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:
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