Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-06T02:05:50.286Z Has data issue: false hasContentIssue false

Infections in Organ Transplant Recipients

Published online by Cambridge University Press:  02 January 2015

Richard A. Garibaldi*
Affiliation:
Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut
*
Department of Medicine, University of Connecticut Health Center, Farmington, CT 06032

Abstract

Since the introduction and widespread performance of transplant surgery in the 1950s and 1960s, infectious complications have been a major cause of morbidity and mortality. The risks of infection are directly related to the potency and duration of immunosuppressive therapies, organ-donor selection, surgical techniques, and postoperative exposures to invasive procedures or treatments.

Despite impressive advancements to decrease the risks of infection, between 40% and 80% of renal transplant patients become infected within the first two or three postoperative years. Infections that occur during the first month following transplantation are often caused by common nosocomial pathogens and are secondary to invasive procedures or therapies. Infections that occur between one and six months post-surgery are often caused by opportunistic pathogens. Symptomatic and subclinical cytomegalovirus (CMV) infections are common during this time and may contribute to a further impairment of host defenses. Late infections involve both opportunistic and conventional pathogens; opportunistic infections occur in patients with poor transplant function who require high levels of immunosuppression and conventional infections occur in patients who require little immunosuppression.

During the past two decades, there has been a significant decrease in deaths from infectious complications among renal transplant recipients. Further reductions in morbidity and mortality will occur with the development of more specific approaches for immunosuppressive therapy, new strategies to prevent CMV infections and methods to eliminate sources of nosocomial infections.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1983

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Russell, PS, Winn, HJ: Medical progress. Transplantation. N Engl J Med 1970;282:786906.CrossRefGoogle Scholar
2.Fahey, JL, Mann, DL, Asofsky, R, et al: Recent progress in human transplantation immunology. NIH clinical staff conference. Ann Intern Med 1969;71:11771196.CrossRefGoogle Scholar
3.Balch, CM, Diethelm, AG: The pathophysiology of renal allograft rejection: A collective review. J Surg Res 1972;12:350377.CrossRefGoogle ScholarPubMed
4.Merrill, JP, Murray, JE, Harrison, JH, et al: Successful homo-transplantation of human kidney between identical twins. JAMA 1956;160:277282.CrossRefGoogle Scholar
5.Rifkind, D, Marchioro, TL, Schneck, SA, et al: Systemic fungal infections complicating renal transplantation and immunosuppressive therapy. Am J Med 1967;43:2838.CrossRefGoogle ScholarPubMed
6.Tilney, NL, Strom, TB, Vineyard, CG, et al: Factors contributing to the declining mortality rate in renal transplantation. N Engl J Med 1978;299:13211325.CrossRefGoogle Scholar
7.Rubin, RH: Infection in the renal transplant patient, in Rubin, RH, Young, LS (eds): Clinical Approach to Infection in the Compromised Host. New York, Plenum Press, 1981, pp 553605.Google Scholar
8.Anderson, RJ, Schafer, LA, Olin, DB, et al: Infectious risk factors in the immunosuppressed host. Am J Med 1973;54:453460.CrossRefGoogle ScholarPubMed
9.Peterson, PK, Balfour, HH, Fryd, DS, et al: Fever in renal transplant recipients: Causes, prognostic significance and changing patterns at the University of Minnesota Hospital. Am J Med 1981;71:345351.CrossRefGoogle ScholarPubMed
10.Ramsey, PG, Rubin, RR, Tolkoff-Rubin, NE, et al: The renal transplant patient with fever and pulmonary infiltrates: Etiology, clinical manifestations and management. Medicine 1980;59:206222.CrossRefGoogle ScholarPubMed
11.Schweizer, RT, Lountz, SL, Belzer, FO: Wound complications in recipients of renal transplants. Ann Surg 1973;177:5862.CrossRefGoogle ScholarPubMed
12.Tolkoff-Rubin, NE, Cosimi, AB, Russell, PS, et al: A controlled study of trimethoprim sulfamethoxazole prophylaxis of urinary tract inlcction in renal transplant recipients. Rev Infect Dis 1982;4:614618.CrossRefGoogle ScholarPubMed
13.Pass, RF, Whitley, RJ, Whelchel, JD, et al: Identification of patients with increased risk of infection with herpes simplex virus after renal transplantation. J Infect Dis 1979;140:487492.CrossRefGoogle ScholarPubMed
14.Rubin, RH, Cosimi, AB, Tolkoff-Rubin, NE, et al: Infectious disease syndromes attributable to cytomegalovirus and their significance among renal transplant recipients. Transplantation 1977;24:458464.CrossRefGoogle ScholarPubMed
15.Richardson, WP, Colvin, RB, Cheeseman, SH, et al: Glomerulopathy associated with cytomegalovirus viremia in renal allografts. N Engl J Med 1981;305:5763.CrossRefGoogle ScholarPubMed
16.Meyers, JD, Thomas, ED: Infection complicating bone marrow transplantation, in Rubin, RH, Young, LS (eds): Clinical Approach to Infection in the Compromised Host. New York, Plenum Press, 1981; pp 507551.Google Scholar
17.Peterson, PK, McGlave, P, Ramsay, NKC, et al: A prospective study of infectious diseases following bone marrow transplantation: Emergence of Aspergillus and Cytomegalovirus as the major causes of mortality. Infect Control 1983;4:8189.CrossRefGoogle ScholarPubMed
18.Winston, DJ, Territo, MC, Wo, WG, et al: Alveolar macrophage dysfunction in human bone marrow transplant recipients. Am J Med 1982;73:859866.CrossRefGoogle ScholarPubMed