patients, donorderived infections have been described within 3 months after transplant. The most common disease manifestations are meningitis and pneumonia. The fungi Cryptococcus neoformans and C. gattii are the main causes of cryptococcosis.

Background Vaccination against hepatitis B virus (HBV) has led to a worldwide reduction in disease burden and mortality. Vaccine immunogenicity data in transplanted children are limited, and vaccine-induced protection may be reduced. We evaluated HBV vaccination coverage, seroprotection rates, and factors influencing vaccine immunity among pediatric solid organ transplant (SOT) patients. Methods We retrospectively identified patients ≤21 years of age evaluated for SOT and/or transplanted at...

Acinetobacter infections have emerged as an important pathogen in transplant recipients. It is a major cause of multidrug-resistant nosocomial infections, particularly pneumonia and bloodstream infections, and is associated with high morbidity and mortality. Given the organism’s propensity to develop resistance to multiple classes of antibiotics, treatment options can be limited but frequently include carbapenems, polymyxins, sulbactams, tetracyclines, and glycylcyclines. Infection...

Candida remains a common infectious complication in the setting of solid organ transplantation. The rates of invasive Candida infection vary among organ transplant, with small bowel accounting for the majority of cases. In this chapter, we review the epidemiology of Candida infections following organ transplantation. While C. albicans continues to be the most common fungal species isolated, more recent data show that non-albicans Candida species are on the rise, specifically drug-resistant...

Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms found in soil and water. The expansion of the transplant population combined with an increase in environmental exposures and improvements in mycobacterial diagnosis has contributed to a rise in the diagnosis of NTM infections among transplant recipients, who are at particular risk for infection as well as increased associated morbidity and mortality.

In order to minimize a solid organ transplant (SOT) recipient’s risk for infection and injury, it is important to anticipate the risks post-transplantation inherent in routine and not so routine activities of daily living. The benefits of longevity by virtue of organ transplantation need to be closely protected by education before, during, and after transplantation about potential infectious risks and measures to mitigate such exposures. SOT recipients cannot stand alone in their efforts...

Infection of the anogenital tract with human papillomavirus (HPV) is very common. Approximately 15–20 anogenital HPV types are oncogenic or “high-risk” and are associated with 99.9% of cervical cancers, 90% of anal cancers, 70% of oropharyngeal cancers, and a high proportion of vaginal, penile, and vulvar cancers. Defects in cellular immunity make solid organ transplant (SOT) recipients particularly susceptible to persistent high-risk HPV infection, development of the cancer precursor...

Transplant tourism and travel posttransplant, both solid organ and hematopoietic stem cell, are important and distinct topics, and each poses a risk of infection for transplant recipients. As solid organ transplant becomes a more common treatment option for end-stage organ disease, wait lists and wait times for these organs grow. Transplant tourism involves traveling abroad for the purposes of organ transplant and often involves commercial transactions. This process has been discouraged on...

Human herpesvirus 5, better known as cytomegalovirus (CMV), infects 50–90% of the adult population worldwide and is the most common opportunistic infection in allogeneic hematopoietic stem cell transplant (HSCT) recipients, causing significant morbidity and mortality [1–6]. Without prophylaxis, CMV reactivation occurs in up to 70–80% of CMV-seropositive individuals [6–9]. This chapter will review the current understanding of CMV infection in HSCT recipients focusing on emerging concepts and...

The purpose of this review is to describe the characteristics of dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) in transplant recipients. The majority of reported cases were transmitted by mosquito bite, but blood and graft transmission may occur. These arbovirus infections are clinically similar, resembling influenza-like illness or frequent transplant syndromes. Therefore, laboratory confirmation is necessary. In the acute phase, nucleic acid tests are preferred. DENV and ZIKV serology...

Diarrhea in the pediatric solid organ transplantation (SOT) recipient is a frequent complaint that is associated with significant morbidity and impaired quality of life. There are limited published data regarding the specific epidemiology, diagnostic evaluation, and treatment of diarrhea after SOT in children. Pediatric SOT recipients have an increased risk of developing diarrhea because of a generalized immunosuppressed state, epidemiologic exposures, and polypharmacy. There is a need to...

Belatacept may increase cytomegalovirus (CMV) disease risk after conversion from CNI-based therapy. We analyzed CMV disease characteristics after belatacept conversion. Propensity score matching was used to compare CMV disease incidence in belatacept- and CNI-treated kidney transplant recipients (KTRs). CMV disease characteristics and risk factors under belatacept were analyzed. In total, 223 KTRs (median age [IQR] 59.2 years [45.4–68.5]) were converted to belatacept (median of 11.5 months...

Infections due to Mucorales fungi in hematopoietic stem cell transplantation (HSCT) and solid organ transplant (SOT) recipients may be increasing. Disease is severe and rapidly progressive and carries high mortality. Both the prevalence and species epidemiology vary with geography. Rhizopus species is the most common pathogen followed by Mucor species. Risk factors in SOT patients include renal failure, diabetes mellitus, and immunosuppression to prevent rejection. Additional risks in HSCT...

Leishmaniasis is a rare disease in both solid-organ and hematopoietic stem cell transplantation. Additionally, the frequency of disease is likely related to the leishmaniasis prevalence in the general population. Although cutaneous leishmaniasis (CL) presentation is more prevalent than that of visceral leishmaniasis (VL) in the general population, the opposite occurs in transplant patients. The current available knowledge is based on small series, case reports, or extrapolations from studies...