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Risks and Epidemiology of Infections After Pancreas or Kidney–Pancreas Transplantation

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Transplant Infections

Abstract

Pancreas transplantation offers the most reliable way to achieve euglycemia for insulin-dependent patients. Thanks to refinements in surgical technique, immunosuppression, donor and recipient selection, improved outcomes have been achieved. Unfortunately, the incidence of complications after pancreas transplant remains the highest of all performed solid organ transplants. In the last decade, the numbers of procedures performed and new listings have suffered a steady decline. Technical failure is the most common cause of pancreas graft loss in the first-year posttransplant, most notably manifesting as vascular thrombosis in half of the cases, followed by infections. The spectrum of possible infections is wide, and no completely satisfactory classification system exists. Some are related directly to the surgical procedure or to complications that develop afterwards. Classification by pathogen into bacterial, viral, or fungal infections is not always clinically useful. One pathogen may be involved in several different infections, or a number of different pathogens may be involved in a single infection. Classification by timing posttransplant, into early, intermediate, or late infections, has some merit as many infections follow a typical temporal pattern. Classification based on surgical and medical infections is useful in a broad sense as it will delineate future interventions.

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Authors and Affiliations

  1. Multi-Organ Transplant Program, University Health Network, PMB 11-175, 585 University Avenue, Toronto, ON, Canada, M5P 3A8

    Atul Humar M.D., M.Sc., F.R.C.P.C.

  2. Department of Transplant Surgery, Thomas Starzl Transplantation Institute, UPMC Montefiore 3459 Fifth Avenue-7 South, Pittsburgh, PA, 15213, USA

    Roberto Lopez M.D.

  3. Department of Surgery, University of Pittsburgh, Room 725, 3259 Fifth Ave, Pittsburgh, PA, 15213, USA

    Abhinav Humar M.D.

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  1. Atul Humar M.D., M.Sc., F.R.C.P.C.
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  2. Roberto Lopez M.D.
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  3. Abhinav Humar M.D.
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Correspondence to Abhinav Humar M.D. .

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  1. Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Per Ljungman

  2. Tufts University School of Medicine Tufts Medical Center, Boston, MA, USA

    David Snydman

  3. University of Washington Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Michael Boeckh

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Humar, A., Lopez, R., Humar, A. (2016). Risks and Epidemiology of Infections After Pancreas or Kidney–Pancreas Transplantation. In: Ljungman, P., Snydman, D., Boeckh, M. (eds) Transplant Infections. Springer, Cham. https://doi.org/10.1007/978-3-319-28797-3_13

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