Log in | Register

Diagnostic and therapeutic approach to infectious diseases in solid organ transplant recipients

Jean-François Timsit| Romain Sonneville| Andre C. Kalil| Matteo Bassetti| Ricard Ferrer| Samir Jaber| Fanny Lanternier| Charles-Edouard Luyt| Flavia Machado| Malgorzata Mikulska| Laurent Papazian| Fréderic Pène| Garyphalia Poulakou| Claudio Viscoli| Michel Wolff| Lara Zafrani| Christian Van Delden
Online First ™ - March , 2019

Pages 1 - 19



Prognosis of solid organ transplant (SOT) recipients has improved, mainly because of better prevention of rejection by immunosuppressive therapies. However, SOT recipients are highly susceptible to conventional and opportunistic infections, which represent a major cause of morbidity, graft dysfunction and mortality.


Narrative review.


We cover the current epidemiology and main aspects of infections in SOT recipients including risk factors such as postoperative risks and specific risks for different transplant recipients, key points on anti-infective prophylaxis as well as diagnostic and therapeutic approaches. We provide an up-to-date guide for management of the main syndromes that can be encountered in SOT recipients including acute respiratory failure, sepsis or septic shock, and central nervous system infections as well as bacterial infections with multidrug-resistant strains, invasive fungal diseases, viral infections and less common pathogens that may impact this patient population.


We provide state-of the art review of available knowledge of critically ill SOT patients with infections.



  1. Lund LH, Khush KK, Cherikh WS, Goldfarb S, Kucheryavaya AY, Levvey BJ, Meiser B, Rossano JW, Chambers DC, Yusen RD, Stehlik J (2017) The registry of the international society for heart and lung transplantation: thirty-fourth adult heart transplantation report-2017; focus theme: allograft ischemic time. J Heart Lung Transplant Off Publ Int Soc Heart Transplant 36:1037–1046
  2. Kalil AC, Levitsky J, Lyden E, Stoner J, Freifeld AG (2005) Meta-analysis: the efficacy of strategies to prevent organ disease by cytomegalovirus in solid organ transplant recipients. Ann Intern Med 143:870–880
  3. Kalil AC, Dakroub H, Freifeld AG (2007) Sepsis and solid organ transplantation. Curr Drug Targets 8:533–541
  4. Fishman JA, Rubin RH (1998) Infection in organ-transplant recipients. N Engl J Med 338:1741–1751
  5. Fishman JA (2017) Infection in organ transplantation. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 17:856–879
  6. Poole D, Skurzak S, Mehra MR (2018) Prediction of optimal outcomes in organ transplantation. Intensive Care Med. https://doi.org/10.1007/s00134-018-5472-6
  7. Pons S, Sonneville R, Bouadma L, Styfalova L, Ruckly S, Neuville M, Radjou A, Lebut J, Dilly MP, Mourvillier B, Dorent R, Nataf P, Wolff M, Timsit JF (2019) Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation. Ann Intensive Care 9:17
  8. Hsu J, Griffith BP, Dowling RD, Kormos RL, Dummer JS, Armitage JM, Zenati M, Hardesty RL (1989) Infections in mortally ill cardiac transplant recipients. J Thorac Cardiovasc Surg 98:506–509
  9. Valapour M, Lehr CJ, Skeans MA, Smith JM, Carrico R, Uccellini K, Lehman R, Robinson A, Israni AK, Snyder JJ, Kasiske BL (2018) OPTN/SRTR 2016 annual data report: lung. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 18(Suppl 1):363–433
  10. Zalawadiya S, Fudim M, Bhat G, Cotts W, Lindenfeld J (2017) Extracorporeal membrane oxygenation support and post-heart transplant outcomes among United States adults. J Heart Lung Transplant Off Publ Int Soc Heart Transplant 36:77–81
  11. Dorschner P, McElroy LM, Ison MG (2014) Nosocomial infections within the first month of solid organ transplantation. Transpl Infect Dis Off J Transplant Soc 16:171–187
  12. Green M (2013) Introduction: infections in solid organ transplantation. Am J Transplant 13(Suppl 4):3–8
  13. Chuang P, Parikh CR, Langone A (2005) Urinary tract infections after renal transplantation: a retrospective review at two US transplant centers. Clin Transplant 19:230–235
  14. Koivusalo A, Isoniemi H, Salmela K, Hockerstedt K (1994) Biliary complications in 100 adult liver transplantations: a retrospective clinical study. Transpl Int 7(Suppl 1):S119–S120
  15. Kusne S, Dummer JS, Singh N, Iwatsuki S, Makowka L, Esquivel C, Tzakis AG, Starzl TE, Ho M (1988) Infections after liver transplantation. An analysis of 101 consecutive cases. Medicine (Baltimore) 67:132–143
  16. Curry MP, Forns X, Chung RT, Terrault NA, Brown R Jr, Fenkel JM, Gordon F, O’Leary J, Kuo A, Schiano T, Everson G, Schiff E, Befeler A, Gane E, Saab S, McHutchison JG, Subramanian GM, Symonds WT, Denning J, McNair L, Arterburn S, Svarovskaia E, Moonka D, Afdhal N (2015) Sofosbuvir and ribavirin prevent recurrence of HCV infection after liver transplantation: an open-label study. Gastroenterology 148(100–107):e101
  17. Levitsky J, Verna EC, O’Leary JG, Bzowej NH, Moonka DK, Hyland RH, Arterburn S, Dvory-Sobol H, Brainard DM, McHutchison JG, Terrault NA (2016) Perioperative ledipasvir–sofosbuvir for HCV in liver-transplant recipients. N Engl J Med 375:2106–2108
  18. Myers TJ, Khan T, Frazier OH (2000) Infectious complications associated with ventricular assist systems. ASAIO J 46:S28–S36
  19. De Vlaminck I, Martin L, Kertesz M, Patel K, Kowarsky M, Strehl C, Cohen G, Luikart H, Neff NF, Okamoto J, Nicolls MR, Cornfield D, Weill D, Valantine H, Khush KK, Quake SR (2015) Noninvasive monitoring of infection and rejection after lung transplantation. Proc Natl Acad Sci USA 112:13336–13341
  20. Goldberg DS, Abt PL, Blumberg EA, Van Deerlin VM, Levine M, Reddy KR, Bloom RD, Nazarian SM, Sawinski D, Porrett P, Naji A, Hasz R, Suplee L, Trofe-Clark J, Sicilia A, McCauley M, Farooqi M, Gentile C, Smith J, Reese PP (2017) Trial of transplantation of HCV-infected kidneys into uninfected recipients. N Engl J Med 376:2394–2395
  21. Ison MG, Hager J, Blumberg E, Burdick J, Carney K, Cutler J, Dimaio JM, Hasz R, Kuehnert MJ, Ortiz-Rios E, Teperman L, Nalesnik M (2009) Donor-derived disease transmission events in the United States: data reviewed by the OPTN/UNOS Disease Transmission Advisory Committee. Am J Transplant 9:1929–1935
  22. Mularoni A, Bertani A, Vizzini G, Gona F, Campanella M, Spada M, Gruttadauria S, Vitulo P, Conaldi P, Luca A, Gridelli B, Grossi P (2015) Outcome of transplantation using organs from donors infected or colonized with carbapenem-resistant gram-negative bacteria. Am J Transplant 15:2674–2682
  23. Levesque E, Suet G, Merle JC, Compagnon P, Amathieu R, Feray C, Botterel F, Foulet F, Azoulay D, Dhonneur G (2014) Candida vascular complication in a liver transplant recipient due to yeast contamination of preservation solution. Transpl Infect Dis Off J Transplant Soc 16:827–829
  24. Mittal C, Hassan S, Arshad S, Jeepalyam S, Bruni S, Miceli M, Jacobsen G, Abouljoud M, Bajjoka I, Ramesh M, Alangaden G (2014) Clostridium difficile infection in liver transplant recipients: a retrospective study of rates, risk factors and outcomes. Am J Transplant 14:1901–1907
  25. Hsu RB, Chang CI, Fang CT, Chang SC, Wang SS, Chu SH (2011) Bloodstream infection in heart transplant recipients: 12-year experience at a university hospital in Taiwan. Eur J Cardiothorac Surg 40:1362–1367
  26. Wan Q, Ye Q, Zhou J (2013) Mortality predictors of bloodstream infections in solid-organ transplant recipients. Exp Clin Transplant 11:211–214
  27. Florescu DF, Sandkovsky U, Kalil AC (2017) Sepsis and challenging infections in the immunosuppressed patient in the intensive care unit. Infect Dis Clin N Am 31:415–434
  28. Trzeciak S, Sharer R, Piper D, Chan T, Kessler C, Dellinger RP, Pursell KJ (2004) Infections and severe sepsis in solid-organ transplant patients admitted from a university-based ED. Am J Emerg Med 22:530–533
  29. Kalil AC, Syed A, Rupp ME, Chambers H, Vargas L, Maskin A, Miles CD, Langnas A, Florescu DF (2015) Is bacteremic sepsis associated with higher mortality in transplant recipients than in nontransplant patients? A matched case-control propensity-adjusted study. Clin Infect Dis Off Publ Infect Dis Soc Am 60:216–222
  30. Bodro M, Sabe N, Tubau F, Llado L, Baliellas C, Roca J, Cruzado JM, Carratala J (2013) Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid-organ transplant recipients. Transplantation 96:843–849
  31. Canet E, Zafrani L, Azoulay E (2016) The critically ill kidney transplant recipient: a narrative review. Chest 149:1546–1555
  32. Azoulay E, Pickkers P, Soares M, Perner A, Rello J, Bauer PR, van de Louw A, Hemelaar P, Lemiale V, Taccone FS, Martin Loeches I, Meyhoff TS, Salluh J, Schellongowski P, Rusinova K, Terzi N, Mehta S, Antonelli M, Kouatchet A, Barratt-Due A, Valkonen M, Landburg PP, Bruneel F, Bukan RB, Pene F, Metaxa V, Moreau AS, Souppart V, Burghi G, Girault C, Silva UVA, Montini L, Barbier F, Nielsen LB, Gaborit B, Mokart D, Chevret S (2017) Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study. Intensive Care Med 43:1808–1819
  33. Kotloff RM, Ahya VN, Crawford SW (2004) Pulmonary complications of solid organ and hematopoietic stem cell transplantation. Am J Respir Crit Care Med 170:22–48
  34. Zeyneloglu P (2015) Respiratory complications after solid-organ transplantation. Exp Clin Transplant 13:115–125
  35. Fernandez-Ruiz M, Lopez-Medrano F, Romo EM, Allende LM, Meneu JC, Fundora-Suarez Y, San-Juan R, Lizasoain M, Paz-Artal E, Aguado JM (2009) Pretransplant lymphocyte count predicts the incidence of infection during the first two years after liver transplantation. Liver Transpl 15:1209–1216
  36. Nierenberg NE, Poutsiaka DD, Chow JK, Cooper J, Price LL, Freeman RB, Rohrer R, Snydman DR (2014) Pretransplant lymphopenia is a novel prognostic factor in cytomegalovirus and noncytomegalovirus invasive infections after liver transplantation. Liver Transpl 20:1497–1507
  37. Sarmiento E, Navarro J, Fernandez-Yanez J, Palomo J, Munoz P, Carbone J (2014) Evaluation of an immunological score to assess the risk of severe infection in heart recipients. Transpl Infect Dis 16:802–812
  38. Calarota SA, Zelini P, De Silvestri A, Chiesa A, Comolli G, Sarchi E, Migotto C, Pellegrini C, Esposito P, Minoli L, Tinelli C, Marone P, Baldanti F (2012) Kinetics of T-lymphocyte subsets and posttransplant opportunistic infections in heart and kidney transplant recipients. Transplantation 93:112–119
  39. Fernandez-Ruiz M, Lopez-Medrano F, Allende LM, Andres A, Garcia-Reyne A, Lumbreras C, San-Juan R, Morales JM, Paz-Artal E, Aguado JM (2014) Kinetics of peripheral blood lymphocyte subpopulations predicts the occurrence of opportunistic infection after kidney transplantation. Transpl Int 27:674–685
  40. Ling X, Xiong J, Liang W, Schroder PM, Wu L, Ju W, Kong Y, Shang Y, Guo Z, He X (2012) Can immune cell function assay identify patients at risk of infection or rejection? A meta-analysis. Transplantation 93:737–743
  41. Mian M, Natori Y, Ferreira V, Selzner N, Husain S, Singer L, Kim SJ, Humar A, Kumar D (2018) Evaluation of a novel global immunity assay to predict infection in organ transplant recipients. Clin Infect Dis 66:1392–1397
  42. Aguado JM, Silva JT, Fernandez-Ruiz M, Cordero E, Fortun J, Gudiol C, Martinez-Martinez L, Vidal E, Almenar L, Almirante B, Canton R, Carratala J, Caston JJ, Cercenado E, Cervera C, Cisneros JM, Crespo-Leiro MG, Cuervas-Mons V, Elizalde-Fernandez J, Farinas MC, Gavalda J, Goyanes MJ, Gutierrez-Gutierrez B, Hernandez D, Len O, Lopez-Andujar R, Lopez-Medrano F, Martin-Davila P, Montejo M, Moreno A, Oliver A, Pascual A, Perez-Nadales E, Roman-Broto A, San-Juan R, Seron D, Sole-Jover A, Valerio M, Munoz P, Torre-Cisneros J, Spanish Society of T, Group for Study of Infection in Transplantation of the Spanish Society of Infectious D, Clinical M, Spanish Network for Research in Infectious D (2018) Management of multidrug resistant gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations. Transplant Rev (Orlando) 32:36–57
  43. van Duin D, van Delden C, Practice ASTIDCo (2013) Multidrug-resistant gram-negative bacteria infections in solid organ transplantation. Am J Transplant 13(Suppl 4):31–41
  44. Garrido RS, Aguado JM, Diaz-Pedroche C, Len O, Montejo M, Moreno A, Gurgui M, Torre-Cisneros J, Pareja F, Segovia J, Garcia M, Lumbreras C (2006) A review of critical periods for opportunistic infection in the new transplantation era. Transplantation 82:1457–1462
  45. Helfrich M, Dorschner P, Thomas K, Stosor V, Ison MG (2017) A retrospective study to describe the epidemiology and outcomes of opportunistic infections after abdominal organ transplantation. Transpl Infect Dis. https://doi.org/10.1111/tid.12691
  46. Kotton CN, Kumar D, Caliendo AM, Huprikar S, Chou S, Danziger-Isakov L, Humar A, The Transplantation Society International CMVCG (2018) The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation 102:900–931
  47. Florescu DF, Kalil AC, Qiu F, Grant W, Morris MC, Schmidt CM, Florescu MC, Poole JA (2014) Does increasing immunoglobulin levels impact survival in solid organ transplant recipients with hypogammaglobulinemia? Clin Transplant 28:1249–1255
  48. Florescu DF, Kalil AC, Qiu F, Schmidt CM, Sandkovsky U (2013) What is the impact of hypogammaglobulinemia on the rate of infections and survival in solid organ transplantation? A meta-analysis. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 13:2601–2610
  49. Fishman JA (2014) From the classic concepts to modern practice. Clin Microbiol Infect 20(Suppl 7):4–9
  50. Kupeli E, Eyuboglu FO, Haberal M (2012) Pulmonary infections in transplant recipients. Curr Opin Pulm Med 18:202–212
  51. De Gasperi A, Feltracco P, Ceravola E, Mazza E (2014) Pulmonary complications in patients receiving a solid-organ transplant. Curr Opin Crit Care 20:411–419
  52. Lichtenstein DA, Meziere GA (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 134:117–125
  53. Weiss E, Paugam-Burtz C, Jaber S (2018) Shock etiologies and fluid management in liver failure. Semin Respir Crit care Med 39:538–545
  54. Bailly S, Leroy O, Montravers P, Constantin JM, Dupont H, Guillemot D, Lortholary O, Mira JP, Perrigault PF, Gangneux JP, Azoulay E, Timsit JF (2015) Antifungal de-escalation was not associated with adverse outcome in critically ill patients treated for invasive candidiasis: post hoc analyses of the AmarCAND2 study data. Intensive Care Med 41:1931–1940
  55. Benoit DD, Doig G, Timsit JF (2016) Focus on adequate antimicrobial treatment and de-escalation in the ICU. Intensive Care Med 42:1856–1858
  56. Jung B, Cisse M, Chanques G, Arsac E, Bismuth M, Panaro F, Perrigault PF, Souche B, Gallix B, Verzilli D, Delay JM, Navarro F, Pageaux GP, Jaber S (2011) Causes of early mortality after liver transplantation: a twenty-years single centre experience. Ann Fr Anesth Reanim 30:899–904
  57. Kalil AC, Opal SM (2015) Sepsis in the severely immunocompromised patient. Curr Infect Dis Rep 17:487
  58. Schachtner T, Stein M, Reinke P (2017) Sepsis after renal transplantation: clinical, immunological, and microbiological risk factors. Transpl Infect Dis Off J Transplant Soc. https://doi.org/10.1111/tid.12695
  59. Trofe-Clark J, Lemonovich TL (2013) Interactions between anti-infective agents and immunosuppressants in solid organ transplantation. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 13(Suppl 4):318–326
  60. Hamandi B, Holbrook AM, Humar A, Brunton J, Papadimitropoulos EA, Wong GG, Thabane L (2009) Delay of adequate empiric antibiotic therapy is associated with increased mortality among solid-organ transplant patients. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 9:1657–1665
  61. de Carvalho MA, Freitas FG, Silva Junior HT, Bafi AT, Machado FR, Pestana JO (2014) Mortality predictors in renal transplant recipients with severe sepsis and septic shock. PLoS ONE 9:e111610
  62. Hotchkiss RS, Moldawer LL, Opal SM, Reinhart K, Turnbull IR, Vincent JL (2016) Sepsis and septic shock. Nat Rev Dis Prim 2:16045
  63. Tu GW, Ju MJ, Zheng YJ, Zhu DM, Xu M, Rong RM, Zhu TY, Luo Z (2014) An interdisciplinary approach for renal transplant recipients with severe pneumonia: a single ICU experience. Intensive care Med 40:914–915
  64. Bige N, Zafrani L, Lambert J, Peraldi MN, Snanoudj R, Reuter D, Legendre C, Chevret S, Lemiale V, Schlemmer B, Azoulay E, Canet E (2014) Severe infections requiring intensive care unit admission in kidney transplant recipients: impact on graft outcome. Transpl Infect Dis Off J Transplant Soc 16:588–596
  65. Annane D, Renault A, Brun-Buisson C, Megarbane B, Quenot JP, Siami S, Cariou A, Forceville X, Schwebel C, Martin C, Timsit JF, Misset B, Ali Benali M, Colin G, Souweine B, Asehnoune K, Mercier E, Chimot L, Charpentier C, Francois B, Boulain T, Petitpas F, Constantin JM, Dhonneur G, Baudin F, Combes A, Bohe J, Loriferne JF, Amathieu R, Cook F, Slama M, Leroy O, Capellier G, Dargent A, Hissem T, Maxime V, Bellissant E (2018) Hydrocortisone plus fludrocortisone for adults with septic shock. New Engl J Med 378:809–818
  66. Patel MS, Niemann CU, Sally MB, De La Cruz S, Zatarain J, Ewing T, Crutchfield M, Enestvedt CK, Malinoski DJ (2015) The impact of hydroxyethyl starch use in deceased organ donors on the development of delayed graft function in kidney transplant recipients: a propensity-adjusted analysis. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 15:2152–2158
  67. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, Van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43:304–377
  68. Bafi AT, Tomotani DY, de Freitas FG (2017) Sepsis in solid-organ transplant patients. Shock 47:12–16
  69. Wright AJ, Fishman JA (2014) Central nervous system syndromes in solid organ transplant recipients. Clin Infect Dis Off Publ Infect Dis Soc Am 59:1001–1011
  70. Sonneville R, Magalhaes E, Meyfroidt G (2017) Central nervous system infections in immunocompromised patients. Curr Opin Crit Care 23:128–133
  71. Sonneville R, Mariotte E, Brouwer MC (2019) Cerebral complications of solid organ transplantation. Intensive Care Med. https://doi.org/10.1007/s00134-019-05540-1
  72. McCarthy M, Rosengart A, Schuetz AN, Kontoyiannis DP, Walsh TJ (2014) Mold infections of the central nervous system. New Engl J Med 371:150–160
  73. Brouwer MC, Tunkel AR, van de Beek D (2014) Brain abscess. New Engl J Med 371:1758
  74. Marzolf G, Sabou M, Lannes B, Cotton F, Meyronet D, Galanaud D, Cottier JP, Grand S, Desal H, Kreutz J, Schenck M, Meyer N, Schneider F, Dietemann JL, Koob M, Herbrecht R, Kremer S (2016) Magnetic resonance imaging of cerebral aspergillosis: imaging and pathological correlations. PLoS ONE 11:e0152475
  75. Coussement J, Lebeaux D, van Delden C, Guillot H, Freund R, Marbus S, Melica G, Van Wijngaerden E, Douvry B, Van Laecke S, Vuotto F, Tricot L, Fernandez-Ruiz M, Dantal J, Hirzel C, Jais JP, Rodriguez-Nava V, Lortholary O, Jacobs F (2016) Nocardia infection in solid organ transplant recipients: a multicenter European case-control study. Clin Infect Dis Off Publ Infect Dis Soc Am 63:338–345
  76. Coussement J, Lebeaux D, Rouzaud C, Lortholary O (2017) Nocardia infections in solid organ and hematopoietic stem cell transplant recipients. Current Opin Infect Dis 30:545–551
  77. Schmidt M, Sonneville R, Schnell D, Bige N, Hamidfar R, Mongardon N, Castelain V, Razazi K, Marty A, Vincent F, Dres M, Gaudry S, Luyt CE, Das V, Micol JB, Demoule A, Mayaux J (2013) Clinical features and outcomes in patients with disseminated toxoplasmosis admitted to intensive care: a multicenter study. Clinl Infect Dis Off Publ Infect Dis Soc Am 57:1535–1541
  78. Fernandez-Sabe N, Cervera C, Farinas MC, Bodro M, Munoz P, Gurgui M, Torre-Cisneros J, Martin-Davila P, Noblejas A, Len O, Garcia-Reyne A, Del Pozo JL, Carratala J (2012) Risk factors, clinical features, and outcomes of toxoplasmosis in solid-organ transplant recipients: a matched case-control study. Clin Infect Dis Off Publ Infect Dis Soc Am 54:355–361
  79. van Veen KE, Brouwer MC, van der Ende A, van de Beek D (2016) Bacterial meningitis in solid organ transplant recipients: a population-based prospective study. Transpl Infect Dis Off J Transplant Soc 18:674–680
  80. George IA, Santos CAQ, Olsen MA, Powderly WG (2017) Epidemiology of cryptococcosis and cryptococcal meningitis in a large retrospective cohort of patients after solid organ transplantation. Open Forum Infect Dis 4:ofx004
  81. Cantier M, Morisot A, Guerot E, Megarbane B, Razazi K, Contou D, Mariotte E, Canet E, De Montmollin E, Dubee V, Boulet E, Gaudry S, Voiriot G, Mayaux J, Pene F, Neuville M, Mourvillier B, Ruckly S, Bouadma L, Wolff M, Timsit JF, Sonneville R (2018) Functional outcomes in adults with tuberculous meningitis admitted to the ICU: a multicenter cohort study. Crit Care 22:210
  82. Saylor D, Thakur K, Venkatesan A (2015) Acute encephalitis in the immunocompromised individual. Curr Opin Infect Dis 28:330–336
  83. Mateen FJ, Muralidharan R, Carone M, van de Beek D, Harrison DM, Aksamit AJ, Gould MS, Clifford DB, Nath A (2011) Progressive multifocal leukoencephalopathy in transplant recipients. Ann Neurol 70:305–322
  84. Silva JT, Fernandez-Ruiz M, Aguado JM (2018) Multidrug-resistant gram-negative infection in solid organ transplant recipients: implications for outcome and treatment. Curr Opin Infect Dis 31:499–505
  85. Qiao B, Wu J, Wan Q, Zhang S, Ye Q (2017) Factors influencing mortality in abdominal solid organ transplant recipients with multidrug-resistant gram-negative bacteremia. BMC Infect Dis 17:171
  86. Timsit JF, Bassetti M, Cremer O, Daikos G, de Waele J, Kallil A, Kipnis E, Kollef M, Laupland K, Paiva JA, Rodriguez-Bano J, Ruppe E, Salluh J, Taccone FS, Weiss E, Barbier F (2019) Rationalizing antimicrobial therapy in the ICU: a narrative review. Intensive Care Med 45:172–189
  87. Camargo LF, Marra AR, Pignatari AC, Sukiennik T, Behar PP, Medeiros EA, Ribeiro J, Girao E, Correa L, Guerra C, Brites C, Pereira CA, Carneiro I, Reis M, Souza MA, Barata CU, Edmond MB (2015) Nosocomial bloodstream infections in a nationwide study: comparison between solid organ transplant patients and the general population. Transpl Infect Dis Off J Transplant Soc 17:308–313
  88. Kritikos A, Manuel O (2016) Bloodstream infections after solid-organ transplantation. Virulence 7:329–340
  89. Cervera C, van Delden C, Gavalda J, Welte T, Akova M, Carratala J (2014) Multidrug-resistant bacteria in solid organ transplant recipients. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Diss 20(Suppl 7):49–73
  90. Neofytos D, Fishman JA, Horn D, Anaissie E, Chang CH, Olyaei A, Pfaller M, Steinbach WJ, Webster KM, Marr KA (2010) Epidemiology and outcome of invasive fungal infections in solid organ transplant recipients. Transpl Infect Dis Off J Transplant Soc 12:220–229
  91. Husain S, Silveira FP, Azie N, Franks B, Horn D (2017) Epidemiological features of invasive mold infections among solid organ transplant recipients: PATH Alliance (R) registry analysis. Med Mycol 55:269–277
  92. Albano L, Bretagne S, Mamzer-Bruneel MF, Kacso I, Desnos-Ollivier M, Guerrini P, Le Luong T, Cassuto E, Dromer F, Lortholary O (2009) Evidence that graft-site candidiasis after kidney transplantation is acquired during organ recovery: a multicenter study in France. Clin Infect Dis Off Publ Infect Dis Soc Am 48:194–202
  93. Camargo JF (2017) Donor-derived infections in solid organ transplant recipients: challenging the 30-day paradigm. Transpl Infect Disease Off J Transplant Soc. https://doi.org/10.1111/tid.12665
  94. Kusne S, Taranto S, Covington S, Kaul DR, Blumberg EA, Wolfe C, Green M (2016) Coccidioidomycosis transmission through organ transplantation: a report of the OPTN ad hoc disease transmission advisory committee. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg 16:3562–3567
  95. Singh N, Perfect JR (2007) Immune reconstitution syndrome associated with opportunistic mycoses. Lancet Infect Dis 7:395–401
  96. Sun HY, Alexander BD, Huprikar S, Forrest GN, Bruno D, Lyon GM, Wray D, Johnson LB, Sifri CD, Razonable RR, Morris MI, Stosor V, Wagener MM, Singh N (2015) Predictors of immune reconstitution syndrome in organ transplant recipients with cryptococcosis: implications for the management of immunosuppression. Clin Infect Dis Off Publ Infect Dis Soc Am 60:36–44
  97. Scemla A, Gerber S, Duquesne A, Parize P, Martinez F, Anglicheau D, Snanoudj R, Zuber M, Bougnoux ME, Legendre C, Lortholary O (2015) Dramatic improvement of severe cryptococcosis-induced immune reconstitution syndrome with adalimumab in a renal transplant recipient. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 15:560–564
  98. Andes DR, Safdar N, Baddley JW, Alexander B, Brumble L, Freifeld A, Hadley S, Herwaldt L, Kauffman C, Lyon GM, Morrison V, Patterson T, Perl T, Walker R, Hess T, Chiller T, Pappas PG (2016) The epidemiology and outcomes of invasive Candida infections among organ transplant recipients in the United States: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Transpl Infect Dis Off J Transplant Soc 18:921–931
  99. Mutschlechner W, Risslegger B, Willinger B, Hoenigl M, Bucher B, Eschertzhuber S, Lass-Florl C (2015) Bronchoalveolar lavage fluid (1,3)beta-d-glucan for the diagnosis of invasive fungal infections in solid organ transplantation: a prospective multicenter study. Transplantation 99:e140–e144
  100. Lopez-Medrano F, Fernandez-Ruiz M, Silva JT, Carver PL, van Delden C, Merino E, Perez-Saez MJ, Montero M, Coussement J, de Abreu Mazzolin M, Cervera C, Santos L, Sabe N, Scemla A, Cordero E, Cruzado-Vega L, Martin-Moreno PL, Len O, Rudas E, de Leon AP, Arriola M, Lauzurica R, David M, Gonzalez-Rico C, Henriquez-Palop F, Fortun J, Nucci M, Manuel O, Pano-Pardo JR, Montejo M, Munoz P, Sanchez-Sobrino B, Mazuecos A, Pascual J, Horcajada JP, Lecompte T, Moreno A, Carratala J, Blanes M, Hernandez D, Farinas MC, Andres A, Aguado JM (2016) Clinical presentation and determinants of mortality of invasive pulmonary aspergillosis in kidney transplant recipients: a multinational cohort study. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 16:3220–3234
  101. Barchiesi F, Mazzocato S, Mazzanti S, Gesuita R, Skrami E, Fiorentini A, Singh N (2015) Invasive aspergillosis in liver transplant recipients: epidemiology, clinical characteristics, treatment, and outcomes in 116 cases. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 21:204–212
  102. Iriart X, Challan Belval T, Fillaux J, Esposito L, Lavergne RA, Cardeau-Desangles I, Roques O, Del Bello A, Cointault O, Lavayssiere L, Chauvin P, Menard S, Magnaval JF, Cassaing S, Rostaing L, Kamar N, Berry A (2015) Risk factors of pneumocystis pneumonia in solid organ recipients in the era of the common use of posttransplantation prophylaxis. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 15:190–199
  103. Werbel WA, Ison MG, Angarone MP, Yang A, Stosor V (2018) Lymphopenia is associated with late onset Pneumocystis jirovecii pneumonia in solid organ transplantation. Transpl Infect Dis Off J Transplant Soc 20:e12876
  104. Neofytos D, Hirzel C, Boely E, Lecompte T, Khanna N, Mueller NJ, Boggian K, Cusini A, Manuel O, van Delden C (2018) Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a descriptive analysis for the Swiss Transplant Cohort. Transpl Infect Dis Off J Transplant Soc 20:e12984
  105. Hodson EM, Jones CA, Webster AC, Strippoli GF, Barclay PG, Kable K, Vimalachandra D, Craig JC (2005) Antiviral medications to prevent cytomegalovirus disease and early death in recipients of solid-organ transplants: a systematic review of randomised controlled trials. Lancet 365:2105–2115
  106. Martin-Loeches I, Schultz MJ, Vincent JL, Alvarez-Lerma F, Bos LD, Sole-Violan J, Torres A, Rodriguez A (2017) Increased incidence of co-infection in critically ill patients with influenza. Intensive Care Med 43:48–58
  107. Kumar D, Ferreira VH, Blumberg E, Silveira F, Cordero E, Perez-Romero P, Aydillo T, Danziger-Isakov L, Limaye AP, Carratala J, Munoz P, Montejo M, Lopez-Medrano F, Farinas MC, Gavalda J, Moreno A, Levi M, Fortun J, Torre-Cisneros J, Englund JA, Natori Y, Husain S, Reid G, Sharma TS, Humar A (2018) A 5-year prospective multicenter evaluation of influenza infection in transplant recipients. Clin Infect Dis Off Publ Infect Dis Soc Am 67:1322–1329
  108. Natori Y, Shiotsuka M, Slomovic J, Hoschler K, Ferreira V, Ashton P, Rotstein C, Lilly L, Schiff J, Singer L, Humar A, Kumar D (2018) A double-blind, randomized trial of high-dose vs standard-dose influenza vaccine in adult solid-organ transplant recipients. Clin Infect Dis Off Publ Infect Dis Soc Am 66:1698–1704
  109. Cordero E, Roca-Oporto C, Bulnes-Ramos A, Aydillo T, Gavalda J, Moreno A, Torre-Cisneros J, Montejo JM, Fortun J, Munoz P, Sabe N, Farinas MC, Blanes-Julia M, Lopez-Medrano F, Suarez-Benjumea A, Martinez-Atienza J, Rosso-Fernandez C, Perez-Romero P (2017) Two doses of inactivated influenza vaccine improve immune response in solid organ transplant recipients: results of TRANSGRIPE 1-2, a randomized controlled clinical trial. Clin Infect Dis Off Publ Infect Dis Soc Am 64:829–838
  110. Paulsen GC, Danziger-Isakov L (2017) Respiratory viral infections in solid organ and hematopoietic stem cell transplantation. Clin Chest Med 38:707–726
  111. Grim SA, Reid GE, Clark NM (2017) Update in the treatment of non-influenza respiratory virus infection in solid organ transplant recipients. Expt Opin Pharmacother 18:767–779
  112. Peghin M, Los-Arcos I, Hirsch HH, Codina G, Monforte V, Bravo C, Berastegui C, Jauregui A, Romero L, Cabral E, Ferrer R, Sacanell J, Roman A, Len O, Gavalda J (2018) Community-acquired respiratory viruses are a risk factor for chronic lung allograft dysfunction. Clin Infect Dis Off Publ Infect Dis Soc Am
  113. Kalil AC, Sandkovsky U, Florescu DF (2018) Severe infections in critically ill solid organ transplant recipients. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 24:1257–1263
  114. Keating MR, Daly JS (2013) Nontuberculous mycobacterial infections in solid organ transplantation. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 13(Suppl 4):77–82
  115. Osmani M, Sotello D, Alvarez S, Odell JA, Thomas M (2018) Mycobacterium abscessus infections in lung transplant recipients: 15-year experience from a single institution. Transpl Infect Dis Off J Transplant Soc 20(2):e12835
  116. Huang HC, Weigt SS, Derhovanessian A, Palchevskiy V, Ardehali A, Saggar R, Kubak B, Gregson A, Ross DJ, Lynch JP 3rd, Elashoff R, Belperio JA (2011) Non-tuberculous mycobacterium infection after lung transplantation is associated with increased mortality. J Heart Lung Transplant Off Publ Int Soc Heart Transplant 30:790–798
  117. Saliba F, Delvart V, Ichai P, Kassis N, Botterel F, Mihaila L, Azoulay D, Adam R, Castaing D, Bretagne S, Samuel D (2013) Fungal infections after liver transplantation: outcomes and risk factors revisited in the MELD era. Clin Transplant 27:E454–E461
  118. Len O, Garzoni C, Lumbreras C, Molina I, Meije Y, Pahissa A, Grossi P (2014) Recommendations for screening of donor and recipient prior to solid organ transplantation and to minimize transmission of donor-derived infections. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 20(Suppl 7):10–18
  119. Fishman JA, Greenwald MA, Grossi PA (2012) Transmission of infection with human allografts: essential considerations in donor screening. Clin Infect Dis Off Publ Infect Dis Soc Am 55:720–727

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement