Strategies for Safe Living After Solid Organ Transplantation

Infections remain a risk to the recipients of solid organ transplantation, long after the initial posttransplant period. Factors that affect risk include the recipient’s net state of immunosuppression, epidemiologic exposures and the consequences of the invasive procedures to which the recipient has been subjected (1–4). Infections can be due to endogenous organisms that reactivate during periods of excess immunosuppression, donor-acquired organisms which are discussed in section 3 of these Guidelines, or from the environment, whether it be in the hospital setting or the community after discharge. They may also develop opportunistic infections with exogenously acquired organisms if exposed to a high inoculum or particularly virulent microbes, even during periods of minimal or maintenance immunosuppression. A major goal of transplantation is to be able to lead as healthy and normal a life as possible; accordingly the risk of exposure to infectious agents will always be present. However, various measures can be taken to reduce high-risk epidemiologic exposures in the hospital and in the community, and transplant recipients should be counseled in ways to minimize the risk of infection. Furthermore, strategies for safe living must be carefully woven with the transplant recipient’s attempts to regain normal function and return to an active and productive life.