Lecture: Infectious disease post transplant

Infection is common in the post-liver transplant setting.  Immediately after surgery, both donor and recipient risk factors must be taken into account.  A general timeline for the most frequent donor and recipient-derived infections post-transplant can be seen on Figure 4. of the link below to a 2007 NEJM article titled Infection in Solid Organ Transplant Recipients.

One of the take home messages from this lecture is the notion that we must “reset the immunologic clock” whenever we give a patient a burst of immunosuppression in the setting of cellular rejection.  Thus, even if the patient is months or even years removed from surgery, we should be vigilant for the common post-transplant infections all over again: Pseudomonas, Clostridium, Aspergillus, MRSA, VRE, Klebsiella etc.

A few comments about CMV post-transplantation:  For patients with HCV, the occurrence of CMV infection increases the incidence of graft failure (52% vs 19%).  The approach to CMV may or may not include medical prophylaxis; at this center it is used in all cases.  Once daily oral valgancyclovir was as clinically effective and as well-tolerated as oral gancyclovir TID for CMV prevention in high risk patients (D+/R-; Am J Transpl. 2004).  Without prophylaxis, 44% of high risk patients will get CMV, and this is decreased to 5% while on prophylaxis, and 15% in the 6 months after it is stopped (NEJM 1999).

For other specific post-transplant infections you might have in mind, click on the link below for a great review:

http://www.nejm.org/doi/full/10.1056/NEJMra064928

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