Prophylactic strategies before solid-organ transplantation.

Abstract

Prophylactic measures prior to organ transplantation are evolving based on recent reports of emerging infectious diseases, as well as an expanded understanding of the epidemiology of familiar infections. This review will highlight developments with potential impact on donor and recipient screening and pretransplant management. Key findings regarding bacterial infections include the lack of utility of mupirocin intranasal decolonization for prevention of Staphylococcus aureus infections after liver transplantation, and the description of transmission of Pseudomonas infection to multiple recipients via an innominate artery graft. The implications of donor bacterial colonization in lung transplantation are further explored. The emergence of non-Candida albicans yeast and non-Aspergillus mold infections may lead to changes in prophylactic strategies. The majority of cystic fibrosis patients have had Aspergillus colonization at some time before transplant; one-quarter of these develop tracheobronchial aspergillosis and anastomotic complications. There are several key developments regarding viral infections. Donor-derived human herpesvirus-8-infected neoplastic cells have been identified in recipients with Kaposi sarcoma. The transmission of human T-cell lymphotropic virus -1 (HTLV-1) to multiple recipients who developed myelopathy underscores the continuing need for donor screening. The striking event of West Nile virus transmission to multiple recipients from a single donor also has raised questions regarding donor screening for this virus. New information on the use of hepatitis B core antibody-positive donor livers, as well as the emergence of hepatitis B virus escape mutants, is discussed. Finally, information on successful retransplantation after BK polyomavirus (BKV) allograft nephropathy is beginning to appear. The pretransplant phase continues to be an important time period for screening and intervention in order to reduce the risk of posttransplant infections. Recent findings add to our current understanding of epidemiology and risk stratification; however, more randomized trials are needed.