Opportunistic infections in transplant recipients

Vaccine and Infectious Disease Division

Opportunistic infections in transplant recipients

Herpes virus and fungal infections remain a problem with high morbidity and mortality in immunocompromised people, such as immunosuppressed organ and tissue transplant patients, despite the availability of effective surveillance and treatment programs.  Two recent studies by VIDD researchers look into these infections in more detail.

To gain a better understanding of the strategies employed to combat these problems in patients who received a type of stem cell transplant, allogeneic hematopoietic cell transplant (HCT), VIDD senior fellow Dr. Margaret Pollack, VIDD member Dr. Michael Boeckh and colleagues developed an internet-based survey of HCT centers.  Analyzing responses from 175 HCT programs in 32 countries, they found that the center practices were generally in accord with the US Centers for Disease Control and Prevention guidelines, with the majority using some form of prophylaxis for patients at risk for infections or outbreaks.  They found significant regional variance regarding specific procedures and treatment durations, but there were no significant differences in practices by center size or whether patients were children or adults.  Overall, HCT centers are following published guidelines.

Multiple studies on the risk and incidence of herpes zoster (HZ), commonly known as shingles, in solid organ transplant recipients have demonstrated widely varied rates of disease.  To further assess the incidence of HZ in this population, VIDD research associate Dr. Steven Pergam, VIDD member Dr. Michael Boeckh, VIDD affiliate investigator Dr. Anna Wald and colleagues examined 1077 patient reports from administrative databases within the US Department of Veterans Affairs healthcare system, and found an incidence rate of 22.2 per 1000 patient-years.  By modeling HZ incidence, they found that African Americans and older transplant recipients had an increased relative hazard for HZ, but that HZ is a common complication following solid organ transplants in all populations, and further studies focused on prevention are needed.

Pollack M, Heugel J, Xie H, Leisenring W, Storek J, Young JA, Kukreja M, Gress R, Tomblyn M, Boeckh M. An International Comparison of Current Strategies to Prevent Herpesvirus and Fungal Infections in Hematopoietic Cell Transplant Recipients.  Biol Blood Marrow Transplant. 2010 Aug 7.

Pergam SA, Forsberg CW, Boeckh MJ, Maynard C, Limaye AP, Wald A, Smith NL, Young BA.  Herpes zoster incidence in a multicenter cohort of solid organ transplant recipients.  Transpl Infect Dis. 2010 Jul 15.