Increasingly potent immunosuppressive agents have dramaticallyreduced the incidence of rejection of transplanted organs whileincreasing patients' susceptibility to opportunistic infectionsand cancer.1,2 At the same time, patterns of opportunistic infectionsafter transplantation have been altered by routine antimicrobialprophylaxis for Pneumocystis carinii (also called P. jirovecii)and cytomegalovirus. These patterns have also been altered bythe emergence of new clinical syndromes (e.g., polyomavirustype BK nephropathy) and by infections due to organisms withantimicrobial resistance. New quantitative molecular and antigen-basedmicrobiologic assays detect previously unrecognized transplantation-associatedpathogens such as lymphocytic choriomeningitis virus. Theseassays are used in the . . . [Full Text of this Article]
General Concepts
Risk of Infection
Epidemiologic Exposures
Donor-Derived Infections and Screening
Recipient-Derived Infections and Detection
Nosocomial Infections and Antimicrobial Resistance
Community Infections
Net State of Immunosuppression and Monitoring of Immune Function
Prevention of Infection
Changing the Pattern of Infection
Early Post-Transplantation Period
Intermediate Post-Transplantation Period
Late Post-Transplantation Period
Common Infections in Transplantation
Cytomegalovirus Infection
Epidemiology
Prevention
Diagnosis and Therapy
Epstein–Barr Virus and Post-Transplantation Lymphoproliferative Disorder
Polyomaviruses BK and JC
Central Nervous System Infection
Pneumonitis and Pneumocystis Infection
Conclusions
Source Information
From the Transplant Infectious Disease and Compromised Host Program, Massachusetts General Hospital, and Harvard Medical School, Boston.
Address reprint requests to Dr. Fishman at the Transplant Infectious Disease and Compromised Host Program, Massachusetts General Hospital, 55 Fruit St., GRJ 504, Boston, MA 02114, or at jfishman@partners.org.
Baden, L. R., Digumarthy, S. R., Guimaraes, A. S.R., Branda, J. A.
(2009). Case 35-2009 -- A 60-Year-Old Male Renal-Transplant Recipient with Renal Insufficiency, Diabetic Ketoacidosis, and Mental-Status Changes. NEJM
361: 1980-1989
[Full Text]
Rodrigues, L. V., Gandara, J., Pires, J., Duarte, R., Calvario, F., Dominguez, M., Carvalho, A., Seca, R.
(2009). Post liver transplant tuberculosis. BMJ Case Reports
2009: bcr0520091847-bcr0520091847
[Abstract][Full Text]
Tyler, K. L.
(2009). Emerging Viral Infections of the Central Nervous System: Part 1. Arch Neurol
66: 939-948
[Abstract][Full Text]
Patterson, T. F., Mackool, B. T., Gilman, M. D., Piris, A.
(2009). Case 22-2009 -- A 59-Year-Old Man with Skin and Pulmonary Lesions after Chemotherapy for Leukemia. NEJM
361: 287-296
[Full Text]
Richeldi, L., Losi, M., D'Amico, R., Luppi, M., Ferrari, A., Mussini, C., Codeluppi, M., Cocchi, S., Prati, F., Paci, V., Meacci, M., Meccugni, B., Rumpianesi, F., Roversi, P., Cerri, S., Luppi, F., Ferrara, G., Latorre, I., Gerunda, G. E., Torelli, G., Esposito, R., Fabbri, L. M.
(2009). Performance of Tests for Latent Tuberculosis in Different Groups of Immunocompromised Patients. Chest
136: 198-204
[Abstract][Full Text]
Remund, K. F., Best, M., Egan, J. J.
(2009). Infections Relevant to Lung Transplantation. Proc Am Thorac Soc
6: 94-100
[Abstract][Full Text]
Trofe, J., Pote, L., Wade, E., Blumberg, E., Bloom, R. D
(2008). Maribavir: A Novel Antiviral Agent with Activity Against Cytomegalovirus. The Annals of Pharmacotherapy
42: 1447-1457
[Abstract][Full Text]
Fishman, J. A., McCullough, L. B., Halpern, S. D., Shaked, A., Caplan, A. L.
(2008). Informing Candidates for Transplantation about Donor Risk Factors. NEJM
359: 1182-1183
[Full Text]
Hunt, S. A., Haddad, F.
(2008). The Changing Face of Heart Transplantation. J Am Coll Cardiol
52: 587-598
[Abstract][Full Text]
Antinori, S., Corbellino, M., Joy, M., Fishman, J. A., Gonzalez, R. G.
(2008). Case 11-2008: Mental-Status Changes after Liver Transplantation. NEJM
359: 207-209
[Full Text]
Seton, M., Pless, M., Fishman, J. A., Caruso, P. A., Hedley-Whyte, E. T.
(2008). Case 18-2008 -- A 68-Year-Old Man with Headache and Visual Changes after Liver Transplantation. NEJM
358: 2619-2628
[Full Text]
Fishman, J. A., Gonzalez, R. G., Branda, J. A.
(2008). Case 11-2008 -- A 45-Year-Old Man with Changes in Mental Status after Liver Transplantation. NEJM
358: 1604-1613
[Full Text]
Cross, T. J.S., Berry, P. A., Burroughs, A. K.
(2008). Infection in Solid-Organ Transplant Recipients. NEJM
358: 1302-1302
[Full Text]