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

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

Jean-François Timsit  1   2 , Romain Sonneville  3   4 , Andre C Kalil  5 , Matteo Bassetti  6 , Ricard Ferrer  7 , Samir Jaber  8 , Fanny Lanternier  9   10 , Charles-Edouard Luyt  11   12 , Flavia Machado  13 , Malgorzata Mikulska  14 , Laurent Papazian  15 , Fréderic Pène  16   17 , Garyphalia Poulakou  18 , Claudio Viscoli  14 , Michel Wolff  19 , Lara Zafrani  20 , Christian Van Delden  21
Affiliations
Review

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

Jean-François Timsit et al. Intensive Care Med. 2019 May.

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.

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Conflict of interest statement

MB has participated in advisory boards and/or received speaker honoraria from Achaogen, Angelini, Astellas, AstraZeneca, Bayer, Basilea, Biomerieux, Cidara, Gilead, Menarini, MSD, Nabriva, Paratek, Pfizer, Roche, The Medicine Company, Shionogi, Tetraphase, VenatoRx and Vifor. RF reports participation in scientific advisory boards: MSD, Shionogi and lectures: Beckton-Dickinson, MSD, Astelas, Pfizer, Thermo, Estor. SJ reports receiving consulting fees from Drager, Hamilton, Maquet, Medtronic and Fisher & Paykel. CEL reports participations in advisory boards (Bayer Healthcare, Carmat, Faron, ThermoFischer Brahms) and lectures (MSD, Nihon-Koden, Biomérieux). MM has received payment for lectures, advisory board participation and travel expenses from MSD, Jansen, Pfizer, Astelas, Gilead, all outside the submitted work. FP reports lecture fees paid to his institution by ALEXION. JFT reports participation to scientific advisory boards (Astra-Zeneca, Pfizer, MSD, Nabriva, Gilead), lectures (Biomerieux, MSD, Astelas, 3M, Pfizer) and scientific grants (MSD, Pfizer). CV reports personal fees from MSD Int, Gilead, Pfizer, Angelini, Astelas and Basilea. LZ reports scientific grants not related to the review by Jazz Pharmaceuticals.

Figures

Fig. 1
Fig. 1
Timeline of the main severe infections after solid-organ transplantation. a Low incidence in SOT recipients; b highest incidence in lung transplant recipients; c mostly in patients without effective prophylaxis
Fig. 2
Fig. 2
Baseline and acquired determinants of infections in SOT recipients. The recipient’s prior health condition accounts for the risk of infections throughout the post-transplantation period. Early-onset infections are related to acquired defense alterations including breakthrough of natural barriers and immune suppression. Late-onset infections are mostly related to the intensity of the immunosuppressive regimen
Fig. 3
Fig. 3
Risk factors for early postoperative infections in SOT recipients. Risk factors that predispose to early postoperative infections in recipients of organ transplantation can be categorized as being present before transplant (recipient or donor) and those secondary to intraoperative or post-transplantation factors
Fig. 4
Fig. 4
Adaptation of the immunosuppressive drugs at the initial phase of sepsis: practical issues. *Immunologic risk assessment: deceased donor, number of human leukocyte antigen (HLA) mismatches, donor-specific antibodies (DSA), organ-specific differences (heart-lung > kidney > liver). Withdrawal of IS drugs should be discussed in close collaboration with transplant physicians
See this image and copyright information in PMC

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