- CMV antibody
- EBV antibody
- HIV antibody
- Hepatitis C antibody
- Hepatitis B surface antigen and antibody; hepatitis B core antibody
- Rapid plasma reagin
- PPD or interferon-release assay for latent tuberculosis
- Toxoplasma antibody (in heart transplant candidates)
- Recipients should be screened for protective antibody to vaccine-preventable viral infections, particularly varicella, measles and mumps. Those without IgG antibody should be vaccinated pre-transplant if not already on immunosuppressive therapy
- A thorough history should be completed to identify potential exposures to infections with a latent or chronic phase which could reactivate on immunosuppressive therapy. Such infections include Mycobacterium tuberculosis, endemic fungi such as Coccidioides, and Strongyloides (see ‘Optional testing’ column)
- Should an infection be identified in the screening of the potential organ transplant recipient, consultation with an infectious disease specialist may be indicated to guide pre-transplant treatment, timing of transplantation when delay is possible, and/or post-transplant monitoring
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- HSV antibody
- HTLV-I/II antibody
- Toxoplasma antibody (in non-heart transplant candidates)
- Trypanosoma cruzi antibody in recipients from endemic areas (e.g. Mexico, Central America, South America)
- Coccidioides antibody in recipients from endemic areas (e.g. south-western USA, Mexico, Central America, South America)
- Histoplasma antibody in recipients from endemic areas (e.g. Ohio and Mississippi river valleys in the USA, other river valleys in North and Central America, Eastern and Southern Europe, Africa and Australia)
- Strongyloides antibody in recipients from endemic areas (e.g. Appalachian USA, Central America, South America, sub-Saharan Africa, South-east Asia, Eastern Europe)
- Brucella serology in recipients from endemic areas (e.g. Middle East, Mediterranean basin, eastern Europe, Asia, Africa, Central and South America). Ingestion of unpasteurized milk or chesses from endemic areas is a risk factor for infection
- West Nile Virus serology
- Human herpes virus-8 (HHV-8) serology
- BK virus serology (kidney transplantation)
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Patients with end-stage organ disease are susceptible to certain infections which should be diagnosed and treated prior to transplantation if at all possible. Specific considerations include the following:
- Kidney – hemodialysis catheter-related bloodstream infections, peritonitis in peritoneal dialysis patients, hepatitis B, hepatitis C, complicated UTIs
- Pancreas – wounds and osteomyelitis related to diabetic neuropathy
- Heart – infection of ventricular assist devices (localized drive line infections or bloodstream infections mimicking endocarditis) should be aggressively treated but do not preclude transplantation. Chagas disease (trypanosomiasis) should be ruled out in the patient from an endemic area with dilated cardiomyopathy. Toxoplasmosis is a particular concern in cardiac transplantation, in which donor transmission can occur in the seronegative recipient of a seropositive heart, resulting in acute myocarditis or disseminated infection
- Liver – hepatitis B, hepatitis C, cholangitis, spontaneous bacterial peritonitis, intravenous catheter-related infections, including candidemia
- Lung – sputum cultures to determine colonizing bacteria, mycobacteria and fungi should guide perioperative antimicrobial choices
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