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Intensive Care Medicine

, Volume 45, Issue 5, pp 573–591 | Cite as

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

  • Jean-François TimsitEmail author
  • Romain Sonneville
  • Andre C. Kalil
  • Matteo Bassetti
  • Ricard Ferrer
  • Samir Jaber
  • Fanny Lanternier
  • Charles-Edouard Luyt
  • Flavia Machado
  • Malgorzata Mikulska
  • Laurent Papazian
  • Fréderic Pène
  • Garyphalia Poulakou
  • Claudio Viscoli
  • Michel Wolff
  • Lara Zafrani
  • Christian Van Delden
Review

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

Sepsis Immunocompromized Solid organ recipient Septic shock Outcome 

Notes

Compliance with ethical standards

Conflicts of interest

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.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jean-François Timsit
    • 1
    • 2
    Email author
  • 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
  1. 1.Medical and Infectious Diseases ICU (MI2)APHP Bichat University HospitalParisFrance
  2. 2.Inserm IAME U1137 IAME: Decision Sciences in Infectious Diseases (DeScID)University Paris, DiderotParisFrance
  3. 3.Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University HospitalParis Diderot UniversityParisFrance
  4. 4.UMR1148, LVTS, Sorbonne Paris Cité, InsermParis Diderot UniversityParisFrance
  5. 5.Transplant Infectious Diseases ProgramUniversity of Nebraska Medical CenterOmahaUSA
  6. 6.Infectious Diseases Clinic, Department of MedicineUniversity of Udine and Azienda Sanitaria Universitaria IntegrataUdineItaly
  7. 7.Department of Intensive Care, Shock, Organ Dysfunction and Resuscitation Research Group (SODIR-VHIR)Vall D’Hebron University HospitalBarcelonaSpain
  8. 8.Anaesthesia and Critical Care Department, Saint Eloi Teaching HospitalPhyMedExp University of MontpellierMontpellierFrance
  9. 9.Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP)Université Paris DescartesParisFrance
  10. 10.Institut Pasteur, CNRS, Centre National de Référence Mycoses Invasives et AntifongiquesUnité de Mycologie Moléculaire, UMR 2000ParisFrance
  11. 11.Médecine Intensive Réanimation, Cardiology Institute, Pitié–Salpêtrière HospitalAssistance Publique–Hôpitaux de ParisParisFrance
  12. 12.UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and NutritionSorbonne UniversitésParisFrance
  13. 13.Anesthesiology, Pain and Intensive Care DepartmentFederal University of São PauloSão PauloBrazil
  14. 14.Division of Infectious DiseasesUniversity of Genova (DISSAL) and Ospedale Polyclinico San MartinoGenovaItaly
  15. 15.Service de Médecine Intensive-Réanimation, Hôpital Nord–AP-HMAix-Marseille UniversitéMarseilleFrance
  16. 16.Service de Médecine Intensive-Réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris-CentreAssistance Publique-Hôpitaux de ParisParisFrance
  17. 17.Institut CochinINSERM U1016-CNRS, UMR 8104, Université Paris DescartesParisFrance
  18. 18.3rd Department of Medicine, School of Medicine, Sotiria General Hospital of AthensAthens National and Kapodistrian UniversityAthensGreece
  19. 19.Service de Réanimation Neurochirurgicale, Hôpital Sainte-AnneGHU Paris Psychiatrie & NeurosciencesParisFrance
  20. 20.Medical ICU, Saint-Louis Hospital, AP-HP, INSERM U976Paris Diderot UniversityParisFrance
  21. 21.Transplant Infectious Diseases UnitUniversity Hospitals GenevaGenevaSwitzerland

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