Connie L Davis

Although the rates are markedly decreased from previous decades, infection is the most important cause of early morbidity and mortality following transplantation. Infection is closely linked to the degree of immunosuppression and thus to the frequency and intensity of rejection and its therapy. The potential sources of infection in the transplant patient are multiple, including organisms from the allograft itself and from the environment. Patients should be advised to be sensible to possible exposures and to wash their hands thoroughly when exposed to infected individuals or human excrement, specifically, exposures in daycare and occupational settings as well as during gardening and pet care. In those taking immunosup-pressive agents, signs and symptoms of infections are frequently blunted until disease is far advanced. Therefore, due to the unusual nature of the infections and the lack of timely symptom development, the key to patient survival is the prevention of infection. Infections may be prevented by pretransplant vaccinations, along with prophylactic medications, preemptive monitoring and behavior modification.

Currently, the most common infectious problems within the first month following transplantation are bacterial infections of the wound, lines, and lungs. Additionally, herpetic stomatitis is common. Beyond 1 month following transplantation, infections are related to more intense immunosuppression and include viral, fungal, protozoal, and unusual bacterial infections. Although hepatitis may occasionally cause fulminate and fatal disease if acquired peritransplantation, the manifestations of hepatitis B or hepatitis C infections occur years following transplantation.

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