Diagnostic and therapeutic approach to infectious diseases in solid organ transplant recipients

Intensive Care Med. 2019 May;45(5):573-591. doi: 10.1007/s00134-019-05597-y. Epub 2019 Mar 25.

Abstract

Purpose: Prognosis of solid organ transplant (SOT) recipients has improved, mainly because of better prevention of rejection by immunosuppressive therapies. However, SOT recipients are highly susceptible to conventional and opportunistic infections, which represent a major cause of morbidity, graft dysfunction and mortality.

Methods: Narrative review.

Results: We cover the current epidemiology and main aspects of infections in SOT recipients including risk factors such as postoperative risks and specific risks for different transplant recipients, key points on anti-infective prophylaxis as well as diagnostic and therapeutic approaches. We provide an up-to-date guide for management of the main syndromes that can be encountered in SOT recipients including acute respiratory failure, sepsis or septic shock, and central nervous system infections as well as bacterial infections with multidrug-resistant strains, invasive fungal diseases, viral infections and less common pathogens that may impact this patient population.

Conclusion: We provide state-of the art review of available knowledge of critically ill SOT patients with infections.

Keywords: Immunocompromized; Outcome; Sepsis; Septic shock; Solid organ recipient.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Communicable Diseases / epidemiology
  • Communicable Diseases / physiopathology
  • Communicable Diseases / therapy*
  • Humans
  • Immunocompromised Host
  • Organ Transplantation / standards*
  • Organ Transplantation / statistics & numerical data
  • Transplant Recipients

Substances

  • Anti-Bacterial Agents