Solid-organ transplant patient infections

Humar A, Kumar D, Boivin G, Caliendo AM. Cytomegalovirus (CMV) viral load kinetics to predict recurrent disease in solid organ transplant patients with CMV disease. J Infect Dis 2002 186 829-33. 

FIGURE 120-2. Timetable for the occurrence of infections in HSCT and solid organ-transplant patients. IV = intravenous UTI = urinary tract infection. 

In a prospective efficacy trial of atovaquone suspension (750 mg od or 250 mg tds for 1 year) in P. jiroveci prophylaxis in 28 liver transplant recipients intolerant of co-trimoxazole, the adverse events reported included diarrhea (n — 7) and bloating or abdominal pain (n — 3) (16). No patient had developed P. jiroveci pneumonia by 37 months. This is a smaller dose than approved for Pneumocystis prophylaxis in HIV infection (1500 mg/day). Further studies in recipients of solid organ transplants are needed to confirm the efficacy of this prophylactic dose. 

Concerns have been raised about the use of adjuvanted pandemic vaccines in patients with immune disorders, such as immunodeficiency, autoimmune disorders, and solid organ transplants. To date, postmarketing surveillance has not found evidence for causality of any adverse reactions in such patients. Viral infections, such as influenza, can lead to severe complications in immunocompromised patients. 

Observational studies Adverse reactions to anidulafungin in solid organ transplantation recipients have been evaluated in a retrospective analysis of 86 consecutive patients [65 ]. Recipients from 14 centres were included who received anidulafungin for atleast 48 h for the treatment of invasive fungal infections or as prophylaxis. 

Infections play an important role in solid organ transplantations. Besides the usual pathogenic organisms, immunocompromised patients are susceptible to infections with organisms that are normally not pathogenic or only sometimes pathogenic. 

Solid organ or bone marrow transplant recipients are a vulnerable group of patients prone to infectious and non-infectious metabolic encephalopathy (Todd, 2006). Depending on the time of the occurrence of the encephalopathy, several scenarios need to be considered. During the early phase of engraflment (usually the first 30 days) patients are vulnerable to infections with Candida, aspergillus, and the herpes... 

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