Advertisement

Infection Complications After Abdominal Organ Transplantation

  • Maddalena Giannella
  • Michele Bartoletti
  • Pierluigi VialeEmail author

Abstract

Infectious diseases are a leading complication after solid organ transplantation being associated with high morbidity and mortality. Patients undergoing abdominal organ transplantation have some unique risk factors for bacterial and fungal infections in the early phase (1 month) after transplantation. Hospital-acquired infections with multidrug-resistant pathogens are the main infectious threat in this period. From the 2nd to 6th month after transplantation, the risk of opportunistic infections is highest due to the high level of immunosuppression usually present at this time. Prevention strategies have reduced the incidence of viral, bacterial, fungal, and Pneumocystis diseases in this period. However, in some cases the incidence of such infections is only deferred to the late period, when prophylaxis is stopped. A lower index of suspicion and atypical manifestations of such infections in the late period (>6 months after SOT) may result in a delayed diagnosis and poor outcome. In the patients with uncomplicated clinical course and good graft function after transplantation, the risk of infection decreases in the late period becoming similar to that of general population. However, community-acquired infections may progress rapidly, and multiple pathogens (virus–bacteria, virus–fungi) may be present. Given the difficulties in diagnosis and management of infections in this setting, the prevention of infections is of paramount importance, and any effort to prevent infectious diseases should be done since the first patient assessment before transplantation. In this chapter the epidemiology, timing, management, and prevention of the main pathogens of infectious diseases after abdominal organ transplantation are reviewed.

Keywords

Abdominal organ transplant recipients Bacterial infection Viral infection Fungal infection Classification of infections after solid organ transplantation Prevention of infections in abdominal organt transplant patients 

References

  1. 1.
    Fishman JA. From the classic concepts to modern practice. Clin Microbiol Infect. 2014;20 Suppl 7:4–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Dharnidharka VR, Agodoa LY, Abbott KC. Risk factors for hospitalization for bacterial or viral infection in renal transplant recipients–an analysis of usrds data. Am J Transplant. 2007;7:653–61.CrossRefPubMedGoogle Scholar
  3. 3.
    Wang SF, Huang ZY, Chen XP. Biliary complications after living donor liver transplantation. Liver Transpl. 2011;17:1127–36.CrossRefPubMedGoogle Scholar
  4. 4.
    DeOliveira ML, Jassem W, Valente R, et al. Biliary complications after liver transplantation using grafts from donors after cardiac death: results from a matched control study in a single large volume center. Ann Surg. 2011;254:716–22; discussion 722–13.CrossRefPubMedGoogle Scholar
  5. 5.
    Arnow PM, Zachary KC, Thistlethwaite JR, Thompson KD, Bova JL, Newell KA. Pathogenesis of early operative site infections after orthotopic liver transplantation. Transplantation. 1998;65:1500–3.CrossRefPubMedGoogle Scholar
  6. 6.
    Lo A, Stratta RJ, Hathaway DK, et al. Long-term outcomes in simultaneous kidney-pancreas transplant recipients with portal-enteric versus systemic-bladder drainage. Am J Kidney Dis. 2001;38:132–43.CrossRefPubMedGoogle Scholar
  7. 7.
    Akhter K, Timpone J, Matsumoto C, Fishbein T, Kaufman S, Kumar P. Six-month incidence of bloodstream infections in intestinal transplant patients. Transpl Infect Dis. 2012;14:242–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Guaraldi G, Cocchi S, Codeluppi M, et al. Outcome, incidence, and timing of infectious complications in small bowel and multivisceral organ transplantation patients. Transplantation. 2005;80:1742–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Middleton SJ, Jamieson NV. The current status of small bowel transplantation in the uk and internationally. Gut. 2005;54:1650–7.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Giani T, Conte V, Mandala S, et al. Cross-infection of solid organ transplant recipients by a multidrug-resistant klebsiella pneumoniae isolate producing the oxa-48 carbapenemase, likely derived from a multiorgan donor. J Clin Microbiol. 2014;52:2702–5.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Mueller NJ, Weisser M, Fehr T, et al. Donor-derived aspergillosis from use of a solid organ recipient as a multiorgan donor. Transpl Infect Dis. 2010;12:54–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Huprikar S, Bosserman E, Patel G, et al. Donor-derived trypanosoma cruzi infection in solid organ recipients in the united states, 2001–2011. Am J Transplant. 2013;13:2418–25.CrossRefPubMedGoogle Scholar
  13. 13.
    Ison MG, Grossi P. Donor-derived infections in solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:22–30.CrossRefPubMedGoogle Scholar
  14. 14.
    Lortholary O, Charlier C, Lebeaux D, Lecuit M, Consigny PH. Fungal infections in immunocompromised travelers. Clin Infect Dis. 2013;56:861–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Giannella M, Munoz P, Alarcon JM, Mularoni A, Grossi P, Bouza E. Pneumonia in solid organ transplant recipients: a prospective multicenter study. Transpl Infect Dis. 2014;16:232–41.CrossRefPubMedGoogle Scholar
  16. 16.
    Fishman JA. From the classic concepts to modern practice. Clin Microbiol Infect. 2014;20 Suppl 7:4–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Bartoletti M, Giannella M, Caraceni P, et al. Epidemiology and outcomes of bloodstream infection in patients with cirrhosis. J Hepatol. 2014;61(1):51–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357:2601–14.CrossRefPubMedGoogle Scholar
  19. 19.
    McKinnell JA, Cannella AP, Kunz DF, et al. Pneumocystis pneumonia in hospitalized patients: a detailed examination of symptoms, management, and outcomes in human immunodeficiency virus (hiv)-infected and hiv-uninfected persons. Transpl Infect Dis. 2012;14:510–8.PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    San Juan R, Aguado JM, Lumbreras C, et al. Incidence, clinical characteristics and risk factors of late infection in solid organ transplant recipients: data from the resitra study group. Am J Transplant. 2007;7:964–71.CrossRefPubMedGoogle Scholar
  21. 21.
    Bate SL, Dollard SC, Cannon MJ. Cytomegalovirus seroprevalence in the united states: the national health and nutrition examination surveys, 1988–2004. Clin Infect Dis. 2010;50:1439–47.CrossRefPubMedGoogle Scholar
  22. 22.
    Cannon MJ, Schmid DS, Hyde TB. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Rev Med Virol. 2010;20:202–13.CrossRefPubMedGoogle Scholar
  23. 23.
    Kotton CN, Kumar D, Caliendo AM, et al. Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2013;96:333–60.CrossRefPubMedGoogle Scholar
  24. 24.
    Husain S, Pietrangeli CE, Zeevi A. Delayed onset cmv disease in solid organ transplant recipients. Transpl Immunol. 2009;21:1–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Cervera C, Fernandez-Ruiz M, Valledor A, et al. Epidemiology and risk factors for late infection in solid organ transplant recipients. Transpl Infect Dis. 2011;13:598–607.CrossRefPubMedGoogle Scholar
  26. 26.
    Razonable RR. Strategies for managing cytomegalovirus in transplant recipients. Expert Opin Pharmacother. 2010;11:1983–97.CrossRefPubMedGoogle Scholar
  27. 27.
    Razonable RR. Cytomegalovirus infection after liver transplantation: current concepts and challenges. World J Gastroenterol. 2008;14:4849–60.PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Razonable RR. Management strategies for cytomegalovirus infection and disease in solid organ transplant recipients. Infect Dis Clin N Am. 2013;27:317–42.CrossRefGoogle Scholar
  29. 29.
    Florescu DF, Qiu F, Schmidt CM, Kalil AC. A direct and indirect comparison meta-analysis on the efficacy of cytomegalovirus preventive strategies in solid organ transplant. Clin Infect Dis. 2014;58:785–803.CrossRefPubMedGoogle Scholar
  30. 30.
    Abate D, Saldan A, Fiscon M, et al. Evaluation of cytomegalovirus (cmv)-specific t cell immune reconstitution revealed that baseline antiviral immunity, prophylaxis, or preemptive therapy but not antithymocyte globulin treatment contribute to cmv-specific t cell reconstitution in kidney transplant recipients. J Infect Dis. 2010;202:585–94.CrossRefPubMedGoogle Scholar
  31. 31.
    Gerna G, Lilleri D, Chiesa A, et al. Virologic and immunologic monitoring of cytomegalovirus to guide preemptive therapy in solid-organ transplantation. Am J Transplant. 2011;11:2463–71.CrossRefPubMedGoogle Scholar
  32. 32.
    Allen UD, Preiksaitis JK. Epstein-barr virus and posttransplant lymphoproliferative disorder in solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:107–20.CrossRefPubMedGoogle Scholar
  33. 33.
    Caillard S, Lamy FX, Quelen C, et al. Epidemiology of posttransplant lymphoproliferative disorders in adult kidney and kidney pancreas recipients: report of the french registry and analysis of subgroups of lymphomas. Am J Transplant. 2012;12:682–93.CrossRefPubMedGoogle Scholar
  34. 34.
    Gulley ML, Swinnen LJ, Plaisance Jr KT, Schnell C, Grogan TM, Schneider BG. Tumor origin and cd20 expression in posttransplant lymphoproliferative disorder occurring in solid organ transplant recipients: implications for immune-based therapy. Transplantation. 2003;76:959–64.CrossRefPubMedGoogle Scholar
  35. 35.
    Olagne J, Caillard S, Gaub MP, Chenard MP, Moulin B. Post-transplant lymphoproliferative disorders: determination of donor/recipient origin in a large cohort of kidney recipients. Am J Transplant. 2011;11:1260–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Wilck MB, Zuckerman RA. Herpes simplex virus in solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:121–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Hirsch HH, Randhawa P. Bk polyomavirus in solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:179–88.CrossRefPubMedGoogle Scholar
  38. 38.
    Cervera C, van Delden C, Gavalda J, Welte T, Akova M, Carratala J. Multidrug-resistant bacteria in solid organ transplant recipients. Clin Microbiol Infect. 2014;20 Suppl 7:49–73.CrossRefPubMedGoogle Scholar
  39. 39.
    Asensio A, Ramos A, Cuervas-Mons V, et al. Effect of antibiotic prophylaxis on the risk of surgical site infection in orthotopic liver transplant. Liver Transpl. 2008;14:799–805.CrossRefPubMedGoogle Scholar
  40. 40.
    Ramos A, Asensio A, Munez E, et al. Incisional surgical site infection in kidney transplantation. Urology. 2008;72:119–23.CrossRefPubMedGoogle Scholar
  41. 41.
    Kusne S. Regarding the risk for development of surgical site infections and bacterial prophylaxis in liver transplantation. Liver Transpl. 2008;14:747–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Grossi PA, Fishman JA. Donor-derived infections in solid organ transplant recipients. Am J Transplant. 2009;9 Suppl 4:S19–26.CrossRefPubMedGoogle Scholar
  43. 43.
    Bishara J, Goldberg E, Lev S, Singer P, Ashkenazi T, Cohen J. The utilization of solid organs for transplantation in the setting of infection with multidrug-resistant organisms: an expert opinion. Clin Transplant. 2012;26:811–5.CrossRefPubMedGoogle Scholar
  44. 44.
    San-Juan R, Aguado JM, Lumbreras C, et al. Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation. Liver Transpl. 2011;17:896–904.CrossRefPubMedGoogle Scholar
  45. 45.
    Satlin MJ, Jenkins SG, Walsh TJ. The global challenge of carbapenem-resistant enterobacteriaceae in transplant recipients and patients with hematologic malignancies. Clin Infect Dis. 2014;58:1274–83.PubMedCentralCrossRefPubMedGoogle Scholar
  46. 46.
    Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP. Outcomes of carbapenem-resistant klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol. 2008;29:1099–106.CrossRefPubMedGoogle Scholar
  47. 47.
    Clancy CJ, Chen L, Shields RK, et al. Epidemiology and molecular characterization of bacteremia due to carbapenem-resistant klebsiella pneumoniae in transplant recipients. Am J Transplant. 2013;13:2619–33.PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Bergamasco MD, Barroso Barbosa M, de Oliveira GD, et al. Infection with klebsiella pneumoniae carbapenemase (kpc)-producing k. Pneumoniae in solid organ transplantation. Transpl Infect Dis. 2012;14:198–205.CrossRefPubMedGoogle Scholar
  49. 49.
    Tacconelli E, Cataldo MA, Dancer SJ, et al. Escmid guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant gram-negative bacteria in hospitalized patients. Clin Microbiol Infect. 2014;20 Suppl 1:1–55.CrossRefPubMedGoogle Scholar
  50. 50.
    van Duin D, van Delden C. Multidrug-resistant gram-negative bacteria infections in solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:31–41.CrossRefPubMedGoogle Scholar
  51. 51.
    Lubbert C, Faucheux S, Becker-Rux D, et al. Rapid emergence of secondary resistance to gentamicin and colistin following selective digestive decontamination in patients with kpc-2-producing klebsiella pneumoniae: a single-centre experience. Int J Antimicrob Agents. 2013;42:565–70.CrossRefPubMedGoogle Scholar
  52. 52.
    Giannella M, Bartoletti M, Morelli MC, et al. Infection with klebsiella pneumoniae carbapenemase producing k. Pneumoniae (kpc-kp) after orthotopic liver transplantation (olt): a risk score. Oral Communication at ICAAC 2014 Washington DC September 5–9 2014. 2014.Google Scholar
  53. 53.
    Simkins J, Muggia V, Cohen HW, Minamoto GY. Carbapenem-resistant klebsiella pneumoniae infections in kidney transplant recipients: a case-control study. Transpl Infect Dis. 2014;16(5):775–82.CrossRefPubMedGoogle Scholar
  54. 54.
    Petrosillo N, Giannella M, Lewis R, Viale P. Treatment of carbapenem-resistant klebsiella pneumoniae: the state of the art. Expert Rev Anti Infect Ther. 2013;11:159–77.CrossRefPubMedGoogle Scholar
  55. 55.
    Viale P, Giannella M, Lewis R, Trecarichi EM, Petrosillo N, Tumbarello M. Predictors of mortality in multidrug-resistant klebsiella pneumoniae bloodstream infections. Expert Rev Anti Infect Ther. 2013;11:1053–63.CrossRefPubMedGoogle Scholar
  56. 56.
    Bouza E. Consequences of clostridium difficile infection: understanding the healthcare burden. Clin Microbiol Infect. 2012;18 Suppl 6:5–12.CrossRefPubMedGoogle Scholar
  57. 57.
    Dubberke ER, Burdette SD. Clostridium difficile infections in solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:42–9.CrossRefPubMedGoogle Scholar
  58. 58.
    Hsu JL, Enser JJ, McKown T, et al. Outcomes of clostridium difficile infection in recipients of solid abdominal organ transplants. Clin Transplant. 2014;28:267–73.CrossRefPubMedGoogle Scholar
  59. 59.
    Bouza E, Munoz P, Alonso R. Clinical manifestations, treatment and control of infections caused by clostridium difficile. Clin Microbiol Infect. 2005;11 Suppl 4:57–64.CrossRefPubMedGoogle Scholar
  60. 60.
    Bauer MP, Kuijper EJ, van Dissel JT. European society of clinical microbiology and infectious diseases (escmid): treatment guidance document for clostridium difficile infection (cdi). Clin Microbiol Infect. 2009;15:1067–79.CrossRefPubMedGoogle Scholar
  61. 61.
    Cornely OA. Current and emerging management options for clostridium difficile infection: what is the role of fidaxomicin? Clin Microbiol Infect. 2012;18 Suppl 6:28–35.CrossRefPubMedGoogle Scholar
  62. 62.
    van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent clostridium difficile. N Engl J Med. 2013;368:407–15.CrossRefPubMedGoogle Scholar
  63. 63.
    Singh N, Paterson DL. Mycobacterium tuberculosis infection in solid-organ transplant recipients: impact and implications for management. Clin Infect Dis. 1998;27:1266–77.CrossRefPubMedGoogle Scholar
  64. 64.
    Bumbacea D, Arend SM, Eyuboglu F, et al. The risk of tuberculosis in transplant candidates and recipients: a tbnet consensus statement. Eur Respir J. 2012;40:990–1013.CrossRefPubMedGoogle Scholar
  65. 65.
    Keating MR, Daly JS. Nontuberculous mycobacterial infections in solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:77–82.CrossRefPubMedGoogle Scholar
  66. 66.
    Silveira FP, Husain S. Fungal infections in solid organ transplantation. Med Mycol. 2007;45:305–20.CrossRefPubMedGoogle Scholar
  67. 67.
    Neofytos D, Fishman JA, Horn D, et al. Epidemiology and outcome of invasive fungal infections in solid organ transplant recipients. Transpl Infect Dis. 2010;12:220–9.CrossRefPubMedGoogle Scholar
  68. 68.
    Pappas PG, Alexander BD, Andes DR, 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.CrossRefPubMedGoogle Scholar
  69. 69.
    Silveira FP, Kusne S. Candida infections in solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:220–7.CrossRefPubMedGoogle Scholar
  70. 70.
    Singh N, Husain S. Aspergillosis in solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:228–41.CrossRefPubMedGoogle Scholar
  71. 71.
    Patterson TF. Approaches to fungal diagnosis in transplantation. Transpl Infect Dis. 1999;1:262–72.CrossRefPubMedGoogle Scholar
  72. 72.
    Cruciani M, Mengoli C, Malena M, Bosco O, Serpelloni G, Grossi P. Antifungal prophylaxis in liver transplant patients: a systematic review and meta-analysis. Liver Transpl. 2006;12:850–8.CrossRefPubMedGoogle Scholar
  73. 73.
    Lafaurie M, Lapalu J, Raffoux E, et al. High rate of breakthrough invasive aspergillosis among patients receiving caspofungin for persistent fever and neutropenia. Clin Microbiol Infect. 2010;16:1191–6.CrossRefPubMedGoogle Scholar
  74. 74.
    Giannella M, Ercolani G, Cristini F, et al. High-dose weekly liposomal amphotericin b antifungal prophylaxis in patients undergoing liver transplantation: a prospective phase ii trial. Transplantation. 2015;99(4):848–54.Google Scholar
  75. 75.
    Bassetti M, Marchetti M, Chakrabarti A, et al. A research agenda on the management of intra-abdominal candidiasis: results from a consensus of multinational experts. Intensive Care Med. 2013;39:2092–106.CrossRefPubMedGoogle Scholar
  76. 76.
    Singh N, Limaye AP, Forrest G, et al. Combination of voriconazole and caspofungin as primary therapy for invasive aspergillosis in solid organ transplant recipients: a prospective, multicenter, observational study. Transplantation. 2006;81:320–6.CrossRefPubMedGoogle Scholar
  77. 77.
    Len O, Garzoni C, Lumbreras C, et al. Recommendations for screening of donor and recipient prior to solid organ transplantation and to minimize transmission of donor-derived infections. Clin Microbiol Infect. 2014;20 Suppl 7:10–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Maddalena Giannella
    • 1
  • Michele Bartoletti
    • 1
  • Pierluigi Viale
    • 1
    Email author
  1. 1.Infectious Diseases Unit, Department of Medical and Surgical SciencesSant’Orsola Malpighi Hospital, Alma Mater Studiorum UniversityBolognaItaly

Personalised recommendations