Advertisement

Infections in Limbs, Integuments, and Face Transplantation

  • Justin M. Broyles
  • Chad R. GordonEmail author
Chapter

Abstract

Both facial and upper extremity composite tissue allotransplants consist of heterogeneous tissues including skin, muscle, bone, fat, nerves, and lymph nodes. These tissues are extremely antigenic and necessitate an immunosuppressive regimen similar to that of solid organ transplants. Thus, the patient with a face or limb transplant has many of the same infection risks in individuals following kidney transplantation such as nosocomial and opportunistic bacterial, viral, fungal, and protozoan infections. However, due to the exposed anatomy, possibility for mucosal exposure, and differing donor microflora, recipients of face or limb transplant are also susceptible to invasive diseases due to several different types of microbes. Here we present a comprehensive review of infections frequently encountered in patients undergoing solid organ transplantation with special attention to the brief experience in the prophylaxis and treatment of infection following composite tissue allotransplantation.

Keywords

Composite tissue allotransplantation Face transplant Hand transplant CTA Limb transplant 

References

  1. 1.
    Rubin RH, Wolfson JS, Cosimi AB, Tolkoff-Rubin NE. Infection in the renal transplant patient. Am J Med. 1981;70:405–11.CrossRefGoogle Scholar
  2. 2.
    Fishman JA, Rubin RH. Infection in organ-transplant recipients. N Engl J Med. 1998;338:1741–51.CrossRefGoogle Scholar
  3. 3.
    Guideline for prevention of nosocomial pneumonia: Centers for Disease Control and Prevention. Respir Care. 1994;39:1191–236.Google Scholar
  4. 4.
    Cook D, Randolph A, Kernerman P. Central venous catheter replacement strategies: a systematic review of the literature. Crit Care Med. 1997;25:1417–24.CrossRefGoogle Scholar
  5. 5.
    Garibaldi RA, Burke JP, Britt MR, Miller MA, Smith CB. Meatal colonization and catheter-associated bacteriuria. N Engl J Med. 1980;303:316–8.CrossRefGoogle Scholar
  6. 6.
    Garibaldi RA, Burke JP, Dickman ML, Smith CB. Factors predisposing to bacteriuria during indwelling urethral catheterization. N Engl J Med. 1974;291:215–9.CrossRefGoogle Scholar
  7. 7.
    Gluckman E, Lotsberg J, Devergie A, Zhao XM, Melo R, Gomez-Morales M, et al. Prophylaxis of herpes infections after bone-marrow transplantation by oral acyclovir. Lancet. 1983;2:706–8.CrossRefGoogle Scholar
  8. 8.
    Ljungman P. Prophylaxis against herpesvirus infections in transplant recipients. Drugs. 2001;61:187–96.CrossRefGoogle Scholar
  9. 9.
    Meyers JD, Wade JC, Mitchell CD, Saral R, Lietman PS, Durack DT, et al. Multicenter collaborative trial of intravenous acyclovir for treatment of mucocutaneous herpes simplex virus infection in the immunocompromised host. Am J Med. 1982;73:229–35.CrossRefGoogle Scholar
  10. 10.
    Quintiliani R, Owens NJ, Quercia RA, Klimek JJ, Nightingale CH. Treatment and prevention of oropharyngeal candidiasis. Am J Med. 1984;77:44–8.PubMedGoogle Scholar
  11. 11.
    San Juan R, Aguado JM, Lumbreras C, Díaz-Pedroche C, López-Medrano F, Lizasoain M, RESITRA Network, 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.CrossRefGoogle Scholar
  12. 12.
    Kirkman RL, Strom TB, Weir MR, Tilney NL. Late mortality and morbidity in recipients. Transplantation. 1982;34:347–51.CrossRefGoogle Scholar
  13. 13.
    Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control. Recomm Rep. 1997;46(RR-8):1–24.Google Scholar
  14. 14.
    Danzinger-Isakov L, Kumar D. Guidelines for vaccination of solid organ transplant candidates and recipients. Am J Transplant. 2009;9(Suppl 4):S258.CrossRefGoogle Scholar
  15. 15.
    Gordon CR. Composite tissue allografts: should we reconsider the terminology? Plast Reconstr Surg. 2009;124:464e–5e.CrossRefGoogle Scholar
  16. 16.
    Gordon CR, Siemionow M, Zins J. Composite tissue allotransplantation: a proposed classification system based upon relative complexity. Transplant Proc. 2009;41:481–4.CrossRefGoogle Scholar
  17. 17.
    Cuellar-Rodriguez J, Avery RK, Lard M, Budev M, Gordon SM, Shrestha NK, et al. Histoplasmosis in solid organ transplant recipients: 10 years of experience at a large transplant center in an endemic area. Clin Infect Dis. 2009;49:710–6.CrossRefGoogle Scholar
  18. 18.
    Singh N, Lortholary O, Alexander BD, Gupta KL, John GT, Pursell K, Cryptococcal Collaborative Transplant Study Group, et al. Allograft loss in renal transplant recipients with Cryptococcus neoformans associated immune reconstitution syndrome. Transplantation. 2005;80:1131–3.CrossRefGoogle Scholar
  19. 19.
    Husain S, Alexander BD, Munoz P, Avery RK, Houston S, Pruett T, et al. Opportunistic mycelial fungal infections in organ transplant recipients: emerging importance of non-Aspergillus mycelial fungi. Clin Infect Dis. 2003;37:221–9.CrossRefGoogle Scholar
  20. 20.
    Herrero IA, Issa NC, Patel R. Nosocomial spread of linezolid-resistant, vancomycin-resistant Enterococcus faecium. N Engl J Med. 2002;346:867–9.CrossRefGoogle Scholar
  21. 21.
    Fishman JA. Vancomycin-resistant Enterococcus in liver transplantation: what have we left behind? Transpl Infect Dis. 2003;5:109–11.CrossRefGoogle Scholar
  22. 22.
    Lo Presti F, Riffard S, Vandenesch F, Reyrolle M, Ronco E, Ichai P, Etienne J. The first clinical isolate of Legionella parisiensis, from a liver transplant patient with pneumonia. J Clin Microbiol. 1997;35:1706–9.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Harbarth S, Pittet D, Romand J. Fatal concomitant nosocomial Legionnaires’ disease and cytomegalovirus pneumonitis after cardiac transplantation. Intensive Care Med. 1996;22:1133–4.CrossRefGoogle Scholar
  24. 24.
    Bert F, Bellier C, Lassel L, Lefranc V, Durand F, Belghiti J, et al. Risk factors for Staphylococcus aureus infection in liver transplant recipients. Liver Transpl. 2005;11:1093–9.CrossRefGoogle Scholar
  25. 25.
    Devauchelle B, Badet L, Lengelé B, Morelon E, Testelin S, Michallet M, et al. First human face allograft: early report. Lancet. 2006;368:203–9.CrossRefGoogle Scholar
  26. 26.
    Dubernard JM, Lengelé B, Morelon E, Testelin S, Badet L, Moure C, et al. Outcomes 18 months after the first human partial face transplantation. N Engl J Med. 2007;357:2451–60.CrossRefGoogle Scholar
  27. 27.
    Guo S, Han Y, Zhang X, Lu B, Yi C, Zhang H, et al. Human facial allotransplantation: a 2-year follow-up study. Lancet. 2008;372:631–8.CrossRefGoogle Scholar
  28. 28.
    Meningaud JP, Benjoar MD, Hivelin M, Hermeziu O, Toure G, Lantieri L. The procurement of total human face graft for allotransplantation: a preclinical study and the first clinical case. Plast Reconstr Surg. 2010;126:1181–90.CrossRefGoogle Scholar
  29. 29.
    Gordon CR, Avery RK, Abouhassan W, Siemionow M. Cytomegalovirus and other infectious issues related to face transplantation: specific considerations, lessons learned, and future recommendations. Plast Reconstr Surg. 2011;127(4):1515–23.CrossRefGoogle Scholar
  30. 30.
    Siemionow MZ, Papay F, Djohan R, Bernard S, Gordon CR, Alam D, et al. First U.S. near-total human face transplantation: a paradigm shift for massive complex injuries. Plast Reconstr Surg. 2010;125:111–22.CrossRefGoogle Scholar
  31. 31.
    National Nosocomial Infections (NNIS) system: data summary from Jan 1992–June 2001. Am J Infect Control. 2001;29:408–21.Google Scholar
  32. 32.
    Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med. 1988;129:433–40.CrossRefGoogle Scholar
  33. 33.
    Fishman JA. Prevention of infection caused by Pneumocystis carinii in transplant recipients. Clin Infect Dis. 2001;33(8):1397.CrossRefGoogle Scholar
  34. 34.
    Nathan SD, Ross DJ, Zakowski P, Kass RM, Koerner SK. Utility of inhaled pentamidine prophylaxis in lung transplant recipients. Chest. 1994;105:417–20.CrossRefGoogle Scholar
  35. 35.
    Olsen SL, Renlund DG, O’Connell JB, Taylor DO, Lassetter JE, Eastburn J. Prevention of Pneumocystis carinii in cardiac transplantation recipients by trimethoprim-sulfamethoxazole. Transplantation. 1993;56:359–62.CrossRefGoogle Scholar
  36. 36.
    Torre Cisneros J, de la Mata M, Lopez Cillero P, Sanchez Guijo P, Mino P. Effectiveness of daily low-dose cotrimoxazole prophylaxis for Pneumocystis carinii pneumonia in liver transplantation—an open clinical trial. Transplantation. 1996;62:1519–21.CrossRefGoogle Scholar
  37. 37.
    Altiparmak MR, Trablus S, Pamuk ON, Apaydin S, Sariyar M, Oztürk R, et al. Diarrhoea following renal transplantation. Clin Transpl. 2002;16:212–6.CrossRefGoogle Scholar
  38. 38.
    Bunnapradist S, Neri L, Wong W, Lentine KL, Burroughs TE, Pinsky BW, et al. Incidence and risk factors for diarrhea following kidney transplantation and association with graft loss and mortality. Am J Kidney Dis. 2008;51:478–86.CrossRefGoogle Scholar
  39. 39.
    Wong NA, Bathgate AJ, Bellamy CO. Colorectal disease in liver allograft recipients: a clinicopathological study with follow-up. Eur J Gastroenterol Hepatol. 2002;14:231–6.CrossRefGoogle Scholar
  40. 40.
    Barbut F, Corthier G, Charpak Y, Cerf M, Monteil H, Fosse T. Prevalence and pathogenicity of Clostridium difficile in hospitalized patients. A French multicenter study. Arch Intern Med. 1996;156:1449–54.CrossRefGoogle Scholar
  41. 41.
    Johnson S, Gerding DN. Clostridium difficile-associated diarrhea. Clin Infect Dis. 1998;26(5):1027–34, quiz 1035–1036.CrossRefGoogle Scholar
  42. 42.
    Riley TV. Clostridium difficile: a pathogen of the nineties. Eur J Clin Microbiol Infect Dis. 1998;17:137–41.PubMedGoogle Scholar
  43. 43.
    Clabots CR, Johnson S, Olson MM, Peterson LR, Gerding DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis. 1992;166:561–7.CrossRefGoogle Scholar
  44. 44.
    McFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med. 1989;320:204–10.CrossRefGoogle Scholar
  45. 45.
    Munksgaard B. Clostridium difficile. Am J Transplant. 2004;4:28–30.CrossRefGoogle Scholar
  46. 46.
    Aslam S, Musher DM. An update on diagnosis, treatment, and prevention of Clostridium difficile-associated disease. Gastroenterol Clin N Am. 2006;35:315–35.CrossRefGoogle Scholar
  47. 47.
    Singh N, Wannstedt C, Keyes L, Gayowski T, Wagener MN, Cacciarelli TV. Efficacy of valganciclovir administered as preemptive therapy for cytomegalovirus disease in liver transplant recipients: impact on viral load and late-onset cytomegalovirus disease. Transplantation. 2005;79:85–90.CrossRefGoogle Scholar
  48. 48.
    Singh N. Antiviral drugs for cytomegalovirus in transplant recipients: advantages of preemptive therapy. Rev Med Virol. 2006;16:281–7.CrossRefGoogle Scholar
  49. 49.
    Rubin RH, Cosimi AB, Tolkoff-Rubin NE, Russell PS, Hirsch MS. Infectious disease syndromes attributable to cytomegalovirus and their significance among renal transplant recipients. Transplantation. 1977;24:458–64.CrossRefGoogle Scholar
  50. 50.
    Rubin RH. The indirect effects of cytomegalovirus infection on the outcome of organ transplantation. JAMA. 1989;261:3607–9.CrossRefGoogle Scholar
  51. 51.
    Ljungman P, Griffiths P, Paya C. Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis. 2002;34:1094–7.CrossRefGoogle Scholar
  52. 52.
    Kalil AC, Levitsky J, Lyden E, Stoner J, Freifeld AG. Meta-analysis: the efficacy of strategies to prevent organ disease by cytomegalovirus in solid organ transplant recipients. Ann Intern Med. 2005;143:870–80.CrossRefGoogle Scholar
  53. 53.
    Strippoli GF, Hodson EM, Jones CJ, Craig JC. Pre-emptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients. Cochrane Database Syst Rev. 2006;1:CD005133.Google Scholar
  54. 54.
    Hodson EM, Jones CA, Webster AC, Strippoli GF, Barclay PG, Kable K. Antiviral medications to prevent cytomegalovirus disease and early death in recipients of solid-organ transplants: a systematic review of randomised controlled trials. Lancet. 2005;365:2105–15.CrossRefGoogle Scholar
  55. 55.
    Munoz-Price LS, Slifkin M, Ruthazer R, Poutsiaka DD, Hadley S, Freeman R, et al. The clinical impact of ganciclovir prophylaxis on the occurrence of bacteremia in orthotopic liver transplant recipients. Clin Infect Dis. 2004;39:1293–9.CrossRefGoogle Scholar
  56. 56.
    Lantieri L, Meningaud J-P, Grimbert P, Bellivier F, Lefaucheur JP, Ortonne N, et al. Repair of the lower and middle parts of the face by composite tissue allotransplantation in a patient with massive plexiform neurofibroma: a 1-year follow-up study. Lancet. 2008;372:639–45.CrossRefGoogle Scholar
  57. 57.
    Gordon C, Siemionow M, Papay F, Pryor L, Gatherwright J, Kodish E, et al. The world’s experience with facial transplantation: what have we learned thus far? Ann Plast Surg. 2009;63:572–8.CrossRefGoogle Scholar
  58. 58.
    Schneeberger S, Lucchina S, Lanzetta M, Brandacher G, Bösmüller C, Steurer W, et al. Cytomegalovirus-related complications in human hand transplantation. Transplantation. 2005;80:441–7.CrossRefGoogle Scholar
  59. 59.
    Painter W, Mossad S, Siemionow M. First use of CMX001, a novel antiviral drug, for the suppression of cytomegalovirus infection in solid organ transplant patients: a case series. American Transplant Congress 2010, oral late-breaking abstract presentation, San Diego, CA.Google Scholar
  60. 60.
    Razonable RR, Eid AJ. Viral infections in transplant recipients. Minerva Med. 2009;100:479–501.PubMedGoogle Scholar
  61. 61.
    Englund JA, Boeckh M, Kuypers J, Nichols WG, Hackman RC, Morrow RA, et al. Brief communication: fatal human metapneumovirus infection in stem-cell transplant recipients. Ann Intern Med. 2006;144:344–9.CrossRefGoogle Scholar
  62. 62.
    Kim YJ, Boeckh M, Englund JA. Community respiratory virus infections in immunocompromised patients: hematopoietic stem cell and solid organ transplant recipients, and individuals with human immunodeficiency virus infection. Semin Respir Crit Care Med. 2007;28:222–42.CrossRefGoogle Scholar
  63. 63.
    Schneeberger S, Ninkovic M, Margreiter R. Hand transplantation: the Innsbruck experience, Ch 17. In: Transplantation of composite tissue allographs. Springer, Boston; 2008. p. 234–250. https://link.springer.com/chapter/10.1007%2F978-0-387-74682-1_17. Epub accessed 2016.CrossRefGoogle Scholar
  64. 64.
    Zuckerman R, Wald A. Herpes simplex virus infections in solid organ transplant recipients. Am J Transplant. 2009;4:104–7.CrossRefGoogle Scholar
  65. 65.
    Walker RC, Marshall WF, Strickler JG, Wiesner RH, Velosa JA, Habermann TM, et al. Pretransplantation assessment of the risk of lymphoproliferative disorder. Clin Infect Dis. 1995;20:1346–53.CrossRefGoogle Scholar
  66. 66.
    Walker RC, Paya CV, Marshall WF, Strickler JG, Wiesner RH, Velosa JA, et al. Pretransplantation seronegative Epstein–Barr virus status is the primary risk factor for posttransplantation lymphoproliferative disorder in adult heart, lung, and other solid organ transplantations. J Heart Lung Transplant. 1995;14:214–21.PubMedGoogle Scholar
  67. 67.
    Husain S, Wagener MM, Singh N. Cryptococcus neoformans infection in organ transplant recipients: variables influencing clinical characteristics and outcome. Emerg Infect Dis. 2001;7:375–81.CrossRefGoogle Scholar
  68. 68.
    Blair JE, Logan JL. Coccidioidomycosis in solid organ transplantation. Clin Infect Dis. 2001;33:1536–44.CrossRefGoogle Scholar
  69. 69.
    Cohen IM, Galgiani JN, Potter D, Ogden DA. Coccidioidomycosis in renal replacement therapy. Arch Intern Med. 1982;142:489–94.CrossRefGoogle Scholar
  70. 70.
    Hadley S, Karchmer AW. Fungal infections in solid organ transplant recipients. Infect Dis Clin N Am. 1995;9:1045–74.Google Scholar
  71. 71.
    Centers for Disease Control and Prevention. Recommended adult immunization schedule—United States, October 2007–September 2008. 56th ed. Atlanta: Centers for Disease Control and Prevention; 2007. p. Q1–4.Google Scholar
  72. 72.
    Kretsinger K, Broder KR, Cortese MM, Joyce MP, Ortega-Sanchez I, Lee GM, Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices, Healthcare Infection Control Practices Advisory Committee. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of TDaP among health-care personnel. MMWR Recomm Rep. 2006;55(RR-17):1–37.PubMedGoogle Scholar
  73. 73.
    Gordon CR, Zor F, Siemionow M. Skin area quantification in preparation for concomitant upper extremity and face transplantation: a cadaver study and literature review. Transplantation. 2011;91(9):1050–6.CrossRefGoogle Scholar
  74. 74.
    Gordon CR, Zor F, Cetrulo C, Brandacher G, Sachs J, Lee WP. Concomitant face and hand transplantation: perfect solution or perfect storm? Ann Plast Surg. 2011;67(3):309–14.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive SurgeryThe Johns Hopkins HospitalBaltimoreUSA

Personalised recommendations