Infectious Disease Testing for Solid Organ Transplantation

Ison, Michael, MD, MS
Assistant Professor, Divisions of Infectious Diseases and Organ Transplantation Northwestern University Feinberg School of Medicine
Medical Director, Transplant & Immunocompromised Host Infectious Diseases Service Northwestern University Comprehensive Transplant Center
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What are the most important current issues and "hot topics" in the field of solid organ transplantation and associated screening for infectious diseases? 

One of the leading topics in solid organ transplantation (SOT) is the role of proper diagnosis of fungal infections (e.g., aspergillosis) acquired by SOT and hematopoietic stem cell transplant (HSCT) patients, who are at increased risk for fungal, viral, bacterial and parasitic infections both pretransplant and post-transplant.

Other key topics include standardization of polymerase chain reaction (PCR) for detection of common viral pathogens such as the cytomegalovirus (CMV) and BK virus, assays for donor-derived infections and identification of "high risk" or "increased risk" donors, testing for rare or "orphan" diseases (e.g. parasitic disease) and the diagnosis of host resistance to viral diseases such as CMV and influenza. 

What are the biggest challenges/difficulties that clinicians face in screening and managing infectious diseases as it relates to solid organ transplantation? 

Some of the biggest challenges that SOT clinicians face in screening for, and managing, infectious diseases include the diagnosis of endemic and rare diseases, the evaluation of donors whose characteristics define them as "high risk" for opportunistic infections, the proper assessment of donor-derived infections, and the assessment of tuberculosis in the transplant population. Extrapulmonary and disseminated forms of tuberculosis are more frequent in transplant patients than in the average patient population, and reaching a definitive diagnosis of tuberculosis takes longer in transplant patients while requiring invasive tests more often.