Infection Prevention in Transplant Recipients

Young Eun Ha, Kyong Ran Peck
2013 Korean Journal of Medicine  
Opportunistic infections are major causes of morbidity and mortality in hematopoietic stem-cell transplant and solid organ transplant recipients. The epidemiology and incidence of opportunistic infections in those patients have been dramatically changed with use of potent immunosuppressive agents as well as routine prophylaxis against various microorganisms such as common bacterial pathogens, fungi, cytomegalovirus, Pneumocystis jirovecii, and so on. Because transplant recipients are at the
more » ... ents are at the greatest risk for infection during early phase (1-3 months) after transplant, safe and effective prevention strategies should be implemented in this period. Moreover, beyond early phase, recipients are often susceptible to infections due to prolonged immunosuppressive therapy for graft rejection or chronic graft-versus-host diseases. Therefore, clinicians should assess a recipient's risk of infection on the basis of concomitant graft function, intensity of immunosuppression, and other factors that may contribute to susceptibility to infections. We discussed infection prevention strategies among recipients of hematopoietic stem-cell and solid organ transplantation against various opportunistic pathogens. Vaccinations should also be recommended for pre-transplant candidates and post-transplant recipients for the best prevention of infections. ( Korean J Med 2013;84:168-178) 서 론 고형 장기 이식 및 조혈모세포 이식 환자의 감염은 이환 율 및 사망의 중요한 원인이 되고 있다. 이식환자는 면역기 능의 저하로 인해 감염 발생에 취약하며, 바이러스에서부터 세균, 진균에 이르기까지 다양한 스펙트럼의 감염병이 발생 하고, 때로는 매우 빠르게 진행하여 치명적인 상태로 악화될 수 있다. 감염병 발생 시 이식편 거부 반응과 같은 비감염성 질환과의 감별이 어려울 때가 많으며, 면역억제제와의 상호 작용 때문에 적절한 항생제 또는 항진균제 치료가 투여되지 못하는 경우가 많다[1]. 특히, 이식 후 첫 1-3개월 사이에 고 강도 면역억제제가 투여되면서 세포 및 체액 면역이 매우
doi:10.3904/kjm.2013.84.2.168 fatcat:5vxp7hckynax5g5nllhktcjodu