Cuéllar-Rodríguez J, Sierra-Madero JG

Language: Spanish
References: 27
Page: 368-380
PDF size: 90.47 Kb.

ABSTRACT

The main problems in solid organ transplant recipients are rejection and infections. The new immunosuppressive regimens have lowered the risk of rejection, however, infections continue to be one of the most important determinants for morbidity and mortality in these patients. The survival of the transplanted organ is also impacted by the different infectious diseases that occur in the post-transplant period. These infections are of viral, bacterial, fungal and parasitic origin, and their presentation occurs characteristically within well defined risk periods after the transplant. The clinical presentation is commonly atypical; therefore for optimal management, it is necessary to have a through knowledge of the epidemiology and clinical manifestations of these problems, but most importantly, the experience of the clinician in the clinical approach and early detection will result in better outcomes. We review recent information regarding the infectious diseases that affect solid organ recipients according to the type of transplant, the post-transplant, risk factors before the transplant and the type of immunosuppressive therapy used, which are the main determinants for these complications and their prognosis.

REFERENCES

1. Simon DM, Levin S. Infectious complications of solid organ transplantations. Infec Dis Clin North Am 2001; 15: 521.

2. Kirkiln JK, Naftel DC, Bourge RC, et al. Evolving trends in risk profiles and causes of death after heart transplantation: A ten year multi-institutional study. J Thorac Cardiovasc Surg 2003; 125: 881.

3. Dummer JS. Infectious in solid organ transplant recipients. In Mandell GL, Bennet JE, Dolin R (Eds.). Principles and practice of infectious diseases. Philadelphia: Churchill Livingstone; 2005, p. 3501-12.

4. Fishman JA, Rubin RH. Infection in organ-transplant recipient. N Engl J Med 1998; 338: 1741.

5. Gottesdiener KM. Transplanted infections: Donor-to-host transmission with the allograft. Ann Intern Med 1989; 110: 1001.

6. Rubin RH, Tolkoff-Rubin NE. Risks and epidemiology of infections after renal transplantation. In: Bowden RA, Ljungman P, Paya CV (Eds.). Transplant Infections. Philadelphia: Lippincott Williams & Wilkins; 2003, p. 99-119.

7. Maurer JR, Tullius E, Grossman RF, et al. Infectious complications following lung transplantation. Chest 1992; 101: 1056.

8. Gavalda J, Román A, Pahissa A. Risks and epidemiology of infections after lung or heart-lung transplantation. In: Bowden RA, Ljungman P, Paya CV (Eds.). Transplant infections. Philadelphia: Lippincott, Williams & Wilkins; 2003, p. 63-85.

9. Soave R. Prophylaxis strategies for solid-organ transplantation. Clin Infect Dis 2001; 33(Suppl 1): S26.

10. Singh N. Impact of current transplantation practices on the changing epidemiology of infections in transplant recipients. Lan Infect Dis 2003; 3(3):156.

11. Singh N, Paterson DL. Aspergillus infections in transplants recipients. Clin Microbiol Rev 2005; 18(1): 44.

12. Kwak EJ, Vilchez RA, Randhawa P, et al. Pathogenesis and management of poliomavirus infection in transplant patients. Clin Infect Dis 2002; 35: 1081.

13. Snydman D. Epidemiology of infections after solid organ transplantation. Clin Infec Dis 2001; 33(Suppl. 1): S5.

14. Kwak EJ, Kusme S. Risks and epidemiology of infections after Liver transplantation. In: Bowden RA, Ljungman P, Paya CV (Eds.). Transplant Infections. Philadelphia: Lippincott Williams & Wilkins; 2003, p. 120-31.

15. Avery RK. Prophylactic strategies before solid organ transplantation. Curr Op Infect Dis 2004; 17: 353.

16. Rodríguez-Luna H, Douglas DD. Natural history of hepatitis C following liver transplantation. Curr Op Infect Dis 2004; 17: 363.

17. Keay S. Risks and epidemiology of infections after heart transplantation. In: Bowden RA, Ljungman P, Paya CV (Eds.). Transplant infections. Philadelphia: Lippincott Williams & Wilkins; 2003, p. 51-62.

18. Humar A, Humar A. Risks and epidemiology of infections after pancreas or kidney-pancreas transplantation. In: Bowden RA, Ljungman P, Paya CV (Eds.). Transplant Infections. Philadelphia: Lippincott Williams & Wilkins; 2003, p. 86-98.

19. Reyes J, Green M. Risks and epidemiology of infections after intestinal transplantation. In: Bowden RA, Ljungman P, Paya CV (Eds.). Transplant Infections. Philadelphia: Lippincott Williams & Wilkins; 2003, p. 132-9.

20. Preiksaitis J, Keay S. Diagnosis and management of postransplant lymphoproliferative disorder in solid-organ transplant recipients. Clin Infect Dis 2001; 33(Suppl. 1): S38.

21. Singh N. Fungal infections in the recipients of solid organ transplantation. Infect Dis Clin North Am 2003; 17(1): 113.

22. Dummer JS. Risk factors and approaches to infections in transplant recipients. In: Mandell GL, Bennet JE, Dolin R (Eds.). Principles and Practice of Infectious Diseases. Philadelphia: Churchill Livingstone; 2005, p. 3476-86.

23. Singh N, Paterson DL. Mycobacterium tuberculosis infection in solid organ transplant recipients: Impact and implications for management. Clin Infect Dis 1998; 27: 1266.

24. Pereyra F, Rubin RH. Prevention and treatment of cytomegalovirus infection in solid organ transplant recipients. Curr Op Infect Dis 2004; 17: 357.

25. Paya C, Razonable RR. Cytomegalovirus infection after solid organ transplantation. In: Bowden RA, Ljungman P, Paya CV (Eds.). Transplant infections. Philadelphia: Lippincott Williams & Wilkins; 2003, p. 298-325.

26. Taber DJ, Ashcraft E, Baillie GM. Valganciclovir prophylaxis in patients at high risk for the development of cytomegalovirus disease. Trans Infect Dis 2004; 6: 101.

27. Mayorga H, Gonzalez Michaca L, Cuellar JV, et al. CMV antigenemia is not associated with adverse graft outcome or CMV disease in intermediate risk transplant recipients. P 806 XX International congress of the transplantation society September 2004.