Update on infections in composite tissue allotransplantation

Several excellent recent reviews have summarized the infectious complications of all composite tissue allograft recipients previously reported. The current review will highlight key management principles derived from these reports.

Severe Gram-negative infections may occur in the early posttransplant period, particularly Pseudomonas spp. Cytomegalovirus continues to be a major pathogen and is closely linked to allograft rejection; however, some patients have had uncomplicated cytomegalovirus (CMV) episodes. Candida has emerged as a cause of early infections, but the incidence of invasive mold infections has been low. More descriptions of infection risk in the late posttransplant period will be helpful, as more composite tissue allotransplantation recipients survive longer. Newer immunosuppressive regimens may reduce infection risks, but more information will be helpful.

Recent reports have provided expanded information on infections in composite tissue allograft recipients. Centers may choose to broaden the Gram-negative prophylaxis, and to include antifungal prophylaxis directed at Candida spp. CMV prevention protocols should take into account recent reports of CMV outcomes. Future reports should contain infection outcomes in sufficient detail to allow for constructive modifications of antimicrobial management in an era of novel immunosuppression and increasing antimicrobial resistance.