Infections After Organ Transplantation

Abstract

Over the last ten to fifteen years medical and surgical advances have led to lower rates of infection and infection-related mortality in transplant recipients. Despite these advances, the process whereby one diagnoses and manages infectious problems in transplant patients has become increasingly complex. Evaluation of transplant patients with infections requires a good understanding of the intricacies of modern immunosuppressive therapy and both the typical and atypical clinical manifestations of many conventional and opportunistic pathogens. In particular, it is incumbent upon the clinicians caring for transplant patients to be familiar with the biology of cytomegalovirus and other herpes viruses, and of the prophylactic strategies that have evolved to lessen the burden of disease from these agents. Thorough knowledge is also required of common fungal pathogens and the viruses that cause chronic hepatitis. Transplant patients also should always be evaluated in the temporal context of their transplant operation, because different diseases are prevalent at different times after transplantation. Since immunosuppressive drugs modify the clinical presentation of infections is important to maintain clinical vigilance and attend to even minor new symptoms. This chapter is designed to provide a relatively concise overview of transplant infections for intensivists or other clinicians who encounter transplant patients in their practice. The references encompass much of the classic transplant infectious disease literature; they are included, not only for citation, but as a bibliography for further study.