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Cytomegalovirus (CMV) is among the most common of infections after transplant. In addition to causing viral infection, it increases the risk for a negative outcome for the organ or bone marrow graft, as well as for higher overall morbidity and mortality. Risk of CMV is especially high in transplant recipients previously nonimmune to the virus. Prevention is key for optimal outcomes, both for individuals and for transplant programs. Optimal disease recognition, diagnostics, prevention, and...

Human herpesviruses (HHV)-6, HHV-7, and HHV-8 were identified as causes of infection in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients nearly three decades ago. HHV-6 infection occurs early posttransplant and may cause fever of unknown origin, diarrhea, rash, pneumonitis, and encephalitis. Chromosomal integration of HHV-6 can complicate diagnostic testing for HHV-6, as these patients have markedly elevated HHV-6 DNA levels due to the presence of HHV-6...

Influenza virus is a common respiratory virus in solid organ and stem cell transplant recipients. Influenza infection in immunocompromised hosts can result in severe disease, as compared to general population. Risk factors for severe influenza infection in transplant recipients include treatment with antilymphocyte globulin, presence of lower respiratory disease, and infection early after transplantation. Transplant programs should act to optimize prevention, early diagnosis, and treatment of...

Cytomegalovirus (CMV) is one of the most common infections occurring after solid organ transplantation. This high burden of disease, which incurs sizeable morbidity, may be worsening with the proportion of high-risk D+/R− solid organ transplantation recipients increasing in some regions globally. Cohort studies continue to support either universal prophylaxis or preemptive therapy as effective prevention strategies. Letermovir prophylaxis was noninferior to valganciclovir in adult high-risk...

Transplant tourism and travel posttransplant, both solid organ and hematopoietic stem cell, are important and distinct topics, and each poses a risk of infection for transplant recipients. As solid organ transplant becomes a more common treatment option for end-stage organ disease, wait lists and wait times for these organs grow. Transplant tourism involves traveling abroad for the purposes of organ transplant and often involves commercial transactions. This process has been discouraged on...

Human herpesvirus 5, better known as cytomegalovirus (CMV), infects 50–90% of the adult population worldwide and is the most common opportunistic infection in allogeneic hematopoietic stem cell transplant (HSCT) recipients, causing significant morbidity and mortality [1–6]. Without prophylaxis, CMV reactivation occurs in up to 70–80% of CMV-seropositive individuals [6–9]. This chapter will review the current understanding of CMV infection in HSCT recipients focusing on emerging concepts and...

Hepatitis A (HAV) is vaccine-preventable disease with an ongoing burden of disease nationally and worldwide. It is caused by a non-enveloped RNA virus with predominantly fecal-oral spread. It does not cause chronic disease and symptomatic infection increases with age. Fulminant disease and death are more common in the elderly and comorbid, particularly those with underlying chronic liver disease. Immunity to HAV infection occurs after infection or vaccination, with antibody levels indicating...

While some biologicals have been routinely used in solid organ and hematopoietic stem cell transplant patients for years, a number of newer compounds have been added to the armamentarium for varying indications spanning from the underlying disease to complications of transplantation. This chapter aims at describing the infectious risk of a selection of compounds. The specific chapters list a number of recommendations to consider for infection prevention, in addition to the standard...

Fungal infections in recipients of solid organ and hematopoietic stem cell transplant recipients are significant causes of morbidity and mortality. Though relatively uncommon compared to other infectious complications, the difficulty in making a timely diagnosis and effectively treating patients presents a daunting challenge. Among the fungi responsible for these infections, there are many that are rarely encountered clinically yet are associated with high mortality in transplant patients....

Herpes Simplex Virus (HSV) 1 and 2 and Varicella Zoster Virus (VZV) are ubiquitous alpha-herpes viruses that establish lifelong latency in nerve root ganglia. They are characterized by clinical and subclinical reactivation which can lead to significant morbidity in the transplant population. Primary infection after transplant can also be highly morbid, potentially fatal. Despite significant advances in screening, diagnosis, treatment and prevention, there are further gains to be made in...

The hepatitis E virus (HEV) is one of the main causative agents of acute viral hepatitis worldwide. Over the past decade, HEV genotypes 3 and 4 have been responsible for chronic infections in immunocompromised patients, especially solid organ transplant recipients. A rapid progression of liver fibrosis and the development of HEV-related cirrhosis have been documented in this specific population. HEV infections have also been associated with extrahepatic manifestations such as neurological...

Both solid organ and hematopoietic stem cell transplant candidates and recipients are at high risk for healthcare-associated infections due to their underlying diseases, comorbid conditions, as well as the receipt of augmented immunosuppression to prevent rejection. Partnership between transplant physicians, institutional leaders, and infection preventionists allows for the accommodation of this growing vulnerable patient population into institutional risk assessments and hazard analyses. In...

We review different types of mechanical circulatory support devices available as a bridge to heart transplantation and then discuss infectious complications in these devices, with a particular focus on ventricular assist devices. We also discuss infection prevention and management strategies, in particular as relevent to transplantation.

Background. We assessed the safety and efficacy of oral antibiotic step-down therapy for uncomplicated gram-negative blood stream infections in solid-organ transplant recipients. Methods. We identified all solid-organ transplant recipients within the Massachusetts General and Brigham and Women’s Hospital systems from 2016 to 2021 with uncomplicated gram-negative bacteremia involving an organism susceptible to an acceptably bioavailable oral antibiotic agent. Using inverse probability of...

As organ transplant recipients live longer and healthier lives after transplant, they increasingly partake in foreign travel, for leisure, adventure, work, or to visit friends or relatives. A review of cohorts of transplant recipients shows that they tend to have minimal or suboptimal preparation prior to travel, with limited pre-travel vaccination, medications, and education, and overall poses greatly increased risk of travel-related infections and complications. Enhancing the knowledge of...

Vaccines are an essential component of protection against infection after solid organ transplantation for both children and adults. Unfortunately, many transplant recipients are undervaccinated. In general, vaccination before transplantation results in better immunologic response, and the period before transplant is a special opportunity to provide protection for this vulnerable population. Live vaccines, such as MMR, varicella/zoster, nasal influenza, yellow fever, oral polio, and others...

In the general population, Mycoplasma spp. and Ureaplasma spp. are considered as pathogens with low virulence. Asymptomatic urogenital colonization with genital mycoplasmas is common. M. pneumoniae infections most frequently present as tracheobronchitis. In immunosuppressed individuals, a broad spectrum of invasive diseases has been attributed to these pathogens. After kidney transplantation and hematopoietic stem cell transplantation, Mycoplasma spp. and Ureaplasma spp. have been detected...

Nocardia species are ubiquitous, environmental, Gram-positive bacteria belonging to the Actinomycetaceae family. Immunocompromised hosts such as recipients of solid organ and hematopoietic stem cell transplants are more susceptible to infection, and the most commonly affected organ is the lung. The net state of immunosuppression is an important risk factor for development of infection in transplant recipients. Isolation of Nocardia spp. in culture from a clinically suspected site of...

Diarrhea affects up to 52% of solid organ transplant recipients and up to 80% of hematopoietic stem cell transplant recipients. Diarrhea can lead to dehydration, electrolyte imbalance, acute renal failure, hypotension, drug toxicity, rejection, and malnutrition. Diarrhea has a significant impact on patients’ quality of life.