INFECTIONS AFTER ORGAN-TRANSPLANTATION

Over the last ten to fifteen years medical and surgical advances have led to lon-er rates of infection and infection-related mortality in tr ansplant recipients, Despite these advances, the process whereby one d iagnoses and manages infectious problems in transplant patients has be come increasingly complex. Evaluation of transplant patients with infe ctions requires a good understanding of the intricacies of modem immun osuppressive therapy and both the typical and atypical clinical manife stations of man! conventional and opportunistic pathogens. in particul ar, it is incumbent upon the clinicians caring for transplant patients to be familiar with the biology of cytomegalovirus and other herpes v iruses, and of the prophylactic strategies that have evolved to lessen the burden of disease from these agents. Thorough knowledge is also r equired of common fungal pathogens and the viruses that cause chronic hepatitis. Transplant patients also should always be evaluated in the temporal contest of their transplant operation, because different dise ases are prevalent at different times after transplantation Since immu nosuppressive drugs modify the clinical presentation of infections is important to maintain clinical vigilance and attend to even minor new symptoms. This chapter is designed to provide a relatively concise ove rview of transplant infections for intensivists or other clinicians wh o encounter transplant patients in their practice, The references enco mpass much of the classic transplant infectious disease literature: th ey are included, not only for citation, but as a bibliography for furt her study.