Preventions and Treatment for infections and cormorbidities

Vial Infections

• If possible, complete live vaccines at least 4 weeks and inactivated vaccines at least 2 weeks before transplant 

• Cytomegalovirus (CMV)

  • Prophylaxis with IV ganciclovir or PO valganciclovir or PO letermovir

• Herpes Simplex Virus

  • Prophylaxis with acyclovir (PO or IV)

    • Other option: valacyclovir and famciclovir

  • Not necessary for people receiving CMV prophylaxis 

• Fungal and Protozoal Infection

  • Pneumocystis jirovecii pneumonia (PJP)

    • Prophylaxis with low dose sulfamethoxazole/trimethoprim

      • Bactrim SS daily (preferred)

      • Bactrim DS MWF

  • Toxoplasmosis gondii

    • Covered by PJP prophylactic regimen

  • Other fungal infections:

    • Prophylaxis for some high risk individuals with:

      • Fluconazole 100-400 mg daily (Alternate: posaconazole,voriconazole, echinocandins)

Malignancy 

• Skin Cancer (most common)

  • Risk factors

    • Azathioprine

    • SMZ/TMP

  • Prophylaxis 

    • sunscreen/protective clothing 

• Post-Transplant Lymphoproliferative Disorder - PTLD

  • Characterized by the presence of abnormal proliferation of lymphoid cells

  • Requires close monitoring in presence of risk factors

  • Risk factors:

    • EBV seronegativity (Donor +, recipient -)

    • Lymphocyte-depleting agents

Hypertention

Hyperlipidemia

New-Onset Diabetes after Transplantation

Other comorbidities

Counceling