Post–Organ Transplantation Complications
المؤلف:
Mary Louise Turgeon
المصدر:
Immunology & Serology in Laboratory Medicine
الجزء والصفحة:
5th E, P455
2025-11-04
82
Because complications are associated with transplantation, their early diagnosis and treatment are essential. The primary risks of transplantation are rejection and infection. Five other major complications of organ transplantation are cancer, osteo porosis, diabetes, hypertension, and hypercholesterolemia.
Infectious Diseases Infections can be viral, such as CMV (80%), Epstein-Barr virus (20% to 30%), hepatitis B, or hepatitis C. Even rabies has been associated with organ transplantation. Other pathogens include Pneumocystis jiroveci (formerly known as P. carinii). Organisms associated with central nervous system infection in renal transplant recipients, in decreasing order of frequency, are Listeria, Cryptococcus, Mycobacterium, Nocardia, Aspergillus, Mucor, Toxoplasma, and Strongyloides spp. Published guide lines advise transplant teams to do the following to minimize transplant risk:
1. Screen for infectious disease agents in the donor and recipient before transplantation.
2. Culture and identify known and novel pathogens in recipients after transplantation.
3. Archive serologic samples before transplantation for identification of new infections later.
Cancer
Organ transplant recipients have a 20% greater risk of the development of cancer. The incidence of non-Hodgkin’s lymphoma is increased by 40%. The greatest risk for lymphoma is within the first 6 to 12 months after transplantation. Trans plant recipients also have a greater risk of skin cancer and a slightly increased risk of cervical cancer. An increased risk of the development of cancer may be the result of chemotherapy and radiation therapy.
Osteoporosis
In the general population, osteoporosis affects one in four women and one in eight men. The general risk factors are age, postmenopausal state, sedentary lifestyle, and inadequate calcium intake. Transplant recipients are at an increased risk of developing osteoporosis because of pretransplantation immobility and long-term effects of steroid therapy. Regular bone density scanning should be a routine component of posttransplantation care.
Diabetes
Diabetes mellitus is a concern in two risk groups, patients with preexisting diabetes (25%) and those who develop diabetes after transplantation (20%). Patients with preexisting diabetes may require increased doses of insulin until stabilized on medications. Posttransplantation steroid-induced hyperglycemia can produce physiologic conditions that negatively affect a graft. Steroid medication might aggravate a familial tendency toward diabetes. The use of steroids results in decreased use of insulin by peripheral tissues, eventual insulin resistance with decreasing receptor sites, reduction in insulin production, and accelerated glycogenolysis by the liver to assist in glucose avail ability. These metabolic activities perpetuate hyperglycemia. In addition to threatening graft survival, diabetes can have other negative health consequences, such as adult blindness, vasculopathy, neuropathy, retinopathy, bladder infections, and a shortened lifespan.
Hypertension
An abnormal increase in blood pressure is usually a preexisting medical condition in transplant recipients. This condition is often associated with renal failure. Hypertension can negatively affect the patient’s general health and graft survival.
Hypercholesterolemia
An increased blood cholesterol is a serious posttransplantation concern because of long-term vascular effects to the patient and engrafted organ. Hypercholesterolemia can result from the return of the patient’s appetite and the lifting of dietary restrictions.
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