Prevention and Management of Infections in Lung Transplant Recipients

Anti-rejection medications are essential in preventing organ rejection amongst solid organ transplant recipients; however, these agents also cause profound immunosuppression, predisposing lung transplant recipients (LTRs) to infectious complications. The timely management including prevention, diagnosis, and treatment of such infectious complications is vital to prevent significant morbidity and mortality in solid organ transplant recipients and allograft dysfunction. LTRs are inundated with microbes that may be recognized as commensals in hosts with intact immune systems. Bacterial infections are the most common ones, followed by viral pathogens. Indications of a brewing infectious process may be subtle. Hence, the importance of adapting vigilance around isolated hints through symptomatology and signs is pivotal. Signals to suggest an infectious process, such as fever and leukocytosis, may be dampened by immunosuppressive agents. One must also be vigilant about drug interactions of antibiotics and immunosuppressive agents. Treatment of infections can become challenging, as antimicrobials can interact with immunosuppressive agents, and antimicrobial resistance can surge under antimicrobial pressure. Transplant infectious disease physicians work in concert with transplant teams to obtain specimens for diagnostic testing and follow through with source control when possible. This heavily impacts medical decisions and fosters a multidisciplinary approach in management. Furthermore, the reduction of immunosuppression, although it augments the risk of allograft rejection, is as crucial as the initiation of appropriate antimicrobials when it comes to the management of infections

Risk Factors of Surgical Site Infections after Simultaneous Kidney Pancreas (SKP) Transplantation

Abstract Background Kidney and pancreas transplantation is a preferred treatment modality to ameliorate the renal failure and other comorbidities associated with type I diabetes. Postoperative surgical site infections (SSIs) and urinary tract infections have been noted to be the most common infections seen after SKP transplantation. This study assessed the incidence of SSIs and risk factors for these SSIs in SKP transplant recipients within the first three months after transplantation. Methods This retrospective, single-center, cohort study was conducted at the Toronto General Hospital of the University Health Network, Toronto, Canada from January 2000 to December 2015. SSIs were classified according to the Centers for Disease Control classification as superficial, deep and organ/space. Results Four hundred and forty-five adult patients were enrolled. The median age of the recipients was 51 (range 19 to 71) years old, and 64.9% were males. SSIs were documented in 108 (24.3%) patients. Organ/space SSIs predominated, accounting for 59 (54.6%) patients followed by superficial SSI (n = 47, 43.5%) with only deep infections. Factors predictive of SSIs by multivariate analysis were pancreas cold ischemic time (Odds ratio 1.002, P = 0.11) and simultaneous SKP transplant (as compared with pancreas transplant alone, Odds ratio 2.38, P = 0.003). SSIs were associated with longer duration of hospital stay (P < 0.001). Conclusion Organ/space SSIs remain a serious and common complication after SKP transplant. Longer pancreas cold ischemic time and simultaneous kidney and pancreas transplantation were the risk factors predictive of SSI. Efforts to improve pancreatic cold ischemic time and optimize perioperative antimicrobial prophylaxis in high-risk patients targeting potential pathogens producing SSIs in SKP transplant patients are warranted. Disclosures All authors: No reported disclosures