Summary
Renal transplant recipients are susceptible to infection by a wide array of pathogens.
Impaired inflammatory responses due to immunosuppressive therapies suppress clinical
and radiologic findings engendered by microbial invasion. As a result, patients are
often minimally symptomatic and evaluation and diagnosis are delayed. Specific microbiologic
diagnosis is essential both for the optimization of antimicrobial therapy and to avoid
unnecessary drug toxicities. Differential diagnosis is guided by knowledge of organisms
commonly involved in infection in immunocompromised hosts and understanding of the
limitations of prophylactic strategies. The risk of infection in the organ transplant
recipient is determined by the interaction between the individual’s epidemiologic
exposures and net state of immunosuppression. Epidemiology includes environmental
exposures in the community and hospital, organisms derived from donor tissues and
latent infections activated in the host during immune suppression. The net state of
immune suppression is determined by the interaction of all factors contributing to
infectious risk. Routine antimicrobial prophylaxis is aimed at common infections and
unique risk factors in individual patient groups. This includes trimethoprim-sulfamethoxazole
(for Pneumocystis, Toxoplasma, most Nocardia and Listeria, common urinary pathogens),
perioperative (eg, anti-fungal prophylaxis for pancreas transplants), or antiviral
(for herpesviruses in high risk recipients).
Keywords
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© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
