Recipients of organ transplantation are at a higher risk of infections because of the multiple drugs that they take to prevent rejection also can increase their risk of developing infections. Therefore, a higher index of suspicion is necessary to avoid major infections after the transplant.
A thorough pre-transplant work-up is necessary to identify and treat any pre-existing infections and to educate the recipient on what to look for once he has received the transplant. This includes:
- A thorough history and physical
Questions on past infections, vaccinations, allergies to antibiotics, potential exposure to infections trough travel in the US and abroad, animal contact, contact with TB
- Tests that need to be done prior to listing for a transplant
PPD for TB, chest x-ray, blood tests to test for immunity to certain viruses such as CMV, varicella zoster, herpes simplex and HIV.
Post transplant infections
It is helpful to divide the timeline into three time periods. Certain infections occur more frequently within one period of time than the others.
First month (early)
This is the time that the immune system is most suppressed in order to prevent early organ rejection. The majority of the infections are either hospital acquired or due to surgery.
Infections may be: urinary tract because of a urinary catheter wound infection on the surgical wound pneumonias bloodstream infections because of pre-existing catheters
Yeast infections from candida and herpes simplex viral infections can also occur.
Months 2 to 6
During this time period, infections from Pneumocystis carinii pneumonia (PCP) or TB can occur. Reactivations of certain viral infections such as CMV, varicella zoster, Epstein Barr virus and hepatitis virus can occur as well.
After 6 months
At this point, most transplant recipients are at risk for community acquired infections such as urinary tract infections, influenza and bacterial pneumonias.