point in the posttransplant course, the etiology will be very different at different points in time
(Table 1).
Importance of the Underlying Disease and Type of Transplantation
The type of organ transplanted, the degree of immunosuppression, the need for additional
antirejection therapy, and the occurrence of technical or surgical complications, all impact on
the incidence of infection posttransplant.
In each type of transplantation, there are patients in which the risk of infection is greater.
In HT, patients with prior ischemic cardiomyopathy experience more surgical complications,
need longer postoperative mechanical assistance, and are more susceptible toPneumocystis
jirovecipneumonia (15,16). Incidence of infection is higher in thoracic transplantation pediatric
population than that in adult (17).
After orthotopic liver transplantation (OLT), patients with prior fulminant liver disease
fared the worst ICU course and cirrhotics the best (18). Thrombocytopenia of< 50 109 /L for
three days is frequent after liver transplantation and as such was not found to be an important
contributor to bleeding. The unique associated event identified for significant bleeding was
sepsis (HR 34.80; 95% CI 1.5–153.4) (19). If severely ill patients with end-stage liver disease are
selected appropriately, liver transplant outcomes are similar to those observed among subjects
who are less ill and are transplanted electively from home (20).
Following lung transplantation, patients with obstructive lung disease, double-lung
transplant, or cystic fibrosis have a longer stay in the ICU and a higher risk of infection
(2,21,22).
The type of SOT also determines the complexity of the surgery, the intensity of
immunosuppression, and the most likely sites of infection. Lung and HT recipients are
especially susceptible to thoracic infections, whereas intra-abdominal complications predom-
inate in OLT or pancreas recipients. Patients receiving alemtuzumab for the treatment of
allograft rejection are more prone to suffer opportunistic infections (23,24).
Certain infections are characteristic of a particular type of transplantation, for example,
infections related to circulatory support devices (intra-aortic balloon pumps, ventricular
Table 1 Chronology of Most Common Infections or Causative Microorganisms in Severely Ill Solid Organ
Transplant Recipients
Chronology of infection Most common syndromes
Early infection (1st month) Bacterial infections
Pneumonia
Surgical wound infection
Deep infections near the surgical area
Intra-abdominal abscesses
Urinary tract infection
Catheter related infection
Bloodstream infection
Antibiotic associated diarrhea
Viral infections
Herpes simplexstomatitis
HHV-6 infections
Primary CMV disease
Infections transmitted with the allograft
Invasive aspergillosis or candidiasis
Intermediate infections
(2–6 months)
Opportunistic infections: bacterial, tuberculosis, nocardiosis, invasive
aspergillosis, other fungal infections, viral diseases, toxoplasmosisLate infections (after 6th month) Common community-acquired infections
Respiratory tract infections
Urinary tract infections
Varicella-zoster infections
CMV, adenovirus
Other opportunistic microorganisms: listeriosis,Cryptococcus,P. jiroveci
388 Mun ̃oz et al.