Evaluation for infection before solid organ transplantation
- Jay A Fishman, MD
Jay A Fishman, MD
- Professor of Medicine
- Harvard Medical School
- Director, Transplant Infectious Disease and Compromised Host Program
- Massachusetts General Hospital
Solid organ transplantation is the therapy of choice for a variety of types of organ failure. Two major complications, infection and malignancy, are the result of the life-long immunosuppression needed to maintain allograft function. The pretransplant evaluation identifies opportunities to assess the risks for common post-transplant infections and to develop individualized preventative strategies.
The components of the pretransplant evaluation will be reviewed here. The infections that follow solid organ transplantation are discussed separately. (See "Infection in the solid organ transplant recipient" and "Prophylaxis of infections in solid organ transplantation" and "Nontuberculous mycobacterial infections in solid organ transplant candidates and recipients" and "Tuberculosis in solid organ transplant candidates and recipients" and "Infectious complications in liver transplantation" and "Bacterial infections following lung transplantation" and "Fungal infections following lung transplantation" and "Prevention of cytomegalovirus infection in lung transplant recipients" and "Clinical manifestations, diagnosis, and treatment of cytomegalovirus infection in lung transplant recipients" and "Differential diagnosis of infection following renal transplantation" and "Clinical manifestations, diagnosis, and management of cytomegalovirus disease in kidney transplant recipients".)
CAUSES OF INFECTION
The organisms commonly associated with posttransplant infection are the result of reactivation of latent infection carried by the donor organ or the recipient or are due to new exposures in the community or in the hospital [1,2]. Latent infection refers to organisms residing in a suppressed state in the recipient or in the donor tissue. Cytomegalovirus, Epstein-Barr virus, Toxoplasma gondii, Strongyloides stercoralis, and Trypanosoma cruzi are examples of organisms that can exist in the normal host and are, in general, controlled by the host immune system. The risk for reactivation (replication) of any latent infection is related to the nature and intensity of the immune suppression following transplantation.
Colonization with pathogens that may be resistant to multiple antimicrobial agents is common in patients with:
●Multiple prior hospitalizations
- Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med 2007; 357:2601.
- Avery RK. Recipient screening prior to solid-organ transplantation. Clin Infect Dis 2002; 35:1513.
- Patel G, Snydman DR, AST Infectious Diseases Community of Practice. Vancomycin-resistant Enterococcus infections in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:59.
- van Duin D, van Delden C, AST Infectious Diseases Community of Practice. Multidrug-resistant gram-negative bacteria infections in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:31.
- Mularoni A, Bertani A, Vizzini G, et al. Outcome of Transplantation Using Organs From Donors Infected or Colonized With Carbapenem-Resistant Gram-Negative Bacteria. Am J Transplant 2015; 15:2674.
- Avery RK. Prophylactic strategies before solid-organ transplantation. Curr Opin Infect Dis 2004; 17:353.
- Fischer SA, Avery RK, AST Infectious Disease Community of Practice. Screening of donor and recipient prior to solid organ transplantation. Am J Transplant 2009; 9 Suppl 4:S7.
- Guidance for HTLV-1 screening and confirmation in potential donors and reporting potential HTLV-1 infection. http://optn.transplant.hrsa.gov/SharedContentDocuments/Guidance_DTAC_HTLV.pdf (Accessed on March 06, 2015).
- Muñoz P, Rodríguez C, Bouza E. Mycobacterium tuberculosis infection in recipients of solid organ transplants. Clin Infect Dis 2005; 40:581.
- Aguado JM, Torre-Cisneros J, Fortún J, et al. Tuberculosis in solid-organ transplant recipients: consensus statement of the group for the study of infection in transplant recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology. Clin Infect Dis 2009; 48:1276.
- Manuel O, Humar A, Preiksaitis J, et al. Comparison of quantiferon-TB gold with tuberculin skin test for detecting latent tuberculosis infection prior to liver transplantation. Am J Transplant 2007; 7:2797.
- Singh N, Paterson DL. Mycobacterium tuberculosis infection in solid-organ transplant recipients: impact and implications for management. Clin Infect Dis 1998; 27:1266.
- Bumbacea D, Arend SM, Eyuboglu F, et al. The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement. Eur Respir J 2012; 40:990.
- Subramanian AK, Morris MI, AST Infectious Diseases Community of Practice. Mycobacterium tuberculosis infections in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:68.
- Kim SH, Lee SO, Park IA, et al. Diagnostic usefulness of a T cell-based assay for latent tuberculosis infection in kidney transplant candidates before transplantation. Transpl Infect Dis 2010; 12:113.
- Mazurek GH, Jereb J, Vernon A, et al. Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection - United States, 2010. MMWR Recomm Rep 2010; 59:1.
- Rogerson TE, Chen S, Kok J, et al. Tests for latent tuberculosis in people with ESRD: a systematic review. Am J Kidney Dis 2013; 61:33.
- Theodoropoulos N, Lanternier F, Rassiwala J, et al. Use of the QuantiFERON-TB Gold interferon-gamma release assay for screening transplant candidates: a single-center retrospective study. Transpl Infect Dis 2012; 14:1.