The American Society of Transplantation Online Transplant Infectious Diseases Library

Despite the availability of an efficacious vaccine, yellow fever continues to pose an emerging human health issue, with outbreaks in Africa and South America. Although the majority of cases are oligosymptomatic, severe cases present high mortality, reaching an overall lethality of 50%. The mainstay for yellow fever control remains adequate vaccine coverage. Because the yellow fever vaccine is composed of live, attenuated virus, it is contraindicated in solid organ transplant (SOT) and...

Vascularized composite allografts, or VCA transplants, are allotransplants that incorporate multiple tissues transplanted as a single functional unit, most commonly hands or face. They are, by definition, transplants aimed at improving quality of life rather than life sparing. Yet they may also be life-giving in the case of temporary uterine transplants, where the goal is to carry a healthy pregnancy through to term and delivery. Because of the multiple tissue layers involved and the systemic...

This chapter reviews the epidemiology, clinical impact, diagnosis, prevention, and management of tuberculosis (TB) in solid organ and hematopoietic stem cell transplantation. Given the limitations of screening for latent TB using either the tuberculin skin test or interferon gamma release assays, it is important to also consider exposure history and chest imaging; promising new TB diagnostic strategies are currently under development. The clinical manifestations of active tuberculosis in...

The impact of pre-transplant (SOT) carbapenem-resistant Enterobacterales (CRE) colonization or infection on post-SOT outcomes is unclear. We conducted a multi-center, international, cohort study of SOT recipients, with microbiologically diagnosed CRE colonization and/or infection pre-SOT. Sixty adult SOT recipients were included (liver n = 30, hearts n = 17). Klebsiella pneumoniae (n = 47, 78%) was the most common pre-SOT CRE species. Median time from CRE detection to SOT was 2.32 months...

Hepatitis B virus (HBV) can be transmitted from organ donor to recipient, but details of transmission events are not widely published. The Disease Transmission Advisory Committee (DTAC) evaluated 105 cases of potential donor derived transmission events of HBV between 2009-2017. Proven, probable or possible transmission of HBV occurred in 25 (23.8%) cases. Recipients of liver grafts were most commonly infected (20 of 21 exposed recipients) compared to 9 of 21 exposed non-hepatic recipients....

We review different types of mechanical circulatory support devices available as a bridge to heart transplantation and then discuss infectious complications in these devices, with a particular focus on ventricular assist devices. We also discuss infection prevention and management strategies, in particular as relevent to transplantation.

Infectious and noninfectious pulmonary syndromes remain significant contributors to morbidity and mortality after solid organ and hematopoietic stem cell transplantation. Multiple factors increase the risk of pulmonary complications including the surgical trauma related to solid organ transplantation, chemotherapy and radiation prior to hematopoietic stem cell transplant, the degree of immunosuppression, and immune factors contributing to rejection and graft-versus-host disease. The first...

Rapidly growing mycobacteria (RGM) are environmental microorganisms that thrive in water-associated biofilms and grow more quickly in the laboratory than slow-growing nontuberculous mycobacteria. Prevalence of RGM infection appears to be increasing, and patients with structural lung disease and immunocompromised hosts, especially patients with cystic fibrosis or lung transplant recipients, are at increased risk. Transplant recipients can acquire RGM from the community or from healthcare...

Letermovir is a new antiviral drug approved for the prophylaxis of CMV infection in allogeneic stem cell transplants. The aim of the study was to assess the therapeutic efficacy of letermovir in difficult to treat CMV infections in lung transplant recipients. All lung transplant recipients between March 2018 and August 2020, who have been treated with letermovir for ganciclovir-resistant or refractory CMV infection were included in the study and analysed retrospectively. In total, 28...

Background Protecting against CMV infection and maintaining CMV in latent state are largely provided by CMV-specific T-cells in lung transplant recipients. The aim of the study was to assess whether a specific T-cell response is associated with the risk for CMV infection in seronegative patients who are at high risk for delayed CMV infection. Methods All CMV-seronegative recipients (R−) from CMV-seropositive donors (D+) between January 2018 and April 2019 were included and retrospectively...

Background Multidrug-resistant Gram-negative bacterial infections are increasingly common among solid organ transplant (SOT) recipients, leading to challenges in the selection of empiric antimicrobial therapy. We sought to develop a clinical tool to predict which SOT recipients are at high risk for extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales (EB) bloodstream infection (BSI). Methods A multicenter case-control study was performed. The source population included SOT...

Background HCT leaves patients in a relative state of immune deficiency both during their initial transplant admission and for several years following discharge. NTM are generally harmless colonizers of the outside environment, but for immunocompromised patients, they can cause significant disease due to a paucity of T-cell defense. While routine prophylaxis against NTM is recommended for patients with low CD4 counts in certain clinical settings (eg, AIDS), this is not yet established for...

Over the last half a century, there have been innumerable advances in our understanding of the human immune system. We now have a better understanding not only of the ways our innate and adaptive immune pathways interact to seek out and control infection and malignancy, but we are closer to understanding some of the control mechanisms behind tissue rejection. Organ allograft rejection, with consequent loss of graft function, remains one of the most challenging problems facing solid organ...

Respiratory syncytial virus (RSV) causes significant morbidity and mortality in immunocompromised hosts with particular burden among allogeneic hematopoietic stem cell transplant and lung transplant recipients. Affected patients have a substantial risk of secondary infection, ICU admission, or death. Improved diagnostic testing with better sensitivity has given new insights into the epidemiology of disease. In particular, it has highlighted the issue of nosocomial transmission and hospital...

Epstein-Barr virus (EBV) is an important potential cause of morbidity and mortality in children and adults undergoing solid organ (SOT) and hematopoietic stem cell transplantation (HSCT). The EBV virus is associated with a range of clinical symptoms and syndromes in both immunocompetent and immunocompromised patients based upon the virus’ ability to transform and immortalize B lymphocytes leading to viral-driven proliferation of infected B cells. In the immunocompetent host, this...

Background: Immunocompromised individuals are at risk for Nocardia infection, with a recurrence rate of approximately 5%. Solid organ transplant (SOT) recipients often receive secondary prophylaxis due to their requirement of lifelong immunosuppression. However, data supporting this practice is sparse. We sought to evaluate Nocardia recurrence in SOT recipients, specifically evaluating secondary prophylaxis. Methods: We conducted a retrospective cohort study of SOT recipients diagnosed with...