| Risk | Impact on Prophylaxis | Impact on Laboratory Monitoring | |
|---|---|---|---|
| Bacterial Infections | No increased risk including Streptococcus, Listeria, Nocardia or MAC (common pathogens in AIDS) (49, 57) | None | Aggressive microbiologic evaluation for febrile transplant recipients who have received ATG |
| BK Virus | Increased risk as compared to IL-2R antagonists or no induction (17) but similar to ATG (23) | N/A | Consider more frequent screening (monthly rather than quarterly) |
| CMV | Increased risk as compared to IL-2R antagonists (48) but likely similar to ATG | Consider extended prophylaxis to 6 months, especially in D+/R-. Failure of prophylaxis has been reported | Consider either prolonged preemptive protocols or screening for reactivation after completion of prophylaxis |
| EBV / PTLD | Likely increased risk but data is mixed and long term data lacking | None | EBV donor + /recipient – patients should be screened for EBV infection |
| Fungal Infections | No increased risk when used for induction, significant increased risk when used for rejection. | If exposure to endemic fungi, prophylaxis for 6-12 months is indicated | If exposure to endemic fungus, routine screening likely indicated |
| HSV/HZV | Increased | Adequately covered by CMV prophylaxis or acyclovir derivatives if not on CMV prophylaxis | None |
| HCV/HBV | No benefit over conventional induction treatment for liver transplant with potential for increased complications including systemic infection (31) | N/A for HCV, Follow standard protocols for HBV prophylaxis | Consider routine viral load monitoring in known to have positive viremia.
Consider monitoring for reactivation of viremia in recipients with negative viral loads prior to transplant |
| Pneumocystis | Prolonged risk due to T-cell depletion | Minimum of 6-12 months of prophylaxis, consider more prolonged prophylaxis in heart and/or lung recipients | None |