INFECTION IN THE BONE-MARROW TRANSPLANT RECIPIENT AND ROLE OF THE MICROBIOLOGY LABORATORY IN CLINICAL TRANSPLANTATION

Over the past quarter century tremendous technological advances have b een made in bone marrow and solid organ transplantation Despite these advances, an enduring problem for the transplant recipient is infectio n. As immunosuppressive regimens have become more systematic, it is ap parent that different pathogens affect the transplant recipient at dif ferent time points in the posttransplantation course, since the), are influenced by multiple intrinsic and extrinsic factors. An understandi ng of this evolving risk for infection is essential to the management of the patient following transplantation and is a key to the early dia gnosis and treatment of infection. Likewise, diagnosis of infection is dependent upon the quality of laboratory support, and services provid ed by the clinical microbiology laboratory play an important role in a ll phases of clinical transplantation. These include the prescreening of donors and recipients for evidence of active or latent infection, t he timely and accurate microbiologic evaluation of the transplant pati ent with suspected infection, and the surveillance of asymptomatic all ograft recipients for infecton. Expert services in bacteriology, mycol ogy, parasitology, virology, and serology are needed and communication between the laboratory and the transplantation team is paramount for providing clinically relevant cost-effective diagnostic testing.