Article information
Abstract
Infection remains a significant complication after solid organ transplantation (SOT). The incidence of various pathogens varies widely depending on the presence of specific factors, according to which patients can be classified into different risk categories that may merit tailored prophylaxis strategies. Both the endogenous origin of microorganisms (previous colonization or latent infection) and new acquisition (primary infection from donor or environment) should be considered. Bacterial infections predominate in patients with complex hospital stays or anatomical alterations. Viral infections, caused both by opportunistic (CMV, EBV, BKV, etc.) and common viruses (influenza, respiratory virus, VVZ, etc.), are of great importance, and may contribute to chronic rejection. Fungal infections are uncommon nowadays, but cause high mortality and deserve prophylaxis for a subset of patients. Parasitic infections are a clear threat, mainly in transplanted patients or those travelling to endemic areas. Physicians attending SOT recipients should be aware of these risk factors, which include specific host characteristics, type of transplantation, microorganism and immunosuppressive policy.
Keywords:
CMV
Epidemiology
Heart transplantation
Infection
Kidney transplantation
Liver transplantation
Lung transplantation
Pancreas transplantation
Prophylaxis
Solid organ transplantation
Resumen
La infección sigue siendo una complicación significativa tras el trasplante de órgano sólido (TOS). La incidencia de los diferentes patógenos varía ampliamente dependiendo de la presencia de factores específicos y, de acuerdo con esto, los pacientes pueden clasificarse en diferentes categorías de riesgo que precisarán estrategias profilácticas específicas para cada categoría. Deben tenerse en cuenta tanto los microorganismos de origen endógeno (colonización previa o infección latente) como los de nueva adquisición (infección primaria a partir del donante o del entorno). Las infecciones bacterianas predominan en los pacientes con estancias hospitalarias complejas o alteraciones anatómicas. Las infecciones virales, causadas tanto por virus oportunistas (citomegalovirus, virus de Epstein-Barr, virus BK, etc.) como por virus comunes (influenza, virus respiratorios, virus de la varicela zoster, etc.) son esenciales y pueden contribuir al rechazo crónico del trasplante. Las infecciones fúngicas no son habituales hoy en día, pero provocan una alta mortalidad y precisan profilaxis en un subgrupo de pacientes. Las infecciones parasitarias son una clara amenaza, principalmente en pacientes trasplantados que viajen a zonas endémicas. Los médicos que tratan a los receptores de TOS deben ser conscientes de estos factores de riesgo, que incluyen las características específicas del receptor, tipo de trasplante, microorganismo y planes de inmunosupresión.
Palabras clave:
CMV
Epidemiología
Infección
Profilaxis
Trasplante de corazón
Trasplante de órgano sólido
Trasplante de páncreas
Trasplante hepático
Trasplante pulmonar
Trasplante renal
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