Table 4 Common post-transplant infections, their sequelae and management
Post-transplant infectionClinical features
Pseudomonas aeruginosa
  • Can cause asymptomatic colonisation, infective exacerbations or pneumonia

  • Occurs anytime but especially in the first year

  • Colonised patients often treated with maintenance nebulised antibiotics

  • Associated with increased risk of developing Bronchiolitis Obliterans Syndrome

Cytomegalovirus
  • Can cause primary infection or re-activation in a previously infected host

  • Typically occurs in first few months, though the first year carries greatest risk

  • Higher risk recipients given anti-CMV prophylaxis for 3–6 months after transplant

  • Associated with increased risk of developing bronchiolitis obliterans syndrome

Epstein-Barr virus
  • Re-activation most common within the first year when immunosuppression at highest levels

  • Reactivation known to drive development of post-transplant lymphoproliferative disorder (PTLD)

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Aspergillus
  • Can cause asymptomatic colonisation, airway infection, invasive or cavitatory disease

  • Occurs anytime but especially in the first year

  • Those colonised with Aspergillus pre-transplant require anti-fungal prophylaxis for 6–12 weeks after transplant

  • Data taken from [16, 17].