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Current Transplantation Reports

, Volume 5, Issue 4, pp 289–294 | Cite as

Infectious Complications in Pancreas Transplantation

  • Jeffrey B. Doyon
  • Emily A. BlumbergEmail author
Pancreas (D Axelrod and N Turgeon, Section Editors)
  • 16 Downloads
Part of the following topical collections:
  1. Topical Collection on Pancreas

Abstract

Purpose of Review

In addition to the infectious risk associated with all solid organ transplants, pancreas transplantation poses some unique risks associated with surgical technique and host risk factors. This review highlights several key areas of infectious diseases that physicians must consider in patients undergoing pancreas transplantation.

Recent Findings

Surgical site infections are common after pancreas transplantation, and empiric antimicrobials, including antifungal coverage, are often needed to reduce the risk of these infections. Cytomegalovirus and Epstein-Barr virus (EBV) infections require close monitoring post-transplant, and we are just beginning to understand risk factors for post-transplant lymphoproliferative disorder, which is often associated with EBV infection in these patients.

Summary

Pancreas transplantation can be a successful cure for diabetes, if post-transplant complications, including rejection and infection, can be appropriately managed. Recent use of pancreata from HIV- and HCV-positive donors has increased the pool of possible donors, and ideally, more centers will begin to use these organs. Islet cell transplantation and xenotransplantation are exciting new avenues of research for potential diabetes cures.

Keywords

Pancreas transplantation Pre-transplant vaccination Fungal infections CMV EBV Surgical site infections Donor-derived infections 

Notes

Compliance with Ethical Standards

Conflict of Interest

Emily Blumberg declares grants from Merck and Shire and serves on Merck’s Scientific Advisory Committee. Jeffrey Doyon declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Kandaswamy R, Stock PG, Gustafson SK, Skeans MA, Curry MA, Prentice MA, et al. OPTN/SRTR 2016 annual data report: pancreas. Am J Transplant. 2018;18:114–71.CrossRefGoogle Scholar
  2. 2.
    Kim WR, Lake JR, Smith JM, Schladt DP, Skeans MA, Harper AM, et al. OPTN/SRTR 2016 annual data report: liver. Am J Transplant. 2018;18:172–253.CrossRefGoogle Scholar
  3. 3.
    Hart A, Smith JM, Skeans MA, Gustafson SK, Stewart DE, Cherikh WS, et al. OPTN/SRTR 2015 annual data report: kidney. Am J Transplant. 2017;17:21–116.CrossRefGoogle Scholar
  4. 4.
    Colvin M, Smith JM, Hadley N, Skeans MA, Carrico R, Uccellini K, et al. OPTN/SRTR 2016 annual data report: heart. Am J Transplant. 2018;18:291–362.CrossRefGoogle Scholar
  5. 5.
    Geerlings SE, Hoepelman AIM. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol. 1999;26:259–65.CrossRefGoogle Scholar
  6. 6.
    Pirsch JD, Odorico JS, D’Alessandro AM, Knechtle SJ, Becker BN, Sollinger HW. Posttransplant infection in enteric versus bladder-drained simultaneous pancreas-kidney transplant recipients. Transplantation. 1998;66:1746–50.CrossRefGoogle Scholar
  7. 7.
    Jiménez-Romero C, Manrique A, Meneu JC, Cambra F, Andrés A, Morales JM, et al. Comparative study of bladder versus enteric drainage in pancreas transplantation. Transplant Proc. 2009;41:2466–8.CrossRefGoogle Scholar
  8. 8.
    Gruessner RWG, Sutherland DER, Troppmann C, Benedetti E, Hakim N, Dunn DL, et al. The surgical risk of pancreas transplantation in the cyclosporine era: an overview. J Am Coll Surg. 1997;185:128–44.CrossRefGoogle Scholar
  9. 9.
    Danziger-isakov L, Kumar D. Vaccination in solid organ transplantation. Am J Transplant. 2013;13:311–7.CrossRefGoogle Scholar
  10. 10.
    Kim DK, Riley LE, Hunter P. Immunization practices recommended immunization schedule for adults aged 19 years or older—United States, 2018. MMWR Morb Mortal Wkly Rep. 2018;67:158–60.CrossRefGoogle Scholar
  11. 11.
    Perdiz LB, Furtado GHC, Linhares MM, Gonzalez AM, Pestana JOM, Medeiros EAS. Incidence and risk factors for surgical site infection after simultaneous pancreas-kidney transplantation. J Hosp Infect. 2009;72:326–31.CrossRefGoogle Scholar
  12. 12.
    Rostambeigi N, Kudva YC, John S, Mailankody S, Pedersen RA, Dean PG, et al. Epidemiology of infections requiring hospitalization during long-term follow-up of pancreas transplantation. Transplantation. 2010;89:1126–33.CrossRefGoogle Scholar
  13. 13.
    Kawecki D, Kwiatkowski A, Sawicka-Grzelak A, Durlik M, Mlynarczyk G, Chmura A. Bacterial and fungal infections in the early post-transplantation period after simultaneous pancreas-kidney transplantation: etiological agents and their susceptibility. Transplant Proc. 2014;46:2802–5.CrossRefGoogle Scholar
  14. 14.
    Everett JE, Wahoff DC, Statz C, Gillingham KJ, Gruessner A, Gruessner RWG, et al. Characterization and impact of wound infection after pancreas transplantation. Arch Surg. 1994;129:1310–7.CrossRefGoogle Scholar
  15. 15.
    Kawecki D, Kwiatkowski A, Michalak G, Sawicka-Grzelak A, Mlynarczyk A, Sokol-Leszczynska B, et al. Surgical site infections in the early posttransplant period after simultaneous pancreas-kidney transplantation. Transplant Proc. 2009;41:3143–7.CrossRefGoogle Scholar
  16. 16.
    Laurence JM, Marquez MA, Bazerbachi F, Seal JB, Selzner M, Norgate A, et al. Optimizing pancreas transplantation outcomes in obese recipients. Transplantation. 2015;99:1282–7.CrossRefGoogle Scholar
  17. 17.
    Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Heal Pharm. 2013;70:195–283.CrossRefGoogle Scholar
  18. 18.
    Anesi JA, Blumberg EA, Abbo LM. Perioperative antibiotic prophylaxis to prevent surgical site infections in solid organ transplantation. Transplantation. 2017;102:21–34.CrossRefGoogle Scholar
  19. 19.
    •• Kotton CN, Kumar D, Caliendo AM, Huprikar S, Chou S, Danziger-isakov L, et al. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2018;102:900–31. This publication provides the most up-to-date and comprehensive guidelines for CMV prevention and management in patients undergoing pancreas transplantation.CrossRefGoogle Scholar
  20. 20.
    Fernández-Burgos I, Montiel Casado MC, Pérez-Daga JA, Aranda-Narváez JM, Sánchez-Pérez B, León-Díaz FJ, et al. Induction therapy in simultaneous pancreas-kidney transplantation: thymoglobulin versus basiliximab. Transplant Proc. 2015;47:120–2.CrossRefGoogle Scholar
  21. 21.
    Magliocca JF, Odorico JS, Pirsch JD, Becker YT, Knechtle SJ, Leverson GE, et al. A comparison of alemtuzumab with basiliximab induction in simultaneous pancreas-kidney transplantation. Am J Transplant. 2008;8:1702–10.CrossRefGoogle Scholar
  22. 22.
    Yamamoto S, Tufveson G, Wahlberg J, Berne C, Wadström J, Biglarnia AR. Factors influencing outcome of simultaneous kidney and pancreas transplantation: a 23-year single-center clinical experience. Transplant Proc. 2010;42:4197–201.CrossRefGoogle Scholar
  23. 23.
    Tanchanco R, Krishnamurthi V, Winans C, Wee A, Duclos A, Nurko S, et al. Beneficial outcomes of a steroid-free regimen with thymoglobulin induction in pancreas-kidney transplantation. Transplant Proc. 2008;40:1551–4.CrossRefGoogle Scholar
  24. 24.
    Montero N, Webster AC, Royuela A, Zamora J, Crespo Barrio M, Pascual J. Steroid avoidance or withdrawal for pancreas and pancreas with kidney transplant recipients. Cochrane Database Syst Rev. 2014;9:1–49.Google Scholar
  25. 25.
    Beam E, Lesnick T, Kremers W, Kennedy CC, Razonable RR. Cytomegalovirus disease is associated with higher all-cause mortality after lung transplantation despite extended antiviral prophylaxis. Clin Transpl. 2016;30:270–8.CrossRefGoogle Scholar
  26. 26.
    Johansson I, Andersson R, Friman V, Selimovic N, Hanzen L, Nasic S, et al. Cytomegalovirus infection and disease reduce 10-year cardiac allograft vasculopathy-free survival in heart transplant recipients. BMC Infect Dis. 2015;15:1–9.CrossRefGoogle Scholar
  27. 27.
    Parsaik AK, Bhalla T, Dong M, Rostambeigi N, Dierkhising RA, Dean P, et al. Epidemiology of cytomegalovirus infection after pancreas transplantation. Transplantation. 2011;92:1044–50.PubMedGoogle Scholar
  28. 28.
    Schachtner T, Zaks M, Otto NM, Kahl A, Reinke P. Simultaneous pancreas/kidney transplant recipients are predisposed to tissue-invasive cytomegalovirus disease and concomitant infectious complications. Transpl Infect Dis. 2017;19 e12742.Google Scholar
  29. 29.
    • Herrero-Martinez JM, Lumbreras C, Manrique A, San-Juan R, Garcia-Reyne A, Lopez-Medrano F, et al. Epidemiology, risk factors and impact on long-term pancreatic function of infection following pancreas-kidney transplantation. Clin Microbiol Infect. 2013;19:1132–9. This study describes the epidemiology of infections after organ transplantation and identifies fungal infections as a potential risk factor for graft dysfunction.CrossRefGoogle Scholar
  30. 30.
    Rausch L, Koenecke C, Koch H, Kaltenborn A, Emmanouilidis N, Pape L, et al. Matched-pair analysis: identification of factors with independent influence on the development of PTLD after kidney or liver transplantation. Transplant Res. 2016;5:1–15.CrossRefGoogle Scholar
  31. 31.
    Elfadawy N, Flechner SM, Liu X, Schold J, Srinivas TR, Poggio E, et al. CMV viremia is associated with a decreased incidence of BKV reactivation after kidney and kidney-pancreas transplantation. Transplantation. 2013;96:1097–103.CrossRefGoogle Scholar
  32. 32.
    Browne BJ, Young J-A, Dunn TB, Matas AJ. The impact of cytomegalovirus infection ≥1 year after primary renal transplantation. Clin Transpl. 2010;24:572–7.CrossRefGoogle Scholar
  33. 33.
    Selvey LA, Lim WH, Boan P, Swaminathan R, Slimings C, Harrison AE, et al. Cytomegalovirus viraemia and mortality in renal transplant recipients in the era of antiviral prophylaxis. Lessons from the western Australian experience. BMC Infect Dis. 2017;17:1–10.CrossRefGoogle Scholar
  34. 34.
    Taylor AL, Marcus R, Bradley JA. Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation. Crit Rev Oncol Hematol. 2005;56:155–67.CrossRefGoogle Scholar
  35. 35.
    •• Jackson K, Ruppert K, Shapiro R. Post-transplant lymphoproliferative disorder after pancreas transplantation: a United Network for Organ Sharing database analysis. Clin Transplant. 2013;27:888–94. PTLD is a dreaded complication of organ transplantation and there is scant information about PTLD after pancreas transplantation. This paper offers one of the most comprehensive assessments of PTLD risk factors and outcomes after pancreas transplantation.CrossRefGoogle Scholar
  36. 36.
    Issa N, Amer H, Dean PG, Kremers WK, Kudva YC, Rostambeigi N, et al. Posttransplant lymphoproliferative disorder following pancreas transplantation. Am J Transplant. 2009;9:1894–902.CrossRefGoogle Scholar
  37. 37.
    Pappas PG, Alexander BD, Andes DR, Hadley S, Kauffman CA, Freifeld A, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis. 2010;50:1101–11.CrossRefGoogle Scholar
  38. 38.
    Benedetti E, Gruessner AC, Troppmann C, Papalois BE, Sutherland DE, Dunn DL, et al. Intra-abdominal fungal infections after pancreatic transplantation: incidence, treatment, and outcome. J Am Coll Surg. 1996;183:307–16.PubMedGoogle Scholar
  39. 39.
    Wang EHZ, Partovi N, Levy RD, Shapiro RJ, Yoshida EM. Pneumocystis pneumonia in solid organ transplant recipients: not yet an infection of the past. Transpl Infect Dis. 2012;14:519–25.CrossRefGoogle Scholar
  40. 40.
    Herer B, Chinet T, Labrune S, Collignon MA, Chretien J, Huchon G. Pancreatitis associated with pentamidine by aerosol. Br Med J. 1989;289:605.CrossRefGoogle Scholar
  41. 41.
    Assi M, Martin S, Wheat LJ, Hage C, Freifeld A, Avery R, et al. Histoplasmosis after solid organ transplant. Clin Infect Dis. 2013;57:1542–9.CrossRefGoogle Scholar
  42. 42.
    Miller R, Assi M. Endemic fungal infections in solid organ transplantation. Am J Transplant. 2013;13:250–61.CrossRefGoogle Scholar
  43. 43.
    Fischer SA, Lu K. Screening of donor and recipient in solid organ transplantation. Am J Transplant. 2013;13:9–21.CrossRefGoogle Scholar
  44. 44.
    Barcán L, Lunaó C, Clara L, Sinagra A, Valledor A, De Rissioí AM, et al. Transmission of T. Cruzi infection via liver transplantation to a nonreactive recipient for Chagas' disease. Liver Transpl. 2005;11:1112–6.CrossRefGoogle Scholar
  45. 45.
    Schwartz BS, Mawhorter SD. Parasitic infections in solid organ transplantation. Am J Transplant. 2013;13:280–303.CrossRefGoogle Scholar
  46. 46.
    Le M, Ravin K, Hasan A, Clauss H, Muchant DG, Pasko JK, et al. Single donor-derived strongyloidiasis in three solid organ transplant recipients: case series and review of the literature. Am J Transplant. 2014;14:1199–206.CrossRefGoogle Scholar
  47. 47.
    Galiano A, Trelis M, Moya-Herráiz A, Sánchez-Plumed J, Merino JF. Donor-derived Strongyloides stercoralis hyperinfection syndrome after simultaneous kidney/pancreas transplantation. Int J Infect Dis. 2016;51:19–21.CrossRefGoogle Scholar
  48. 48.
    Farnon EC, Kokko KE, Budge PJ, Mbaeyi C, Lutterloh EC, Qvarnstrom Y, et al. Transmission of Balamuthia mandrillaris by organ transplantation. Clin Infect Dis. 2016;63:878–88.CrossRefGoogle Scholar
  49. 49.
    Bennett WM, Nespral JF, Rosson MW, McEvoy KM. Use of organs for transplantation from a donor with primary meningoencephalitis due to Naegleria fowleri. Am J Transplant. 2008;8:1334–5.CrossRefGoogle Scholar
  50. 50.
    Stehman-Breen CO, Psaty BM, Emerson S, Gretch D, Bronner M, Marsh C, et al. Association of hepatitis C virus infection with mortality and graft survival in kidney-pancreas transplant recipients. Transplantation. 1997;64:281–6.CrossRefGoogle Scholar
  51. 51.
    Miguel M, Sampaio M, Kuo HT, Poommipanit N, Martin P, Bunnapradist S. Influence of preexisting hepatitis C virus antibody positivity in simultaneous pancreas-kidney transplant recipients. Transplantation. 2010;90:61–7.CrossRefGoogle Scholar
  52. 52.
    Ortiz J, Gunselman J, Javed I, Campos S, Khanmoradi K, Zaki R. Are hepatitis C-positive allografts in simultaneous pancreas-kidney transplantation underutilized? Ann Transpl. 2012;17:39–44.CrossRefGoogle Scholar
  53. 53.
    • Levitsky J, Formica RN, Bloom RD, Charlton M, Curry M, Friedewald J, et al. The American Society of Transplantation consensus conference on the use of hepatitis C viremic donors in solid organ transplantation. Am J Transplant. 2017;17:2790–802. Pancreata from HCV-positive donors are underutilized, and this consensus statement provides important guidance to promote use of organs from these donors.CrossRefGoogle Scholar
  54. 54.
    Roland ME, Stock PG. Review of solid-organ transplantation in HIV-infected patients. Transplantation. 2003;75:425–9.CrossRefGoogle Scholar
  55. 55.
    Morabito V, Grossi P, Lombardini L, Ricci A, Trapani S, Peritore D, et al. Solid organ transplantation in HIV+ recipients : Italian experience. Transplant Proc. 2016;48:424–30.CrossRefGoogle Scholar
  56. 56.
    Shapiro AMJ, Pokrywczynska M, Ricordi C. Clinical pancreatic islet transplantation. Nat Publ Group. 2016;13:268–77.Google Scholar
  57. 57.
    Colling KP, Blondet JJ, Balamurugan AN, Wilhelm JJ, Dunn T, Pruett TL, et al. Positive sterility cultures of transplant solutions during pancreatic islet autotransplantation are associated infrequently with clinical infection. Surg Infect. 2015;16:115–23.CrossRefGoogle Scholar
  58. 58.
    Denner J. Why was PERV not transmitted during preclinical and clinical xenotransplantation trials and after inoculation of animals ? Retrovirology. 2018;15:1–9.CrossRefGoogle Scholar
  59. 59.
    Niu D, Wei H, Lin L, George H, Wang T, Lee I, et al. Inactivation of porcine endogenous retrovirus in pigs using CRISPR-Cas9. Science. 2018;357:1303–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Division of Infectious Diseases, Department of MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA

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