| Risk | Impact on Prophylaxis | Impact on Laboratory Monitoring | |
|---|---|---|---|
| Bacterial Infections | Unclear impact | None | Aggressive microbiologic evaluation for febrile transplant recipients who have received ATG |
| BK Virus | Increased risk of infection especially with higher doses of ATG administration (54) | N/A | Consider more frequent screening (monthly rather than quarterly) |
| CMV | Increased risk of infection (9) | Consider extended prophylaxis to 6 months, especially in D+/R- | If preemptive protocol followed, consider extended duration of monitoring |
| EBV / PTLD | Possible increased risk, especially EBV D+/R-, though data is mixed (64) | None | Active screening for EBV viremia if EBV D+/R- |
| Fungal Infections | No increased risk during induction; Increased risk during rejection therapy | If exposure to endemic fungi, prophylaxis for 6-12 months is indicated | If exposure to endemic fungus, routine screening likely indicated |
| HCV/HBV | Accelerated HCV replication but no increased rate of hepatic graft injury (24)
No association with poor outcomes with HCV + renal transplant pts. |
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 |
| HSV/HZV | Increased | Adequately covered by CMV prophylaxis or acyclovir derivatives if not on CMV prophylaxis | None |
| Pneumocystis | Increased risk of infection without appropriate prophylaxis (29) | Minimum of 6-12 months of prophylaxis, consider prolonged prophylaxis in heart and/or lung recipients | None |