The AST Handbook of Transplant Infections Disclaimer This Document is provided for informational and general educational purposes only. This Document should not be used in place of professional medical advice and is not intended to be a substitute for consultation with or treatment by a medical professional. This Document is an educational tool designed only to enhance and support the treatment and education process. This Document should not be substituted for specifi c medical advice or instruction by a physician, nurse or pharmacist. The AST Handbook of Transplant Infections EDITED BY Deepali Kumar MD MSc FRCPC Transplant Infectious Diseases University of Alberta Edmonton Canada Atul Humar MD MSc FRCPC Transplant Infections Diseases University of Alberta Edmonton Canada Associate Editors Emily Blumberg MD Marian G. Michaels MD, MPH Kieren Marr MD On behalf of The American Society of Transplantation Infectious Diseases Community of Practice This edition fi rst published 2011, © 2011 by Blackwell Publishing Ltd Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing program has been merged with Wiley’s global Scientifi c, Technical and Medical business to form Wiley-Blackwell. 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ISBN 978-0-470-65827-7 (pbk. : alk. paper) 1. Communicable diseases—Handbooks, manuals, etc. 2. Transplantation of organs, tissues, etc.—Complications—Handbooks, manuals, etc. I. Kumar, Deepali. II. Humar, Atul. III. American Society of Transplantation. Infectious Diseases Community of Practice. IV. Title: Handbook of transplant infections. [DNLM: 1. Transplants—adverse effects—Handbooks. 2. Bacterial Infections—therapy—Handbooks. 3. Mycoses—therapy— Handbooks. 4. Virus Diseases—therapy—Handbooks. WO 39] RC112.A88 2011 616.9(cid:2)8—dc22 2011002978 ISBN: 9780470658277 A catalogue record for this book is available from the British Library. This book is published in the following electronic formats: ePDF 9781444397925; Wiley Online Library 9781444397949; ePub 9781444397932 Set in 9/12pt Meridien by MPS Limited, a Macmillan Company, Chennai, India 1 2011 Contents List of Contributors, ix Preface, xiii Acknowledgements, xv Part 1 General Issues and Infectious Syndromes, 1 1 Timeline of Infections After Organ Transplant, 3 Christian van Delden 2 Timeline of Infections After Hematopoietic Stem Cell Transplant, 4 Sarah P. Hammond & Francisco M. Marty 3 Immune Reconstitution After Myeloablative Stem Cell Transplant, 5 Sarah P. Hammond & Francisco M. Marty 4 Pre-transplant Infectious Disease Evaluation of the Organ Transplant Candidate, 6 Staci A. Fischer 5 Pre-transplant Infectious Disease Evaluation of the Hematopoietic Stem Cell Transplant Candidate, 8 Staci A. Fischer 6 Technical Complications after Organ Transplant and Associated Infections, 9 Abhinav Humar 7 Evaluation and Initial Treatment of Infectious Complications Among Organ Transplant Recipients, 11 Kathleen Julian 8 Management of Infections in Kidney Transplant Recipients, 20 Bartholomew Bono 9 Management of Infections in Pancreas Transplant Recipients, 22 Bartholomew Bono 10 Management of Infections in Liver Transplant Recipients, 23 Bartholomew Bono 11 Management of Infections in Lung, Heart–Lung, and Heart Transplant Recipients, 25 Shahid Husain & S.M. Hosseini-Mogaddham 12 Management of Infections in Intestinal Transplant Recipients, 29 Michael Green v vi Contents 13 Antimicrobial Management of Patients with Fever and Neutropenia Following Hematopoietic Stem Cell Transplantation, 31 Upton D. Allen Part II Specifi c Pathogens, 33 14 Cytomegalovirus, 35 Raymund R. Razonable & Atul Humar 15 Epstein-Barr Virus and Post-transplant Lymphoproliferative Disorders, 42 Rebecca Madan & Betsy Herold 16 Management of herpes simplex virus, 45 Marian G. Michaels 17 Management of Varicella Zoster Virus, 47 Marian G. Michaels 18 Prevention and Treatment of Human Herpesvirus 6, 7 and 8 Infections in Transplant Recipients, 49 Raymund R. Razonable 19 BK Polyomavirus and Polyomavirus-associated Nephropathy, 51 Hans H. Hirsch 20 Respiratory Viruses, 55 Oriol Manuel 21 Human Papillomavirus, 59 Gail E. Reid 22 Hepatitis B, 61 Karen E. Doucette 23 Hepatitis C Management in Transplant Candidates and Recipients, 63 Karen E. Doucette 24 Management Algorithm for Transplantation in Patients with Human Immunodefi ciency Virus, 64 Shirish Huprikar 25 Management of Selected Fungal Infections After Transplantation, 68 Michele I. Morris 26 Treatment of Nocardia Infections, 73 Nina M. Clark 27 Tuberculosis: Treatment and Prevention, 74 Nina M. Clark 28 Treatment of Non-tuberculous Mycobacterium Infections, 77 Nina M. Clark 29 Pneumocystis jiroveci Pneumonia: Prophylaxis and Therapy, 79 Nicolas J. Mueller 30 Suggested Therapy of Clostridium diffi cile Colitis After Transplantation, 80 Aneesh K. Mehta Contents vii 31 Diagnosis and Treatment of Multidrug-Resistant Bacteria, 81 Emily A. Blumberg 32 Management of Selected Parasitic Infections After Transplant, 84 Sanjay Mehta & Robert Huang Part III Donor Issues, 87 33 Infectious Disease Evaluation of the Potential Organ Donor, 89 Staci A. Fischer 34 Infectious Disease Evaluation of the Potential Hematopoietic Stem Cell Transplant Donor, 91 Staci A. Fischer 35 Donor-derived Infections, 93 Michael G. Ison 36 Estimates of Window Period Length for Serology and Nucleic Acid Testing, 97 Atul Humar 37 Estimates of Residual Risk of HIV or HCV when using Selected Increased Risk Donor Categories, 98 Atul Humar 38 Management of Recipients of Hepatitis B Core Antibody-Positive Donor Organ, 99 Karen E. Doucette 39 Donor Tuberculosis Issues: Potential Scenarios and Management, 100 Camille N. Kotton & Michele I. Morris Part IV Prevention of Infections after Transplantation, 103 40 Suggested Prophylaxis Regimens in Organ Transplant Recipients, 105 Nasia Safdar, Germana L.M. Silva & Jennifer Hsu 41 Antimicrobial Prophylaxis Regimen for Allogeneic Hematopoietic Stem Cell Transplant Recipients, 107 Sherif Mossad 42 Antimicrobial Prophylaxis Regimen for Autologous Hematopoietic Stem Cell Transplant Recipients, 109 Sherif Mossad 43 Adult Vaccination Schedule After Solid Organ Transplant, 110 Marissa Wilck & Lindsey Baden 44 Adult Vaccination Schedule After Allogeneic Stem Cell Transplant, 113 Lindsey Baden & Marissa Wilck 45 Immunizations After Pediatric Solid Organ Transplant and Hematopoietic Stem Cell Transplant, 116 Tanvi Sharma & Lynne Lewis 46 Recommendations for Travel-related Vaccinations and Medications for Transplant Travelers, 120 Camille N. Kotton vviiiiii CCoonntteennttss 47 Safe Living Strategies for Transplant Patients, 123 Julia Garcia-Diaz & Shannon Bergeron Part V Post-transplant Medications and Drug Interactions, 127 48 Common Immunosuppressive Drugs, Mechanisms of Action, Side-effects, and Other Interactions, 129 Daniel Kaul 49 Infectious Risks Associated with Anti-thymocyte Globulin (ATG, Thymoglobulin), 131 Steven D. Burdette 50 Infectious Risks Associated with Alemtuzumab (Campath), 133 Steven D. Burdette 51 Infectious Risks Associated with IL-2R Antagonist [Basiliximab (Simulect) and Daclizumab (Zenapax)], 135 Steven D. Burdette 52 Infectious Risks Associated With Rituximab (Rituxan), 136 Steven D. Burdette 53 Drug Interactions Between Antimicrobial Agents and Common Immunosuppressive Drugs Used in Transplantation, 137 Christian Garzoni 54 Antiviral Agents for Adult Transplant Recipients, 140 Valentina Stosor 55 Antifungal Agents in Adult Transplant Recipients, 146 Shmuel Shoham 56 Antiviral Agents for Pediatric Transplant Recipients, 150 Lara Danziger-Isakov, Lizbeth Hansen & Elizabeth Neuner 57 Antifungal Agents for Pediatric Transplant Recipients, 158 Lara Danziger-Isakov, Lizbeth Hansen & Elizabeth Neuner Index, 165 List of Contributors Upton D. Allen MBBS, MSc, Lara Danziger-Isakov MD, MPH Sarah P. Hammond MD FAAP, FRCPC, FRCP (UK) Staff, Center for Pediatric Infectious Instructor of Medicine Professor, Departments of Diseases; Director for Pediatric Clinical Harvard Medical School Paediatrics and Health Policy Research Division of Infectious Diseases Management and Evaluation The Children’s Hospital at Cleveland Brigham and Women’s Hospital University of Toronto Clinic Boston, MA, USA Division Head, Infectious Diseases Assistant Professor of Pediatrics The Hospital for Sick Children Cleveland Clinic Lerner College of Lizbeth Hansen Toronto, Canada Medicine at CWRU Cleveland Clinic Cleveland, OH, USA Lerner College of Medicine at CWRU Lindsey R. Baden MD Cleveland, OH, USA Karen Doucette MD, MSc (Epi), Division of Infectious Disease FRCPC Brigham and Women’s Hospital Associate Professor, Division of Betsy Herold MD Dana Farber Cancer Institute Infectious Diseases Professor, Department of Pediatrics Boston, MA, USA Education Director, Transplant (Infectious Diseases) Infectious Diseases Fellowship Professor, Department of Microbiology & Emily A. Blumberg MD University of Alberta Immunology Professor of Medicine Edmonton, AB, USA Professor, Department of Division of Infectious Diseases Obstetrics & Gynecology and University of Pennsylvania School of Staci A. Fischer MD, FACP, FIDSA Women’s Health Medicine Associate Professor of Medicine Albert Einstein College of Medicine Philadelphia, PA, USA The Warren Alpert Medical School of New York Brown University NY, USA Bartholomew Bono MD Director, Transplant Infectious Diseases Program Director, Infectious Rhode Island Hospital Hans H. Hirsch MD, MSc, FMH Disease Providence, RI, USA (Inf Diseases), FMH (Internal Albert Einstein Healthcare Network Medicine), FAMH (Medical Philadelphia, PA, USA Julia Garcia-Diaz MD, MS, FACP Microbiology) Department of Infectious Diseases Acting Director, Institute for Medical Ochsner Clinic Foundation Steven D. Burdette MD, FIDSA Microbiology New Orleans, LA, USA Infectious Diseases Fellowship Department of Biomedicine Director & Associate Professor University of Basel, and Christian Garzoni MD of Medicine Attending Physician, University Clinic for Infectious Disease Infectious Disease Advisor to Miami Division of Infectious Diseases & Bern University Hospital, Inselspital Valley Hospital Transplant Program Hospital Epidemiology Bern, Switzerland WSU Boonshoft School of Medicine University Hospital Basel Dayton, OH, USA Basel, Switzerland Michael Green MD, MPH Professor of Pediatrics, Surgery & Nina M. Clark MD Clinical and Translational Science S.M. Hosseini-Mogaddham Associate Professor University of Pittsburgh School of Medicine Urology and Nephrology Research Department of Internal Medicine Division of Infectious Diseases Center (UNRC) University of Illinois at Chicago Children’s Hospital of Pittsburgh Shahid Beheshti University Chicago, IL, USA Pittsburgh, PA, USA Tehran, Iran ix x List of Contributors Jennifer Hsu MD Daniel Kaul MD Marian G. Michaels MD, MPH Division of Infectious Diseases Director, Transplant ID Service Professor of Pediatrics and Surgery Department of Medicine Division of Infectious Disease University of Pittsburgh School of University of Wisconsin School of University of Michigan Medical School Medicine Medicine and Public Health Ann Arbor, MI USA Children’s Hospital of Pittsburgh of Madison, WI, USA UPMC Camille Nelson Kotton MD Division of Pediatric Infectious Robert Huang MD Clinical Director, Transplant and Diseases Department of Medicine Immunocompromised Host Infectious Pittsburgh, PA, USA Division of Infectious Diseases Diseases University of California at San Diego Infectious Diseases Division Michele I. Morris MD, FACP, La Jolla, CA, USA Massachusetts General Hospital and FIDSA Assistant Professor Clinical Chief, Division of Infectious Abhinav Humar MD Harvard Medical School Diseases Professor, Department of Surgery Harvard University Director, Immunocompromised Host Clinical Director, Starzl Transplant Boston, MA, USA Section Institute Associate Professor of Clinical Medicine University of Pittsburgh Lynne Lewis RN, MS, CPNP University of Miami Miller School of Pittsburgh, PA, USA Coordinator, Division of Pediatric Medicine Infectious Diseases Miami, FL, USA Shirish Huprikar MD Section on Immunocompromised Hosts Director, Transplant Infectious Diseases Children’s Hospital Boston Sherif Beniameen Mossad MD, Program Boston, MA, USA FACP, FIDSA Associate Professor, Department of Staff Department of Infectious Diseases Medicine Rebecca P. Madan MD, MSc Section Head of Transplant Infectious Mount Sinai School of Medicine Assistant Professor Diseases New York, NY, USA Division of Pediatric Infectious Diseases Medicine Institute and Transplant Albert Einstein College of Medicine Center Shahid Husain MD, MS New York, NY, USA Associate Professor of Medicine Assistant Professor of Medicine CCLCM of CWRU Cleveland Director, Transplant Infectious Oriol Manuel MD OH, USA Diseases Infectious Diseases Service and Division of Infectious Diseases and Transplantation Center Nicolas J. Mueller MD Multi-organ Transplantation University Hospital Center (CHUV) and Senior Attending Physician University Health Network/University University of Lausanne Division of Infectious Diseases and of Toronto Lausanne, Switzerland Hospital Epidemiology Toronto, Canada University Hospital Zurich Michael G. Ison MD MS Francisco M. Marty MD Zurich, Switzerland Assistant Professor, Divisions of Division of Infectious Disease Infectious Diseases and Organ Brigham and Women’s Hospital Elizabeth A. Neuner PharmD, Transplantation Boston, MA, USA BCPS Northwestern University Feinberg Infectious Diseases Clinical Specialist School of Medicine Sanjay R. Mehta MD, DTM&H Department of Pharmacy Medical Director, Transplant & Assistant Clinical Professor of Medicine Cleveland Clinic Immunocompromised Host Division of Infectious Diseases Cleveland, OH, USA Infectious Diseases Service University of California Northwestern University San Diego, CA, USA Raymund R. Razonable MD Comprehensive Transplant Center Associate Professor of Medicine Chicago, IL, USA Aneesh K. Mehta MD Director, Transplant Infectious Assistant Professor of Medicine Diseases Kathleen Julian MD Assistant Director of Transplant Associate Chair for Faculty Assistant Professor of Medicine Infectious Diseases Development and Diversity Division of Infectious Diseases Division of Infectious Diseases Division of Infectious Diseases Penn State Hershey Medical Center Emory University School of Medicine College of Medicine Hershey, PA, USA Atlanta, GA, USA Mayo Clinic Rochester, MN, USA