Burden and Timeline of Infectious Diseases in the First Year After Solid Organ Transplantation in the Swiss Transplant Cohort Study
Authors: van Delden Christian , Stampf Susanne , Hirsch Hans H , Manuel Oriol , Meylan Pascal , Cusini Alexia , Hirzel Cédric , Khanna Nina , Weisser Maja , Garzoni Christian , Boggian Katja , Berger Christoph , Nadal David , Koller Michael , Saccilotto Ramon , Mueller Nicolas J ,   Swiss Transplant Cohort Study, Amico Patrizia , Aubert John-David , Banz Vanessa , Beldi Guido , Benden Christian , Berger Christoph , Binet Isabelle , Bochud Pierre-Yves , Branca Sanda , Bucher Heiner , Carell Thierry , Catana Emmanuelle , Chalandon Yves , de Geest Sabina , de Rougemont Olivier , Dickenmann Michael , Duchosal Michel , Elkrief Laure , Fehr Thomas , Ferrari-Lacraz Sylvie , Garzoni Christian , Gasche Soccal Paola , Gaudet Christophe , Giostra Emiliano , Golshayan Déla , Hadaya Karine , Halter Jörg , Hauri Dimitri , Heim Dominik , Hess Christoph , Hillinger Sven , Hirsch Hans H , Hofbauer Günther , Huynh-Do Uyen , Immer Franz , Klaghofer Richard , Koller Michael , Laesser Bettina , Laube Guido , Lehmann Roger , Lovis Christian , Majno Pietro , Manuel Oriol , Marti Hans-Peter , Yves Martin Pierre , Martinelli Michele , Meylan Pascal , Mueller Nicolas J , Müller Antonia , Müller Thomas , Müllhaupt Beat , Pascual Manuel , Passweg Jakob , Posfay-Barbe Klara , Rick Juliane , Roosnek Eddy , Rosselet Anne , Rothlin Silvia , Ruschitzka Frank , Schanz Urs , Schaub Stefan , Schnyder Aurelia , Seiler Christian , Sprachta Jan , Stampf Susanne , Steiger Jürg , Stirnimann Guido , Toso Christian , Van Delden Christian , Venetz Jean-Pierre , Villard Jean , Wick Madeleine , Wilhelm Markus , Yerly Patrick , Amico Patrizia , Aubert John-David , Banz Vanessa , Beldi Guido , Benden Christian , Berger Christoph , Binet Isabelle , Bochud Pierre-Yves , Branca Sanda , Bucher Heiner , Carell Thierry , Catana Emmanuelle , Chalandon Yves , de Geest Sabina , de Rougemont Olivier , Dickenmann Michael , Duchosal Michel , Elkrief Laure , Fehr Thomas , Ferrari-Lacraz Sylvie , Garzoni Christian , Gasche Soccal Paola , Gaudet Christophe , Giostra Emiliano , Golshayan Déla , Hadaya Karine , Halter Jörg , Hauri Dimitri , Heim Dominik , Hess Christoph , Hillinger Sven , Hirsch Hans H , Hofbauer Günther , Huynh-Do Uyen , Immer Franz , Klaghofer Richard , Koller Michael , Laesser Bettina , Laube Guido , Lehmann Roger , Lovis Christian , Majno Pietro , Manuel Oriol , Marti Hans-Peter , Yves Martin Pierre , Martinelli Michele , Meylan Pascal , Mueller Nicolas J , Müller Antonia , Müller Thomas , Müllhaupt Beat , Pascual Manuel , Passweg Jakob , Posfay-Barbe Klara , Rick Juliane , Roosnek Eddy , Rosselet Anne , Rothlin Silvia , Ruschitzka Frank , Schanz Urs , Schaub Stefan , Schnyder Aurelia , Seiler Christian , Sprachta Jan , Stampf Susanne , Steiger Jürg , Stirnimann Guido , Toso Christian , Van Delden Christian , Venetz Jean-Pierre , Villard Jean , Wick Madeleine , Wilhelm Markus , Yerly Patrick 
Published: November 2019

Abstract

Background
The burden and timeline of posttransplant infections are not comprehensively documented in the current era of immunosuppression and prophylaxis.

Methods
In this prospective study nested within the Swiss Transplant Cohort Study (STCS), all clinically relevant infections were identified by transplant–infectious diseases physicians in persons receiving solid organ transplant (SOT) between May 2008 and December 2014 with ≥12 months of follow-up.

Results
Among 3541 SOT recipients, 2761 (1612 kidney, 577 liver, 286 lung, 213 heart, and 73 kidney-pancreas) had ≥12 months of follow-up; 1520 patients (55%) suffered 3520 infections during the first year posttransplantation. Burden and timelines of clinically relevant infections differed between transplantations. Bacteria were responsible for 2202 infections (63%) prevailing throughout the year, with a predominance of Enterobacteriaceae (54%) as urinary pathogens in heart, lung, and kidney transplant recipients, and as digestive tract pathogens in liver transplant recipients. Enterococcus spp (20%) occurred as urinary tract pathogens in kidney transplant recipients and as digestive tract pathogens in liver transplant recipients, and Pseudomonas aeruginosa (9%) in lung transplant recipients. Among 1039 viral infections, herpesviruses predominated (51%) in kidney, liver, and heart transplant recipients. Among 263 fungal infections, Candida spp (60%) prevailed as digestive tract pathogens in liver transplant recipients. Opportunistic pathogens, including Aspergillus fumigatus (1.4%) and cytomegalovirus (6%), were rare, scattering over 12 months across all SOT recipients.

Conclusions
In the current era of immunosuppression and prophylaxis, SOT recipients experience a high burden of infections throughout the first year posttransplantation, with rare opportunistic pathogens and a predominance of bacteria.