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Risk Assessment of Infections in SOT Recipients

  • Mario Fernández-Ruiz
  • Nicole M. Theodoropoulos
Chapter

Abstract

The susceptibility to infection among solid organ transplant (SOT) recipients is modulated by a number of pre- and post-transplant variables that must be taken into account in the risk assessment process. Causative agents of post-transplant infection may be endogenous (reactivation of a chronic or latent infection), derived from the donor or the preservation fluid or acquired from an exogenous source (through environmental, vector, or human-to-human exposure). Overall, the latter group represents the most usual mechanism of infection among SOT recipients. Due to their frequent requirement for prolonged hospitalization, invasive diagnostic and therapeutic procedures, and broad-spectrum antibiotic therapy, healthcare-associated exposure is of particular concern. The present chapter will discuss how to evaluate the individual risk of infection in an individual SOT candidate or recipient. We will cover variables such as the timing from transplant, donor and surgical factors, the impact of antimicrobial prophylaxis and antirejection therapy, and the net state of immunosuppression. The changing nature of most of these variables should motivate a dynamic risk assessment throughout the entire post-transplant period. In addition, the different strategies currently available for post-transplant immune monitoring (either non-specific or specifically focused on a given pathogen, such as cytomegalovirus) will be reviewed.

Keywords

Infection risk assessment Pre-transplant factors Donor-derived infections Post-transplant factors Net state of immunosuppression Immune monitoring CMV-specific cell-mediated immunity 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Mario Fernández-Ruiz
    • 1
  • Nicole M. Theodoropoulos
    • 2
  1. 1.Unit of Infectious DiseasesHospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), School of Medicine, Universidad ComplutenseMadridSpain
  2. 2.Division of Infectious Diseases and ImmunologyUniversity of Massachusetts Medical School, UMass Memorial Medical CenterWorcesterUSA

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