Infection and Malignancy
Preventing Infection and Cancer After an Organ TransplantAs a transplant recipient, you have a higher risk of developing infection and certain types of cancer because you are taking anti-rejection medications. These anti-rejection drugs keep the immune system from attacking your new organ. However, they also weaken your body’s natural ability to attack organisms of all types that enter the body.
All infections in transplant recipients with a weakened immune system should be considered serious, though most are not life-threatening. Taking steps to avoid infection is important to your health. Also, recognizing the signs of infection and taking immediate action can help stop these organisms from making you sick.
Infections From A Hospital StayInfections after surgery and other hospital procedures are a significant problem in transplant patients. . The use of catheters and intravenous lines to deliver medication carries some risk for infection. Some patients may develop pneumonia shortly after surgery. Common signs of infection from a hospital stay include:
- Fever and chills
- Redness or unusual pain around the incision
- Fluid leaking from the incision
- New cough with sputum production
- Pain when urinating
- Pain or redness where the catheter was inserted
- Diarrhea or abdominal pain, nausea, and vomiting
- Headache that lasts a long time
Infection After Returning HomeTransplant recipients are more likely to get an infection from different types of organisms after they return home from the hospital.
Viral InfectionsThere are several forms of viral infections that transplant recipients can get after returning home from the transplant center.
Some viruses can go into hiding (latency) only to become active again. New and hidden viral infections can be diagnosed by a blood test. You will also need to be on the lookout for the signs and symptoms of viral infections.
Figure. Viral Infections
Bacterial InfectionsWhen the immune system is changed by transplant medications or surgery, the risk for bacterial infections goes up. Bacterial infection may cause fever and chills, diarrhea, cough, headache, shortness of breath, pain when urinating, abdominal pain, nausea, vomiting, a new rash, or other signs. Infections are easiest to treat when caught early, so it is important to call your transplant team immediately if you think you might have an infection.
Fungal InfectionsIn some transplant recipients, organisms called fungi (such as molds or yeasts) may cause infection. Fungi called Candida can produce a whitish coating in the mouth and throat ("thrush"). This type of fungal infection is easily treated. Others fungi may cause pneumonia or other serious infections including meningitis. These fungi include Pneumocystis jiroveci. pneumonia ( previously known as Pneumocystis carinii or PCP), Aspergillus, and Cryptococcus. Most transplant recipients will receive antifungal medication to reduce the risk for developing fungal infectionsfor at least 3 months or longer after surgery.
A Timeline of InfectionSome infections are more likely to happen sooner (within the first 6 months after transplant surgery) rather than later. The Table below is a timeline of when to be on the lookout for certain infections.
|Common Infections 0 to 4 Weeks After Surgery||Common Infections 1 to 6 Months After Surgery||Infections More Than 6 Months After Surgery|
|Wound infections |
Infection at catheter site
Urinary tract infections
| Respiratory infections |
Urinary tract infections
Herpes simplex virus
Hepatitis B virus (recurrence)
Hepatitis C virus (recurrence)
| Respiratory infections |
Urinary tract infections
Herpes simplex virus
Keeping Your New Organ SafeInfections can do more than make you sick. They can hurt your new organ and increase the risk of rejection. Even though your immune system has been "slowed down" by the anti-rejection drugs you are taking, there are many things you can do to prevent illness:
- Stay away from people who show signs of being sick
- Wash your hands frequently
- Wear gloves when gardening
- Avoid areas with mold, bird droppings, fresh fertilizer, or decaying plants (for example, compost heaps)
- Avoid going barefoot
- Use insect repellent especially at dawn and dusk
- Clean cuts and scrapes with soap and water
- Practice food safety (wash your hands before preparing food, after handling raw meat, and before you eat. Avoid consuming raw or undercooked foods and unpasteurized juices or milk)
- Avoid cleaning out the litter box or birdcage. Try not to have contact with stray animals, chicks, baby ducks, and monkeys. These animals can carry diseases.
- If traveling abroad, don’t drink tap water, ice or beverages made with tap water, fresh fruit juices, and unpasteurized milk or dairy products. Raw fruits and vegetables should also be avoided.
VaccinationsBecause anti-rejection drugs "slow down" your immune system and increase the risks of developing infections, you should stay up-to-date on vaccines that help prevent viral infections, including influenza (flu shot) and all of the routine "shots" that we receive as children. Your doctor may recommend routine annual vaccination against influenza and periodic vaccination against the pneumococal bacteria. Also, you should be vaccinated against hepatitis A and B. Members of your household should also receive routine vaccinations. The ideal time to vaccinate is prior to taking anti-rejection drugs when possible (although not all patients with chronic disease respond to vaccinations). After your transplant, the transplant team will probably recommend that you wait a certain amount of time before getting shots. In general, it is wise to wait for at least 6 months after transplantation or after an episode of acute rejection before receiving any vaccine.
With the exception of the live virus vaccinations, transplant patients can and should receive the same immunizations as nontransplant patients. Transplant recipients should probably not receive shots that use a live virus such as those used for chicken pox, measles, and mumps and the intranasal influenza vaccine . Your transplant team can tell you more. More information concerning vaccines is available at www.cdc.gov.
Vaccines that are widely considered safe when administered to patients taking anti-rejection drugs or their household contacts are listed below:
Hepatitis A, B or the combination of A/B
Haemophilus influenzae type b (Hib)
Alert Your Physician When TravelingTravel can increase the risks of infection. Prior to traveling, transplant recipients should take certain precautions. Most importantly, tell your doctor that you are planning to travel. The Centers for Disease Control (CDC) provides general "Travelers' Health " information to assist travelers and their health care providers in deciding the vaccines, medications, and other measures necessary to prevent illness during international travel. Although this information is focused on the general traveling public, you can find useful information about vaccinations and disease outbreaks.
When traveling, you should take along additional supplies of required medications, like anti-rejection drugs, in case of loss. Consider packing some of your medications in carry-on luggage.
Lastly, make sure you have the contact addresses and phone numbers of the nearest transplant centers in the city/country of your destination.
Should You Be Concerned About Cancer?Transplant recipients have a higher risk of developing certain types of cancers than people who have not had a transplant. Risk factors such as age, smoking and alcohol seem to play a role in the higher risk for malignancies, but taking anti-rejection drugs for a long time is the basis for the higher rate of some cancers. Some transplant recipients will develop skin cancer. Others may develop certain types of cancer of the lymph glands (lymphoma) and cancer of the cervix, which are caused by viruses. Transplant recipients also have a risk of developing other types of cancer such as breast cancer, lung cancer, and colon cancer. Regular medical exams to detect cancer are very important to your ongoing health and well-being.
Several types of skin cancers can occur more frequently in transplant recipients including squamous cell carcinomas (SCC), basal cell carcinomas and melanomas.
Figure. Types of Skin Cancer
- Limit the time you spend in the sun (especially when the sun is most intense between 10:00 am and 2:00 pm
- Wear sunscreen (SPF 45 or higher)
- Wear a wide-brimmed hat and gloves
Virus-related CancersSome of the other malignancies that are more frequent after transplantation are those related to viral infection. These include Kaposi’s sarcoma (human herpes virus 8), anogenital lesions (human papillomavirus), carcinoma of the uterine cervix (human papillomavirus related), and posttransplant lymphoproliferative disorders (PTLD) and B-cell lymphomas (related to Epstein Barr virus).
Posttransplant Lymphoproliferative Disorder (PTLD)Post-transplant lymphoproliferative disorder is a cancer of certain white blood and is related to some anti-rejection medications and the Epstein-Barr virus. This disorder can be treated by decreasing some anti-rejection medications, taking anti-viral medications, or chemotherapy.
While cancer can occur at any time, some malignancies, such as skin cancers and PTLD, are more likely to arise in the first couple years after transplant surgery.
Figure. When cancer most commonly occurs
Screening for breast, prostate and colon cancer should be performed at the appropriate sex, age and frequency as recommended by the American Cancer Society (ACS).
Figure. Cancer screening schedule
All transplant recipients should receive a thorough dermatologic exam yearly and should be educated on the use of sun screen and avoidance of sun exposure. If you do develop cancer, your transplant team will want you to see a specialist to treat the condition. You will also need to let your transplant team know if you are diagnosed with cancer.