Impact of Infection on Transplant Outcomes: Transplant Infectious Disease Expertise as an Essential Component of Transplant Programs

Abstract

Infectious complications are a major cause of morbidity and mortality in both solid organ and hematopoietic stem cell transplant patients. The risk of infection by common opportunistic pathogens like cytomegalovirus can be mitigated with the optimal use of molecular diagnostics and antiviral prophylaxis. Novel and emerging bacterial, viral, fungal, and parasitic pathogens may be more successfully managed with early diagnosis and therapy. In the care of solid organ and hematopoietic stem cell transplant candidates and recipients, involvement of physicians with expertise in transplant infectious diseases has been shown to improve outcomes. In addition to their essential role in decreasing patient morbidity and mortality, infectious disease specialists also add value to the transplant program through the development and implementation of infection prevention protocols. These specialists are on the front line of the response to new organisms that may present atypically or be difficult to recognize in patients receiving immunosuppressive therapies pre-and post-transplant. In this rapidly changing field, the Emerging Transplant Infections textbook provides updated information on the diagnosis, treatment, and prevention of significant infections often seen in this highly immunocompromised population.

Advanced practice providers in infectious disease: Enhancing the infectious disease team of the future

“…Immunocompromised ID specifically offers a unique workplace for APPs to practice. Due to the high acuity of these patients as well as the multiple transitions of care and prolonged hospital stays, more infectious disease programs are routinely embedded within transplant centers 21 . Given the intrinsic complexity of these patients, APPs can add valuable historical context, continuity, and collaboration of care with the primary oncology or transplant teams, extending high‐quality care to more patients as the field continues to grow.…”

A review of transplant infectious diseases and pediatric transplant infectious diseases curriculum

“…Infectious disease-related complications occur in more than half (58%) of hospitalized solid organ transplant recipients (SOTRs) [8]. The benefit of infectious diseases consultation has been well established in numerous infections which are commonly seen among transplant populations: Staphylococcus aureus bacteremia, candidemia, and sepsis [9][10][11][12]. Indeed, solid organ transplant recipients have lower associated mortality due to sepsis than nontransplant patients, possibly due to early subspecialty care by TID physicians allowing for expedited diagnosis and early, appropriate empiric therapy [9,[13][14][15].…”

“…The benefit of infectious diseases consultation has been well established in numerous infections which are commonly seen among transplant populations: Staphylococcus aureus bacteremia, candidemia, and sepsis [9][10][11][12]. Indeed, solid organ transplant recipients have lower associated mortality due to sepsis than nontransplant patients, possibly due to early subspecialty care by TID physicians allowing for expedited diagnosis and early, appropriate empiric therapy [9,[13][14][15]. Inpatient TID consultation is associated with reduced mortality and rehospitalization rates; however, when delayed more than 48 h after admission, the cost benefit of input is diminished, indicating early consultation is more impactful [8].…”

“…Inpatient TID consultation is associated with reduced mortality and rehospitalization rates; however, when delayed more than 48 h after admission, the cost benefit of input is diminished, indicating early consultation is more impactful [8]. Similarly, among hematopoietic stem cell transplant recipients, infection is a common primary or contributory cause of mortality [9]. Given the record-breaking number of transplants taking place yearly and a clearly demonstrated mortality benefit to early and specialized infectious diseases care, the creation and advancement of TID training programs is critical [16].…”