The American Society of Transplantation Online Transplant Infectious Diseases Library

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of Pneumocystis jiroveci fungal infection transplant recipients. Pneumonia (PJP) may develop via airborne transmission or reactivation of prior infection. Nosocomial clusters of infection have been described among transplant recipients. PJP should not occur during prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX)....

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...

Infections caused by Candida species range from local mucous membrane involvement to widely disseminated disease. In patients who have received a hematopoietic cell or solid organ transplant, candidiasis is one of the most common infections that is seen and is often life threatening. Candida species are part of the normal human microbiota and, as such, rarely cause infection in healthy hosts. Infections arise when the organisms are able to proliferate locally and gain access to the...

Epstein-Barr virus (EBV) is an oncogenic herpesvirus with a worldwide seroprevalence of >90%. Like all members of the herpesvirus family, EBV establishes infection that persists for the lifetime of the host. In most healthy patients, both primary EBV infection and lifelong latent infection are benign. However, in an immunocompromised host, such as a transplant recipient, either primary infection or reactivation of latent infection can lead to severe disease. The most significant...

Intestinal and multivisceral transplantation are associated with a significantly higher risk of infectious complications compared to other transplants. In this chapter we describe the approach to common infections after intestinal and multivisceral transplantation along with recent developments in the understanding of the gut microbiota and intestinal immune homeostasis.

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of urinary tract infections (UTI) in solid organ transplantation, focusing on kidney transplant (KT) recipients. KT recipients have unique risk factors for UTI, including indwelling stents and surgical manipulation of the genitourinary tract. KT recipients experience multi-drug antibiotic-resistant infections—UTI prevention...

This new guideline from the AST IDCOP reviews intra-abdominal infections (IAIs), which cause substantial morbidity and mortality among abdominal SOT recipients. Each transplant type carries unique risks for IAI, though peritonitis occurs in all abdominal transplant recipients. Biliary infections, bilomas, and intra-abdominal and intrahepatic abscesses are common after liver transplantation and are associated with the type of biliary anastomosis, the presence of vascular thrombosis or...

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...

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...

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...

Background Recurrent urinary tract infections (UTI) are an important cause of morbidity and mortality in renal transplant recipients (RTR). Methods In this retrospective study we gathered clinical data from patients prescribed methenamine hippurate to prevent recurrent UTI pre- and post-intervention. Thirty-eight RTR ≥18 years old at Northwestern Memorial Hospital from 2006-2017 were included in the final analysis. Results The median and range for follow-up days were 365 (299-365) pre- vs...

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.

These updated AST-IDCOP guidelines provide information on epidemiology, diagnosis, and management of Aspergillus after organ transplantation. Aspergillus is the most common invasive mold infection in solid-organ transplant (SOT) recipients, and it is the most common invasive fungal infection among lung transplant recipients. Time from transplant to diagnosis of invasive aspergillosis (IA) is variable, but most cases present within the first year post-transplant, with shortest time to onset...

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...

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of Human T-cell lymphotrophic virus 1 (HTLV)-1 in the pre- and post-transplant period. HTLV-1 is an oncogenic human retrovirus rare in North America but endemic in the Caribbean and parts of Africa, South America, Asia, and Oceania. While most infected persons do not develop disease, <5% will develop adult T-cell...

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...