Practice Essentials
Worldwide, an estimated 152,863 solid organ transplants were performed in 2019.
In the United States, 39,000 organ transplantations were performed in 2020.
Renal transplants were the most common, followed by those of the liver, heart, lung, and others, including dual organ, pancreatic, and intestinal transplantation. Over the last several decades, the field of solid organ transplantation (SOT) science and practice has advanced significantly, only to be continually challenged by the risks for infection in SOT recipients.
The positive effects of the immunosuppressive agents, obligatory for the prevention of organ rejection, have been tempered by the negative effects of these same therapies, leading to various infections that range in both frequency and severity.
Fortunately, experienced SOT researchers and practitioners have been involved in the development and implementation of proactive guidelines such as the 2006 American Society of Transplantation guidelines
on screening, monitoring, and reporting of infectious complications in SOT recipients.
Newer immunomodulating agents have been developed, increasing the number of therapies that prevent organ rejection. However, this has simultaneously created newer unwanted opportunities for pathogens to cause infectious complications.
These adverse effects are the result of their negative impact on both the cellular and humoral arms of the SOT recipient’s immune system. Fortunately, newer diagnostic laboratory methods have also added much-needed capacity to identify the presence and types of pathogens, often early enough in the SOT recipient’s course to prevent or mitigate severe infection.
Guidelines are constantly being refined to outline the most practical and appropriate screening processes to minimize donor-related infections.
Conversely, attention to implementing preventive measures such as pretransplant vaccination in SOT recipients also represents an important step in optimizing safe organ donation and retention.
Newer host-related challenges, such as the increasing prevalence of obesity, and system-related problems, such as healthcare-acquired infections, represent other challenges for successful infection prevention.
Finally, several areas related to infections in SOT recipients are unresolved and controversial. Recognized emerging issues include donor-derived infection (eg, arboviruses such as Zika, West Nile, and dengue; lymphocytic choriomeningitis virus [LCMV])
; drug-resistant infections, including multidrug-resistant tuberculosis; and many others; see webcasts from the 2016 International Transplant Infectious Disease conference here [account required]).
Given the broad scope of this topic and the availability of Medscape articles covering related areas in transplantation, the reader is referred to the relevant links available in the Medscape Transplantation volume. The September 2019 issue of the American Journal of Transplantation contains a comprehensive review of the various topics within the scope of infections in SOT recipients.
The focus of this article is adult populations, although infectious disease issues germane to the pediatric SOT recipient are discussed in Special Host Considerations.