[Sense and nonsense in infection prevention following organ transplantation]

Incidence and severity of infectious complications in solid-organ transplant recipients depend on the epidemiological exposure of the patients to infectious agents and the degree of immunosuppression. The timetable for the occurrence of infections reflects this interaction: up to one month after transplantation, patients suffer from infections related to the surgical procedure. Prevention is provided by careful surgical technique and perioperative antibiotics. One to six months after transplantation is the critical period for severe opportunistic infections: herpes viruses, fungi, mycobacteria and protozoal infections. Cytomegalovirus (CMV) are by far the most important source of morbidity and mortality. Various preventive strategies for CMV disease are critically reviewed; at present, pre-emptive therapy is our choice. Finally, we discuss prophylaxis of specific infections due to toxoplasma, P. carinii and M. tuberculosis. The value of local experiences (epidemiological exposures of patients, immunosuppressive regimes and antirejection therapy) for the choice of preventive strategies cannot be overemphasized.