Introduction: Infection in Solid Organ Transplant Recipients

Abstract

Infectious disease after transplantation remains a field in evolution. Improved immunosuppressive therapies for organ transplantation have reduced the incidence of allograft rejection while increasing susceptibility to opportunistic infections and virally mediated malignancies. Traditional patterns of opportunistic infection after transplantation have also been altered by the emergence of organisms with antimicrobial resistance and by antifungal (including Pneumocystis) and antiviral prophylaxis (i.e. for cytomegalovirus [CMV] and other herpesviruses) (1). Improved microbiologic diagnostic tools (e.g. nucleic acid testing) are used in the routine management of common infections (e.g. CMV, Epstein-Barr virus [EBV]) and have allowed the definition of new clinical syndromes (e.g. BK polyomavirus nephropathy) and of donor-derived infections (e.g. due to lymphocytic choriomeningitis virus [LCMV]). At the same time, a variety of newer techniques are available, largely on a research basis (e.g. HLA-linked tetramer binding, intracellular cytokine staining) to assess pathogen-specific immunity. These may be used to investigate the recipient’s susceptibility to specific infections and are increasingly entering clinical practice. In the past decade, Transplant infectious disease has emerged as an integral subspecialty component of most successful transplant programs.