Opportunistic Infections After Solid Organ Transplantation (SOT) Are Rare in The Swiss Transplant Cohort Study (STCS).

Abstract

Introduction. New immunosuppressive agents, demographic changes in donor and recipients and prophylactic strategies are likely to impact the pattern of infections after SOT. Methods. The STCS prospectively collects data at transplantation, 6 months, and yearly thereafter in >95% of all SOT recipients in Switzerland. Validated definitions are used for infectious diseases (ID) events. Results. 1675 patients (median observation time 2 years (range 1.5 to 2.2) were included (125 heart, 1002 kidney, 43 kidney-pancreas, 335 liver, 170 lung patients). 88% had antibacterial, 53% antiviral, 14% antifungal prophylaxis. 856 patients (51%) experienced at least one of the 2113 proven ID events (PE). Bacterial infections occurred early with E. coli (568 PE, 26.9% of all PE), Klebsiella spp (158 PE, 7.5%),or P.aeruginosa (140 PE, 6.6%), or Enteroccus (290 PE, 13.7%) bloodstream and nosocomial gastrointestinal, respiratory or urinary tract infections dominating the first 120 days. Opportunistic pathogens were rare (Nocardia spp, 5 PE, 0.2%; Legionella spp, 1 PE, 0.05%; Mycobacteria, 9 PE, 0.4%; Listeria spp, 0 PE), except for Clostridium spp (89 PE, 4.2%). Viral proven events were dominated by Herpes simplex virus (98 PE, 4.6%). CMV events were rare (65 PE, 3.0%), similar to Influenza (30 PE, 1.4%), as were Parvovirus (2 PE, 0.1%), Adenovirus (9 PE,0.4%) and HHV-6/8 (1 PE, 0.05%). Early postoperative Candida spp infections were common (64 PE, 3.0%), while Aspergillus spp (18 PE, 0.8%), Zygomycetes (2 PE, 0.09%) and C. neoformans (1 PE, 0.05%) were rarely found. P. jirovecii was responsible for 21 PE, 1.0%. Conclusions. Most infectious events in our cohort are postoperative bloodstream and nosocomial infections whereas opportunistic infections are rare compared to the literature. Thus, our findings may indicate that prophylactic strategies successfully reduced opportunistic infections. Efforts to improve the early postoperative infection rate should deserve more attention.