Solid Organ Alıcılarında İnfeksiyon Riski ve Sık Görülen İnfeksiyonlar

Etkili immünsupressif ilaçların kullanıma girmesi ile son dönem organ yetmezliği olan hastalarda organ nakilleri giderek artan oranlarda başarı ile uygulanmaya başlamıştır. İnfeksiyon etkenlerine duyarlı hale gelen bu hastalarda cerrahi öncesi ve sonrasında iyi bir infeksiyon koruma programı uygulanması gerektiği ortaya çıkmıştır. Nakil öncesi ve sonrasında alıcının infeksiyon risklerinin belirlenmesi ve önlemlerin alınması gerekmektedir. Uygun immünsupressif tedavinin yapılması, hastanın ve ailesinin eğitimi, kişisel ve çevresel hijyene dikkat edilmesi, beslenme ve egzersiz programları bir bütün halinde planlanmalıdır

Anahtar Kelimeler:

Organ Nakli, İmmünsüpresyon, Fırsatçı İnfeksiyonlar

Infection Risks and Frequent Infections in Solid Organ Transplanted Patients

As the effective immunesuppressive drugs were discovered, successful organ transplantations have been performed increasingly in the patients with end-stage organ failures. A requirement for well-documented infection prevention and control program covering pre- and postoperative phases has emerged in these patients who have increased susceptibility to infectious agents. The recipient’s risks for infection development in pre- and postoperative periods must be determined, and required measures must be established. For transplant patients, appropriate immunesuppressive treatment should be performed, and education of the both patients and the family, establishment of the personal and environmental hygienic standards, nutrition supply and physical activity programs must be programmed in detail

Keywords:

Organ Transplantation, Immunesuppression, Opportunistic Infections.,

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1. Avkan-Oğuz V. Solid organ transplant alıcılarında pulmoner fungal infeksiyonların yönetimi Klimik Dergisi 2009; 21 (özel sayı): 23-33.
2. Haberal M. Development of transplantation in Turkey. Transplant Proc 2001; 33: 3027-9.
3. İstatistiklerle Türkiye 2012. Türkiye İstatistik Kurumu. http://www.tuik.gov.tr
4. Fischman JA. Infection in solid-organ transplant recipients N Engl J Med 2007; 357: 2601-14.
5. Infectious Disease Community of Practice. American Society of Transplantation, Infectious Disease Guidelines for Transplantation, Am J Transplant 2004; 4 (suppl 10): 5-166.
6. Syndman DR. Epidemiology of infections after solidorgan transplantation. Clin Infect Dis 2001; 33(Suppl 1): 5-8.
7. Kahan BD, Transcoso P. Introduction to solid organ transplantation. In: Bowden RA, Ljungman P,Paya C (eds). Transplant Infections. 2 nd ed. Philadelphia: Lippincot Williams and Wilkins Press. 2003: 17-27.
8. Young LR, Palmer S. Community respiratory viral infections; An overlooked cause of morbidity and mortality in transplant recipients. In: ‘Singh N, Aquado JM (eds): Infection Complications in Transplant Recipients’. Boston: Kuwer Academic Publ. 2000: 31- 57.
9. Wilck M, Fishman JA. The challenges of infection in transplantation: donor-derived infections. Curr Opin Transplant 2005; 10: 301-6.
10. Fishman JA, Rubin HR: Infection in organ transplant recipients, New Engl J Med 1998; 24: 1741-50.
11. Singh N, Chang FY, Gayowski T. Fever in liver transplant recipients in the invazive care unit. Clin Transplant 1999; 13: 504-11.
12. Fishman JA. Infection in solid-organ transplant recipients. Up To Date (17.2: May, 2009).
13. Schmaldienst S, Hörl WH. Bacterial infections after renal transplantation. Nephron 1997; 75: 140-53.
14. Wood KJ, Spesific immunsupression. Morris PJ (ed), Erek E (çeviri ed), Böbrek transplantasyonu. İstanbul: Nobel Tıp Kitabevleri Ltd., 1997: 253-65.
15. Tolloff-Rubin NE, Rubin RH. Infection in the renal transplant patient. In: Jacobson HR, Striker GE, Klahr S (eds). The Principles and Practice of Nephrology. St Louis: Mosby, 1995: 826-33.
16. Rubin RH, Infectious disease complications of renal transplantation, Kidney Int 1993; 44: 221-44.
17. Schaffner A. Pretransplant evaluation for infections in donors and recipients of solid organs. Clin Infect Dis 2001; 33: 9-14.
18. Munskgaard B. Screening of donor and recipient prior to solid organ transplantation. Am J Transplant 2004; 4 (Suppl 10): 10-20.
19. Delmonico FL. Cadaver donor screening for infection agents in solid organ transplantation. Clin Infect Dis 2000 ; 31: 781-6.
20. Avery RK. Recipients screening priot to solid organ transplantation. Clin Infect Dis 2002; 35: 1513-9.
21. Kim W, Bradley A, Wiesner R, et al. The ecomonic impact of CMV infection after liver transplantation. Transplantation 2000; 69: 357-61.
22. Duchini A, Goss JA, Karpen S, Packros PJ. Vaccinations for adult solid organ transplant recipients: current recommendations and protocols. Clin Microb Rev 2003; 16: 357-64.
23. Danzinger-Isakov L, Kumar D. AST Infectious Diseases Community of Practice: Guidelines for vaccination of solid organ transplant candidates and recipients. Am J Transplant 2004; 10 (suppl): 160-3.
24. Avery RK, Ljungman P. Prophylactic measures in the solid organ recipient before transplantation. Clin Infect Dis 2001; 33 (suppl 1): 15-21.
25. Olsson SE, Villa LL, Costa RL, et al. Induction of immune memory following administration of a prophylactic quadrivalent human papillomavirus (HPV) types 6/11/16/18 L1 virus-like particle (VLP) vaccine. Vaccine 2007; 25: 4931-9.
26. Al-Hasan MN, Razonable RR, Eckel-Passow JE, Baddour LM. Incidance rate and outcome of gramnegative bloodstream infection in solid organ transplant recipients. Am J Transplant 2009; 9: 835-43.
27. Patel R, Paya CV. Infectıons in solid-organ transplant recipients. Clin Microbiol Rew 1997; 10: 86-124.
28. Kalil AC, Dakroub H, Freifeld AG, Sepsis and solid organ transplantation. Curr Drug Targets 2007; 8: 533- 41.
29. Snydman DR, Infection in solid organ transplantation. Transplant Infect Dis 1999; 1: 21-8.
30. Wade JJ, Rolando N, Hayylar K, Philport-Howard J, Casewell MW, Williams R. Bacterial and fungal infections after liver transplantation an analyses of 284 patients. Hepatology 1995; 21: 1328-36.
31. Ficher SA. Infections complicating solid organ transplant. Surg Clin N Am 2006; 86: 1127-48.
32. Humar A, Syndman D. AST infectious diseases community of practice CMV in solid organ recipients. Am J Transplant 2009; 9 (suppl 4): 78-86.
33. Gabardi S, Kubiak D, Chandraker AK, et al. Invazive fungal infections and antifungal therapies in solid organ transplant recipients. Transplant Int 2007; 20: 993- 1015.
34. Singh N, Husain S. AST infectious diseases community of practice. Invazive aspergillosis in solid organ recipients. Am J Transplant 2009; 9 (suppl 4): 180-91.
35. Pjaller Mai Diekema DJ. Epidemiology of invazive candidiasis a persistant public health problem. Clin Microbiol Rev 2007; 20: 133-63.
36. Green M. Introduction: Infections in solid organ transplantation. Am J Transplant 2013; 3: 3-8.
37. Keating MR, Daly JS, AST Infectious Diseases Community of Practice. Nontuberculous mycobacterial infections in solid organ transplantation. Am J Transplant 2013; 3: 77-82.
38. Clark NM, Reid GE, AST Infectious Diseases Community of Practice. Nocardia infections in solid organ transplantation. Am J Transplant 2013; 3: 83-92.
39. Pergam SA, Limaye AP, AST Infectious Diseases Community of Practice. Varicella zoster virus in solid organ transplantation. Am J Transplant 2013; 3: 138- 146.
40. Hirsch HH, Randhawa P, AST Infectious Diseases Community of Practice. BK Polyoma virus in solid organ transplantation. Am J Transplant 2013; 3: 179- 188