Infection Prevention
Help to avoid a common transplant risk
Reducing Infection in Organ Transplant Recipients
An organ transplant is lifesaving. But when you receive a new liver, kidney or other solid organ, your immune system sees it as something that doesn’t belong in your body and attacks it. This is known as organ rejection. To prevent rejection, you must take lifelong medications that suppress your immune system.
When your immune system is tamped down, it’s more difficult than it normally would be for your body to fight off infectious diseases. An old infection, like tuberculosis, that your immune system previously kept well-controlled could reemerge. Or, if you’re exposed to germs, a new infection could develop.
Your risk depends on the type of transplant you have, which immunosuppressive medications doctors prescribe for you and your exposure history.
At Lahey Clinic, preventing infection after transplant is one of our priorities.
Pre-Transplant Infection Prevention Care
Before you receive a transplant, you undergo an infectious disease evaluation. The goal is to make sure you don’t have a hidden infection that needs treatment or that could interfere with your transplant.
The pre-transplant evaluation includes a thorough history and physical exam and certain medical tests.
History and Physical Exam
You undergo a physical exam to make sure you can tolerate a transplant.
Your history includes questions about:
- Antibiotic allergies
- Past infections, including childhood infections
- Potential exposures to infections through travel within the U.S. and overseas, contact with animals, dietary habits and contact with tuberculosis testing
- Vaccinations
Medical Tests
Medical tests that may be part of your evaluation include:
- A tuberculin skin test (PPD) to determine exposure to tuberculosis
- Chest X-ray
- Lab tests to determine your immunity to certain viruses, including Cytomegalovirus (CMV), varicella zoster virus (VZV), herpes simplex virus (HSV) and human immunodeficiency virus (HIV)
Based on your physical exam and exposure history, we may recommend other tests, as well.
Will Past Infections Prevent a Transplant?
Having a history of infection with conditions such as tuberculosis or HSV doesn’t necessarily prevent you from getting an organ transplant. But when we know about your history, we can anticipate possible complications. This may allow us to prevent infections or treat them early.
Infection Care After Your Transplant
Your immune system is usually most suppressed in the first month after transplant. Surgical and hospital-acquired infections are the most common infections during this period. These may include infections from bacteria or a yeast called candida. They may present as:
- Bloodstream infections
- Pneumonia
- Urinary tract infections
- Wound infections
HSV may reactivate and lead to cold sores. In many cases, we prescribe medication to prevent this.
Opportunistic infections after transplant such as pneumocystis carinii pneumonia and tuberculosis are most likely to develop in this period. These are infections that don’t usually cause problems if you have a fully functioning immune system.
In months two through six, you’re also at highest risk for reactivation of certain viruses, including:
- Cytomegalovirus (CMV): CMV may present in a variety of ways. Some people have flu-like symptoms, such as fever, muscle aches and fatigue. Others may develop hepatitis.
CMV develops in between 44% and 85% of people who have kidney, heart and liver transplants. Between 8% to 29% of kidney and liver transplant recipients get symptomatic CMV. Even if you haven’t had CMV, you could get it if your donor had the infection.
With antiviral medications, we can prevent and treat CMV.
- Varicella zoster virus (VZV): VZV is the virus that causes chickenpox. Ninety percent of adult transplant recipients have been exposed to VZV during childhood. If you were exposed, you’re at risk for reactivation of VZV in a form called shingles. Shingles is a painful, blister-like rash.
- Epstein Barr virus (EBV): EVB is the virus that causes mononucleosis, or “mono.” If you’re not immune to EBV, you may get mono. Symptoms include fever, fatigue, and muscles aches and pains.
EBV may also reactivate and cause post-transplantation lymphoproliferative disease (PTLD.) It affects 1% to 2% of kidney and liver transplants respectively. Symptoms vary. They may include fever, sore throat, abdominal pain, jaundice, or kidney or liver problems. Treatment depends on the extent of your disease.
- Hepatitis B and C: Viral hepatitis can recur if you receive your transplant because of chronic hepatitis. Hepatitis B recurs in 5% to 10% of recipients. Hepatitis C recurs in 80% to 90% of transplant recipients.
Most transplant recipients do well six months after transplant. However, you are at risk for acquiring infections outside of the hospital. These include urinary tract infections, influenza and pneumococcal (bacterial) pneumonia.
We use antibiotics in two ways after a transplant:
- To prevent infections from developing (preventive therapy)
- To treat active infections
When you leave the hospital, you remain at increased risk of infection. Following these recommendations may help protect you:
- Avoid people who have colds, influenza, tuberculosis and other contagious infections.
- Discuss any travel plans outside the U.S. with your transplant team.
- If possible, avoid changing a cat’s litter box. If you must change it, wear gloves and change the box daily. This helps prevent toxoplasmosis, an infection caused by a parasite.
- If you have not had chickenpox or received the chickenpox vaccine, avoid being around anyone who has the disease. If you come in contact with someone who has chickenpox, call your doctor right away.
- Wash or peel all fresh fruit and vegetables.
Your transplant team will offer more tips for protecting yourself from infection while at home.
