tailieunhanh - Chapter 126. Infections in Transplant Recipients (Part 13)

As in other transplantation settings, reactivation disease with herpes-group viruses is common (Table 126-3). Herpesviruses can be transmitted in donor organs. Although CMV hepatitis occurs in ~4% of liver transplant recipients, it is usually not so severe as to require retransplantation. Without prophylaxis, CMV disease develops in the majority of seronegative recipients of organs from CMVpositive donors, but fatality rates are lower among liver transplant recipients than among lung or heart-lung transplant recipients. Disease due to CMV can also be associated with the vanishing bile duct syndrome after liver transplantation. Patients respond to treatment with ganciclovir; prophylaxis with oral. | Chapter 126. Infections in Transplant Recipients Part 13 As in other transplantation settings reactivation disease with herpes-group viruses is common Table 126-3 . Herpesviruses can be transmitted in donor organs. Although CMV hepatitis occurs in 4 of liver transplant recipients it is usually not so severe as to require retransplantation. Without prophylaxis CMV disease develops in the majority of seronegative recipients of organs from CMV-positive donors but fatality rates are lower among liver transplant recipients than among lung or heart-lung transplant recipients. Disease due to CMV can also be associated with the vanishing bile duct syndrome after liver transplantation. Patients respond to treatment with ganciclovir prophylaxis with oral forms of ganciclovir or high-dose acyclovir may decrease the frequency of disease. A role for HHV-6 reactivation in posttransplantation fever and leukopenia has been proposed although the more severe sequelae described in hematopoietic stem cell transplantation are unusual. HHV-6 and HHV-7 appear to exacerbate CMV disease in this setting. EBV-LPD after liver transplantation shows a propensity for involvement of the liver and such disease may be of donor origin. See previous sections for discussion of EBV infections in solid organ transplantation. Pancreas Transplantation Transplantation of the pancreas can be complicated by early bacterial and yeast infections. Most pancreatic transplants are drained into the bowel whereas the remaining transplants 20 are drained into the bladder. A cuff of duodenum is used in the anastomosis between the pancreatic graft and either the gut or the bladder. Bowel drainage poses a risk of early abdominal and allograft infections with enteric bacteria and yeasts. These infections often result in loss of the graft. Bladder drainage causes a high rate of urinary tract infection and sterile cystitis however infection can usually be cured with appropriate antimicrobial agents. In both procedures .