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Chapter 126. Infections in Transplant Recipients (Part 12)

Late Infections The incidence of Pneumocystis infection (which may present with a paucity of findings) is high among lung and heart-lung transplant recipients. Some form of prophylaxis for Pneumocystis pneumonia is indicated in all organ transplant situations (Table 126-5). Prophylaxis with TMP-SMX for 12 months after transplantation may be sufficient to prevent Pneumocystis disease in patients whose degree of immunosuppression is not increased. As in other transplant recipients, infection with EBV may cause either a mononucleosis-like syndrome or EBV-LPD. The tendency of the B cell blasts to present in the lung appears to be greater after lung transplantation than after. | Chapter 126. Infections in Transplant Recipients Part 12 Late Infections The incidence of Pneumocystis infection which may present with a paucity of findings is high among lung and heart-lung transplant recipients. Some form of prophylaxis for Pneumocystis pneumonia is indicated in all organ transplant situations Table 126-5 . Prophylaxis with TMP-SMX for 12 months after transplantation may be sufficient to prevent Pneumocystis disease in patients whose degree of immunosuppression is not increased. As in other transplant recipients infection with EBV may cause either a mononucleosis-like syndrome or EBV-LPD. The tendency of the B cell blasts to present in the lung appears to be greater after lung transplantation than after the transplantation of other organs. Reduction of immunosuppression and switching of regimens as discussed in earlier sections causes remission in some cases but airway compression can be fatal and more rapid intervention may therefore become necessary. The approach to EBV-LPD is similar to that described in other sections. Liver Transplantation Early Infections As in other transplantation settings early bacterial infections are a major problem after liver transplantation. Many centers administer systemic broadspectrum antibiotics for the first 24 h or sometimes longer after surgery even in the absence of documented infection. However despite prophylaxis infectious complications are common and are correlated with the duration of the surgical procedure and the type of biliary drainage. An operation lasting 12 h is associated with an increased likelihood of infection. Patients who have a choledochojejunostomy with drainage of the biliary duct to a Roux-en-Y jejunal bowel loop have more fungal infections than those whose bile is drained via a choledochocholedochostomy with anastomosis of the donor common bile duct to the recipient common bile duct. Peritonitis and intraabdominal abscesses are common complications of liver transplantation. Bacterial