Prediction of Infection After Solid Organ Transplantation: Is Measuring Cell-Mediated Immunity the Answer?

Solid organ transplantation (SOT) is used for the management of a broad range of patients with end-stage organ dysfunction, but infectious complications remain an important barrier to the success of these procedures. The need for lifelong immunosuppressive therapy to prevent allograft rejection places SOT recipients at increased risk for a variety of infections. Although the incidence, general timing, and type of infectious complications have been established, accurately predicting which specific patients will ultimately develop significant infection(s) is not feasible. Consequently, standard posttransplant antimicrobial preventive strategies are relegated to an imprecise "one size fits all" approach, informed by the organ transplanted, immunosuppressive regimen used, donor and recipient exposures, and the posttransplant clinical course. Over- and underuse of various preventive strategies in individual patients is an inherent limitation of current protocols.