Post Kidney Transplant: Infectious Complication

Abstract

Solid organ transplant recipients are at higher risk of infection than the non-immunosuppressed population. Individual risk of infection is a composite of epidemiologic exposure and net state of immunosuppression. One of the most predictive aspects of the immunosuppressive regimen on infection risk is temporal distribution from date of transplant. Patients are at highest risk for opportunistic infections such as Nocardia, pneumocystis, listeria, cryptococcal disease, and endemic fungal infections in post transplant months 2-6. Immunomodulating viruses such as CMV, EBV, VZV, adenovirus, RSV, HCV, HBV and parasitic infections such as Strongyloides, toxoplasmosis, leishmania, and Trypanosoma cruzi are also a concern during this time period. In order to prevent OI in transplant recipients, transplant providers will provide antimicrobials prior to disease processes. The recommended prophylactic method after transplant will differ based on organism, as well as individual patient characteristics. Throughout this chapter multiple drug therapies will be reviewed, however in the setting of opportunistic infection, the key to mitigation is allowance of host immune reconstitution. The presence of opportunistic infection suggests an imbalance between rejection prevention with iatrogenic immunosuppression and infection.