Article

Transplant Related Infections

Managing infections post transplant through monitoring

 

Transplantations of solid organs, tissues, or cells from a donor to a recipient are often the only cure for certain diseases or health conditions. Transplantations save and extend patient’s lives or dramatically improve their quality of life. Complications due to infections are the main cause of morbidity and mortality after (organ) transplantation.These infections can be either donor-derived or opportunistic post-transplant due to immunosuppressive treatment in the recipient.

 

While complications related to organ rejection are kept under control with immunosuppressive agents, donor-derived and recipient-derived infections are still on the rise due to patient susceptibility.1 Major transplant-transmitted infections are through viruses, such as Cytomegalovirus (CMV), BK virus (BKV), Epstein-Barr virus (EBV), Herpes Simplex Virus (HSV), Varicella Zoster Virus and human Adenovirus (hADV). Infections are also transmitted through bacteria such as mycobacterium and fungi. Of these, CMV is one of the major sources of transplant-transmitted infection, affecting about 60-100% of adults after transplantation.2

146,840

solid organ transplants are performed every year worldwide3

liver

Liver

 34,074

heart

Heart

8,311

kidney

Kidney

95,479

lungs

Lung

6,475

In 2012, the world’s first millionth blood stem cell transplant was performed,4 and more than 70,000 stem cell transplants were performed worldwide in 2013.5

Because most of these viruses are mostly latent in the body, most people with healthy immune systems do not realize that they are infected. Diagnosis of infections before transplantation can make a marked difference in the success of transplantation.

Reliable IVD tests play a key role supporting transplantation safety. A variety of tests can be performed pre- and post-transplantation.

 

Pre-transplantation: serological tests are commonly used to characterize donors, organs and tissues, and recipients for the presence of active or past infections


Post-transplantation: nucleic acid tests (NAT) are commonly performed to test and monitor recipients during and after treatment

 

Roche is developing a complete portfolio of both serological and molecular tests to aid in the diagnostic continuum of transplant donors and recipients.

References

 

  1. Fishman JA. Infection in solid-organ transplant recipients. The new England J of Medicine. 2007;357:2601-2614.

  2. Ghady H, Singh N. Viral infections in solid organ transplant recipients: novel updates and a review of the classics. Curr. Opinion in Infectious Diseases. 2017; 30;6:579-588.

  3. http://www.transplant-observatory.org/contador1/ Last visited: September 2020.

  4. https://www.fcarreras.org/en/a-total-of-1-million-stem-cell-transplants-have-been-performed-worldwide_147898 Last visited: June 2020.

  5. Baldomero H, Aljurf M, Zaidi SZA, et al. 2018. Narrowing the gap for hematopoietic stem cell transplantation in the East-Mediterranean/African region: comparison with global HSCT indications and trends. Bone Marrow Transplantation. doi: 10.1038/s41409-018-0275-5