Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5258_Библиотеки_им_академика_М_И_Перельмана.pdf
287
papilloma virus-associated warts are also common. The characteristic appearances
of these infections may be diminished in solid organ transplant recipients.
Consequently, microbiologic and histologic tests should not be delayed. Within the
rst 3months after transplant, common bacterial and viral infections predominate.
In the later period after transplantation more rare bacteria and opportunistic infec-
tions such as fungi may be seen (See Chap. 8).
9.5.3 Graft-Versus-Host Disease (GVHD)
GVHD is a multisystem disorder which is most commonly a complication of allo-
geneic hematopoietic cell transplant (HCT) and occurs when the immune cells
transplanted from a non-identical donor (the graft) recognize the transplant recipi-
ent (host) as foreign, thereby initiating an immune reaction that causes disease in
the transplant recipient. The development of GVHD is very rare in solid organ trans-
plant patients but is potentially lethal. Solid organ transplant-associated GVHD
most commonly occurs in liver and small bowel transplants, usually between 2 to
6weeks after transplant. Late onset cases, however, have been seen in other trans-
plant settings [ 49].
The clinical presentation of solid organ transplant-associated GVHD is variable.
The organs most frequently involved are the skin, liver, and intestinal mucosa. In
most cases, GVHD quickly advances to a multisystem disease affective the bone
marrow and other non-transplanted organs [ 49].
There is both an acute and chronic form of cutaneous GVHD.Acute disease usu-
ally develops within 2 to 4weeks of stem cell infusion around the time of engraft-
ment. Chronic cutaneous GVHD usually develops within a mean of 4months after
transplant [78]. Acute disease typically presents as red to violet maculopapular
lesions rst appearing on the neck, ears, shoulder and the palms of hands and soles
but may progress to the whole body, coalesce and in severe cases lead to the devel-
opment of vesicles or bullae or a toxic epidermal necrolysis-like picture. It may be
described as a sunburn and can be pruritic or painful. Chronic cutaneous GVHD
manifests with mucocutaneous lesions, sclerotic (resembling scleroderma) and non-
sclerotic (lichen planus-like) skin lesions. In rare cases hyperacute cutaneous
GVHD can occur with the onset prior to day 14 following transplant. Hyperacute
GVHD manifests with high fevers and more severe skin disease [79].
The mortality rate of solid organ transplant-associated GVHD can exceed more
than 75% [49]. Skin biopsy may support the clinical impression; however, skin
biopsies are not always reliable in differentiating GVHD from drug eruptions, viral
exanthems, eruption of lymphocyte recovery and toxic erythema or chemotherapy.
Dermatology involvement is encouraged to aid in diagnosis and treatment. Systemic
therapy is generally required for management of patients with acute GVHD.High
potency topical steroids may be helpful in patients with limited skin disease and no
systemic involvement.
9 Common Syndromes intheAdult Solid Organ Transplant Recipient
288
9.5.4 Cosmesis
Immunosuppressive medications have been associated with a variety of cosmetic
skin changes including but not limited to acne, alopecia, hypertrichosis, sebaceous
hyperplasia, stomatitis, gingival hyperplasia, and cushingoid features. When new
dermatologic conditions develop a review of potential side effects of medications is
necessary. Common immunosuppressives that may cause cosmetic skin changes
include azathioprine, cyclosporine, glucocorticoids, mycophenolate mofetil,
rapamycin and tacrolimus.
9.5.5 Key Points
• Routine skin exams are recommended for solid organ transplant recipients
because of the high incidence of skin cancers.
• A complete skin exam is indicated, as skin cancers may arise in partial sun-
exposed areas or sun-protected areas, especially in patients with more pig-
mented skin.
• The incidence of both basal cell carcinoma and squamous cell carcinoma is
increased in solid organ transplant recipients, but in contrast to the general popu-
lation, squamous cell carcinoma is relatively more common than basal cell
carcinoma.
9.6 Musculoskeletal Symptoms
Musculoskeletal concerns are a common presenting symptom in primary care—in
one study of outpatient ofce visits, 25% of patients had at least one musculoskel-
etal concern [80]. The overall epidemiology of musculoskeletal presenting symp-
toms in solid organ transplant recipients has not been extensively studied, limited to
small case series showing a prevalence of 30–36% [81, 82]. Musculoskeletal issues
are likely due to a myriad of factors which may include immobility, decreased bone
density, secondary hyperparathyroidism due to renal insufciency, medication side
effects, and hyperuricemia.
9.6.1 Joint Pain: General Approach
9.6.1.1 Assess Clinical Stability
• Although most patients who present to primary care with joint pain are stable, in
rare cases they may have sepsis due to an infection, or neurologic compromise as
seen in severe spine conditions. As with the other conditions above, patients who
K. O’Connor and C. J. Wong
289
have potential signs of an emergency should be transferred to an acute care set-
ting for rapid evaluation and treatment.
9.6.1.2 History
• Core transplant history: Important initial information to gather includes the time
since transplantation, prior episodes of rejection, as the types of infections a solid
organ transplant recipient is more susceptible to may vary based on this history;
and CMV and EBV serostatus (For more in-depth discussion, see Chap. 8)
• Medications: The degree of immunosuppression may affect the level of suspi-
cion for septic arthritis. Transplant immunosuppressive medications can cause
hyperuricemia—especially cyclosporine, which causes hyperuricemia in up to
80% of patients [83] (See also Chap. 3).
• Risk factors for gout: Hyperuricemia occurs in 5%–84% of SOT recipients with
1.7%–28% of these patients experiencing gout [84]. (See Chap. 11). In addition
to medications, a history of pre-transplant gout, traditional risk factors such as
elevated BMI, alcohol consumption, chronic kidney disease, hypertension, and
diuretic use should be reviewed. Hyperuricemia and gout are more common kid-
ney, heart, and to a lesser extent liver transplant recipients [82].
• History of prior or current rheumatologic disease.
• Risk factors for osteoarthritis.
• Risk factors for infection: in addition to level of immune suppression, consider
trauma, injection drug use, known or possible other sites of infection.
• Risk factors for calcium pyrophosphate deposition disease (CPPD).
• Risk factors for fracture:
– Osteoporosis: Previous bone density test results, if available; most patients
will have had testing done prior to transplantation; practices vary for post-
transplant screening and surveillance (see Chap. 11). The amount of gluco-
corticoid exposure varies post-transplantation; in addition, many patients
have received glucocorticoid exposure prior to transplantation to treat their
underlying condition. Assess for other medications associated with
osteoporosis.
– History of trauma.
• Time course: acute or chronic.
• Location(s): monoarticular, polyarticular, symmetry.
• Pattern: Mechanical (worse with use) or inammatory (worse with rest).
• Associated symptoms: systemic (e.g., fever), symptoms beyond the joint region
(e.g., soft tissue pain, muscle weakness).
9 Common Syndromes intheAdult Solid Organ Transplant Recipient
290
9.6.1.3 Physical Examination
• Vitals signs.
• Musculoskeletal examination.
– Inspection: deformity, signs of trauma, redness of the joint and surrounding
soft tissues, skin integrity.
– Palpation for tenderness, uctuance, synovitis.
– Range of motion, passive and active.
– Additional maneuvers as indicated.
• Neurologic examination if indicated.
• Cardiovascular examination if indicated.
• Skin: assess for tophi (tophi may be more common in solid organ transplant
recipients with gout compared to those with gout in the general population [82]),
rash, signs of cellulitis.
9.6.1.4 Differential Diagnosis
• The possible causes of joint pain in solid organ transplant recipients are similar
to that of the general population. However, it is important to consider the
increased risk of infection, gout, fracture, and malignancy.
• Gout: As discussed in Chap. 11, hyperuricemia and gout are common in solid
organ transplant recipients. Timing is typically 1.5–2 years post-transplant
(rather than after several years of hyperuricemia, as in the general population);
the rst metatarsophalangeal joint remains a common location for an attack of
gout, but less common locations may occur in this population, including the
sacroiliac joint, costochondral junction, and the spine [81, 82].
• Fracture: As discussed in Chap. 11, solid organ transplant recipients are at mark-
edly increased risk for osteoporosis and osteoporotic fractures. In addition,
bisphosphonate therapy is rarely associated with atypical femur fractures and
osteonecrosis.
• Infection: A study of bone and joint infections (osteomyelitis and septic arthritis)
in solid organ transplant recipients found an overall incidence of 281 per 100,000
patient-years, with osteomyelitis being far more common than septic arthritis.
Kidney transplant recipients more commonly developed diabetic foot osteomy-
elitis, while heart and lung transplant recipients more commonly developed
osteomyelitis of other sites, including the sternum. Fever as a presenting symp-
tom was uncommon, and sepsis was rare [85]. Median time since transplant at
presentation varies by study—18months to 3.7years—but consistently show an
earlier risk in heart and lung transplant recipients [83, 86].
• Cancer: As discussed in Chap. 10, there is a greatly increased risk of cancer in
this population. Patients may present with bone or joint region pain due to a pri-
mary cancer involving the bone (e.g., myeloma) or metastatic disease; if meta-
K. O’Connor and C. J. Wong
291
static, patients may not have symptoms that point to the primary source. Rare
cancers involving the musculoskeletal system that are increased in solid organ
transplant recipients include leiomyosarcoma, although it remains rare over-
all [87].
• Osteoarthritis: Osteoarthritis clearly occurs in solid organ transplant recipients,
as evidenced by ample literature regarding total joint arthroplasty; however, the
exact prevalence, and whether it is more common in the population, is uncertain.
Osteoarthritis presents similarly to the general population, with slow progression
of pain occurring in weight-bearing joints that is worse with use.
• Avascular necrosis (AVN): Risk factors include corticosteroid and alcohol use.
Incidence may be decreasing, with a study of kidney transplant recipients from
2004 to 2014 showing a prevalence of 4% [88]. In that same study, symptoms
generally occurred within 2 years of transplantation, with diagnoses often
delayed. Common locations include the femur, shoulder, and ankle.
• Inammatory arthritis: although solid organ transplant recipients receive immune
suppression, they may still develop an inammatory arthritis post- transplantation,
either de novo or as a recurrence of an underlying autoimmune disorder.
9.6.1.5 Additional Testing
• Clinicians evaluating a patient who has active synovitis should have a lower
threshold to obtain a joint aspirate to denitely assess for septic arthritis or crys-
tal arthropathy.
• There should be a low threshold for obtaining imaging for unexplained joint
pain, especially due to the increased risk of infection, malignancy, and fracture.
• Advanced imaging is often required if there is a high clinical suspicion, as osteo-
myelitis, occult fracture, and avascular necrosis may be not evident on X-rays.
• As part of the infection workup, laboratory testing may be indicated (e.g., com-
plete blood count, inammatory markers, blood cultures).
• Patients may present with more than one condition at the same time—for exam-
ple, septic arthritis can co-exist with gout in patients with chronic kidney disease,
pre-existing joint abnormalities, or those receiving immunosuppression.
9.6.2 Other Musculoskeletal Symptoms
Other musculoskeletal symptoms should be evaluated similarly to the general popu-
lation, but with increased suspicion for infection and malignancy.
Calcineurin inhibitor-induced pain syndrome (CIPS): Some authors have
reported a pain syndrome consisting of bilateral lower extremity pain associated
with cyclosporine or tacrolimus [89]. The mechanism is uncertain.
9 Common Syndromes intheAdult Solid Organ Transplant Recipient
292
Antibiotics can be associated with a variety of musculoskeletal complications.
Solid organ transplant recipients may be at increased risk for tendinopathy due to
potentially requiring uoroquinolone antibiotic therapy more often as well as con-
comitant prednisone use. Voriconazole can rarely cause periostitis due to its uoride
content, with the risk being dose-dependent and cumulative. Voriconazole-induced
periostitis may present with bone pain and fragility, elevated plasma alkaline phos-
phatase levels and/or radiologic imaging ndings of periostitis [90].
9.7 Constitutional Symptoms
At times patients may present with constitutional symptoms such as fevers, chills,
fatigue, or unintentional weight loss. When this occurs, a thorough history and
physical examination should be performed to review risk factors and identify local-
izing symptoms or signs.
Fever: While some low-risk patients in the general population may be managed
with observation, presuming a low-risk viral syndrome, solid organ transplant recip-
ients should receive a workup even if there are no localizing symptoms or exam
ndings; evaluation should be directed toward infection (if short duration) as well
as malignancy (if longer duration).
Unintentional weight loss: There are many potential causes of unintentional
weight loss. In solid organ transplant recipients, an evaluation is indicated, with
attention toward assessment for cancer given their higher risk.
9.8 Conclusion
Care of the solid organ transplant recipient will likely require the primary care pro-
vider to be familiar with common syndromes that may be rst encountered in the
outpatient clinic, including respiratory symptoms, urinary symptoms, diarrhea,
musculoskeletal symptoms, and skin problems. The initial approach to evaluating
these syndromes requires recognizing key differences between solid organ trans-
plant recipients and the general population, including having an expanded differen-
tial diagnosis, being aware of medication side effects, considering an increased risk
of infection and malignancy, and knowing when a workup needs to be performed
more quickly or with additional testing. In many cases, earlier consultation or triage
to a higher level of care is necessary. With attentive care, the primary care provider
can appropriately evaluate, triage, and manage the solid organ transplant recipient
who presents to the outpatient clinic with these syndromes.
K. O’Connor and C. J. Wong
293
References
1. Santo L, Kang K.National Ambulatory Medical Care Survey: 2019 National Summary Tables.
https://doi.org/10.15620/cdc:123251.
2. Cairns C, Kang K.National Hospital Ambulatory Medical Care Survey: 2021 emergency
department summary tables. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_
Documentation/NHAMCS/doc21- ed- 508.pdf.
3. Marks WH, Florence L, Lieberman J, Chapman P, Howard D, Roberts P, Perkinson
D.Successfully treated invasive pulmonary aspergillosis associated with smoking marijuana
in a renal transplant recipient. Transplantation. 1996;61(12):1771–4.
4. Giannella M, Muñoz P, Alarcón JM, Mularoni A, Grossi P, Bouza E, PISOT study group.
Pneumonia in solid organ transplant recipients: a prospective multicenter study. Transpl Infect
Dis. 2014;16(2):232–41. https://doi.org/10.1111/tid.12193.
5. Bonatti H, Pruett TL, Brandacher G, Hagspiel KD, Housseini AM, Sifri CD, Sawyer
RG.Pneumonia in solid organ recipients: spectrum of pathogens in 217 episodes. Transplant
Proc. 2009;41(1):371–4. https://doi.org/10.1016/j.transproceed.2008.10.045.
6. Wang EZ, Partovi N, Levy RD, Shapiro RJ, Yoshida EM, Greanya ED.Pneumocystis pneu-
monia in solid organ transplant recipients: not yet an infection of the past. Transpl Infect Dis.
2012;14(5):519–25.
https://doi.org/10.1111/j.1399- 3062.2012.00740.x.
7. Iriart X, Challan Belval T, Fillaux J, Esposito L, Lavergne RA, Cardeau-Desangles I, Roques
O, Del Bello A, Cointault O, Lavayssière L, Chauvin P, Menard S, Magnaval JF, Cassaing
S, Rostaing L, Kamar N, Berry A.Risk factors of pneumocystis pneumonia in solid organ
recipients in the era of the common use of posttransplantation prophylaxis. Am J Transplant.
2015;15(1):190–9. https://doi.org/10.1111/ajt.12947.
8. De La Cruz O, Silveira FP.Respiratory fungal infections in solid organ and hematopoietic
stem cell transplantation. Clin Chest Med. 2017;38(4):727–39. https://doi.org/10.1016/j.
ccm.2017.07.013.
9. Koval CE. Prevention and treatment of cytomegalovirus infections in solid organ trans-
plant recipients. Infect Dis Clin N Am. 2018;32(3):581–97. https://doi.org/10.1016/j.
idc.2018.04.008.
10. Huo Z, Li C, Xu X, Ge F, Wang R, Wen Y, Peng H, Wu X, Liang H, Peng G, Li R, Huang
D, Chen Y, Zhong R, Cheng B, Xiong S, Lin W, He J, Liang W.Cancer risks in solid organ
transplant recipients: results from a comprehensive analysis of 72 cohort studies. Onco
Targets Ther. 2020;9(1):1848068. https://doi.org/10.1080/2162402X.2020.1848068. PMID:
33299661; PMCID: PMC7714465.
11. Lengwiler E, Stampf S, Zippelius A, Salati E, Zaman K, Schäfer N, Schardt J, Siano M,
Hofbauer G.The Swiss transplant cohort study. Solid cancer development in solid organ trans-
plant recipients within the Swiss transplant cohort study. Swiss Med Wkly. 2019;149:w20078.
https://doi.org/10.4414/smw.2019.20078.
12. Engels EA, Pfeiffer RM, Fraumeni JF Jr, Kasiske BL, Israni AK, Snyder JJ, Wolfe RA,
Goodrich NP, Bayakly AR, Clarke CA, Copeland G, Finch JL, Fleissner ML, Goodman MT,
Kahn A, Koch L, Lynch CF, Madeleine MM, Pawlish K, Rao C, Williams MA, Castenson D,
Curry M, Parsons R, Fant G, Lin M.Spectrum of cancer risk among US solid organ transplant
recipients. JAMA. 2011;306(17):1891–901. https://doi.org/10.1001/jama.2011.1592.
13. Mann JMV, Holland AE, Goh NSL, etal. Understanding patient experience of chronic cough in
interstitial lung disease. ERJ Open Res. 2023;9:00039–2023. https://doi.org/10.1183/2312054
1.00039- 2023.
14. Siddiqui AS, Zimmerman JL.Everolimus associated interstitial pneumonitis in a liver trans-
plant patient. Respir Med Case Rep. 2016;19:15–7. https://doi.org/10.1016/j.rmcr.2016.06.004.
15. Baas MC, Struijk GH, Moes DJ, van den Berk IA, Jonkers RE, de Fijter JW, van der Heide
JJ, van Dijk M, ten Berge IJ, Bemelman FJ.Interstitial pneumonitis caused by everolimus: a
case-cohort study in renal transplant recipients. Transpl Int. 2014;27(5):428–36. https://doi.
org/10.1111/tri.12275.
9 Common Syndromes intheAdult Solid Organ Transplant Recipient
294
16. Champion L, Stern M, Israël-Biet D, Mamzer-Bruneel MF, Peraldi MN, Kreis H, Porcher R,
Morelon E.Brief communication: sirolimus-associated pneumonitis: 24 cases in renal trans-
plant recipients. Ann Intern Med. 2006;144(7):505–9.
17. Crespo MM, McCarthy DP, Hopkins PM, Clark SC, Budev M, Bermudez CA, Benden C,
Eghtesady P, Lease ED, Leard L, D'Cunha J, Wigeld CH, Cypel M, Diamond JM, Yun JJ,
Yarmus L, Machuzak M, Klepetko W, Verleden G, Hoetzenecker K, Dellgren G, Mulligan
M. ISHLT consensus statement on adult and pediatric airway complications after lung
transplantation: denitions, grading system, and therapeutics. J Heart Lung Transplant.
2018;37(5):548–63. https://doi.org/10.1016/j.healun.2018.01.1309. Epub 2018 Feb 7. PMID:
29550149.
18. Castro K, Naik CA, Spak CW, etal. Management of SARS-CoV-2 and persistent viral detec-
tion in solid organ transplant recipients. Curr Pulmonol Rep. 2024;13:26–37. https://doi.
org/10.1007/s13665- 024- 00338- z.
19. Franquet T, Lee KS, Müller NL. Thin-section CT ndings in 32 immunocompromised
patients with cytomegalovirus pneumonia who do not have AIDS. AJR Am J Roentgenol.
2003;181(4):1059–63.
20. Wang X, Wang Y, Zhu Q, Guo G, Yuan H.Pulmonary infection in the renal transplant recipi-
ents: analysis of the radiologic manifestations. Radiol Infect Dis. 2014;1:3–6. https://doi.
org/10.1016/j.jrid.2014.10.001.
21. Moon SM, Sung H, Kim MN, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH.Diagnostic
yield of the cytomegalovirus (CMV) antigenemia assay and clinical features in solid organ
transplant recipients and hematopoietic stem cell transplant recipients with CMV pneumonia.
Transpl Infect Dis. 2012;14(2):192–7.
https://doi.org/10.1111/j.1399- 3062.2011.00703.x.
22. Aboagye JK, Hayanga JWA, Lau BD, Bush EL, Shaffer DL, Hobson DB, Kraus PS, Streiff MB,
Haut ER, D'Cunha J.Venous thromboembolism in patients hospitalized for lung transplanta-
tion. Ann Thorac Surg. 2018;105(4):1071–6. https://doi.org/10.1016/j.athoracsur.2017.10.041.
23. Sáez-Giménez B, Berastegui C, Loor K, López-Meseguer M, Monforte V, Bravo C, Santamaría
A, Roman A.Deep vein thrombosis and pulmonary embolism after solid organ transplan-
tation: an unresolved problem. Transplant Rev (Orlando). 2015;29(2):85–92. https://doi.
org/10.1016/j.trre.2014.12.005.
24. Tsai HI, Liu F, Lee CW, Kuo CF, See LC, Chung TT, Yu HP. Cardiovascular disease
risk in patients receiving organ transplantation: a national cohort study. Transpl Int.
2017;30(11):1161–71. https://doi.org/10.1111/tri.13010.
25. Abbott KC, Cruess DF, Agodoa LY, Sawyers ES, Tveit DP.Early renal insufciency and late
venous thromboembolism after renal transplantation in the United States. Am J Kidney Dis.
2004;43(1):120–30.
26. Tveit DP, Hypolite I, Bucci J, Hshieh P, Cruess D, Agodoa LY, Welch PG, Abbott KC.Risk
factors for hospitalizations resulting from pulmonary embolism after renal transplantation in
the United States. J Nephrol. 2001;14(5):361–8.
27. Gillis KA, Patel RK, Jardine AG.Cardiovascular complications after transplantation: treat-
ment options in solid organ recipients. Transplant Rev (Orlando). 2014;28(2):47–55. https://
doi.org/10.1016/j.trre.2013.12.001.
28. Maher TM. Interstitial lung disease: a review. JAMA. 2024;331(19):1655–65. https://doi.
org/10.1001/jama.2024.3669. PMID: 38648021.
29. Blosser CD, Bloom RD. Posttransplant anemia in solid organ recipients. Transplant Rev
(Orlando). 2010;24(2):89–98. https://doi.org/10.1016/j.trre.2010.01.006. PMID: 20303457.
30. Heinrich TW, Marcangelo M. Psychiatric issues in solid organ transplantation. Harv Rev
Psychiatry. 2009;17(6):398–406. https://doi.org/10.3109/10673220903463259. PMID:
19968454.
31. Kotloff RM, Ahya VN, Crawford SW.Pulmonary complications of solid organ and hemato-
poietic stem cell transplantation. Am J Respir Crit Care Med. 2004;170(1):22–48. https://doi.
org/10.1164/rccm.200309- 1322SO. Epub 2004 Apr 7. PMID: 15070821.
K. O’Connor and C. J. Wong
295
32. Freedman ND, Silverman DT, Hollenbeck AR, Schatzkin A, Abnet CC.Association between
smoking and risk of bladder cancer among men and women. JAMA. 2011;306(7):737–45.
https://doi.org/10.1001/jama.2011.1142.
33. Vidal E, Torre-Cisneros J, Blanes M, Montejo M, Cervera C, Aguado JM, Len O, Carratalá
J, Cordero E, Bou G, Muñoz P, Ramos A, Gurguí M, Borrell N, Fortún J.Spanish network
for research in infectious diseases (REIPI). Bacterial urinary tract infection after solid organ
transplantation in the RESITRA cohort. Transpl Infect Dis. 2012;14(6):595–603. https://doi.
org/10.1111/j.1399- 3062.2012.00744.x.
34. Parasuraman R, Julian K.AST infectious diseases Community of Practice. Urinary tract infec-
tions in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):327–36. https://doi.
org/10.1111/ajt.12124.
35. Goldman JD, Julian K.Urinary tract infections in solid organ transplant recipients: guidelines
from the American Society of Transplantation infectious diseases Community of Practice. Clin
Transpl. 2019;33:e13507. https://doi.org/10.1111/ctr.13507.
36. Rouphael NG, Laskar SR, Smith A, Lyon GM. Cytomegalovirus prostatitis in a heart
transplant recipient. Am J Transplant. 2011;11(6):1330–3. https://doi.org/10.1111/
j.1600- 6143.2011.03519.x. Epub 2011 Apr 12. PMID: 21486388.
37. Siddiqui TJ, Zamani T, Parada JP.Primary cryptococcal prostatitis and correlation with serum
prostate specic antigen in a renal transplant recipient. J Infect. 2005;51(3):e153–7. https://
doi.org/10.1016/j.jinf.2004.12.005. Epub 2005 Jan 22. PMID: 16230196.
38. Angarone M, Snydman DR.Diagnosis and management of diarrhea in solid-organ trans-
plant recipients: guidelines from the American Society of Transplantation infectious diseases
Community of Practice. Clin Transpl. 2019;33:e13550.
39. Buchan CA, Kotton CN.AST infectious diseases Community of Practice. Travel medicine,
transplant tourism, and the solid organ transplant recipient-guidelines from the American
Society of Transplantation infectious diseases Community of Practice. Clin Transpl.
2019;33(9):e13529. https://doi.org/10.1111/ctr.13529. Epub 2019 Apr 14. PMID: 30859623.
40. Cusini A, Béguelin C, Stampf S, Boggian K, Garzoni C, Koller M, Manuel O, Meylan P,
Mueller NJ, Hirsch HH, Weisser M, Berger C, van Delden C, Swiss Transplant Cohort Study.
Clostridium difcile infection is associated with graft loss in solid organ transplant recipients.
Am J Transplant. 2018;18(7):1745–54. https://doi.org/10.1111/ajt.14640.
41. Mullane KM, Dubberke ER, AST ID Community of Practice. Management of Clostridioides
(formerly clostridium) difcile infection (CDI) in solid organ transplant recipients: guide-
lines from the American Society of Transplantation Community of practice. Clin Transpl.
2019;33(9):e13564. https://doi.org/10.1111/ctr.13564. Epub 2019 Jun 20. PMID: 31002420.
42. Boutros M, Al-Shaibi M, Chan G, Cantarovich M, Rahme E, Paraskevas S, Deschenes M,
Ghali P, Wong P, Fernandez M, Giannetti N, Cecere R, Hassanain M, Chaudhury P, Metrakos
P, Tchervenkov J, Barkun JS.Clostridium difcile colitis: increasing incidence, risk factors,
and outcomes in solid organ transplant recipients. Transplantation. 2012;93(10):1051–7.
https://doi.org/10.1097/TP.0b013e31824d34de.
43. Loo VG, Bourgault AM, Poirier L, Lamothe F, Michaud S, Turgeon N, Toye B, Beaudoin
A, Frost EH, Gilca R, Brassard P, Dendukuri N, Béliveau C, Oughton M, Brukner I, Dascal
A.Host and pathogen factors for Clostridium difcile infection and colonization. N Engl J
Med. 2011;365(18):1693–703.
44. Ponticelli C, Passerini P.Gastrointestinal complications in renal transplant recipients. Transpl
Int. 2005;18(6):643–50.
45. Razonable RR, Humar A. Cytomegalovirus in solid organ transplant recipients-guidelines
of the American Society of Transplantation infectious diseases Community of Practice. Clin
Transpl. 2019;33(9):e13512. https://doi.org/10.1111/ctr.13512.
46. Arslan H, Inci EK, Azap OK, Karakayali H, Torgay A, Haberal M.Etiologic agents of diarrhea
in solid organ recipients. Transpl Infect Dis. 2007;9:270–5.
9 Common Syndromes intheAdult Solid Organ Transplant Recipient
296
47. Al-Absi AI, Cooke CR, Wall BM, Sylvestre P, Ismail MK, Mya M. Patterns of injury in
mycophenolate mofetil-related colitis. Transplant Proc. 2010;42(9):3591–3. https://doi.
org/10.1016/j.transproceed.2010.08.066.
48. Behrend M.Adverse gastrointestinal effects of mycophenolate mofetil: aetiology, incidence
and management. Drug Saf. 2001;24(9):645–63.
49. Zhang Y, Ruiz P.Solid organ transplant-associated acute graft-versus-host disease. Arch
Pathol Lab Med. 2010;134(8):1220–4.
50. Pant C, Deshpande A, Larson A, O'Connor J, Rolston DD, Sferra TJ.Diarrhea in solid-organ
transplant recipients: a review of the evidence. Curr Med Res Opin. 2013;29(10):1315–28.
https://doi.org/10.1185/03007995.2013.816278.
51. Hampton DD, Poleski MH, Onken JE.Inammatory bowel disease following solid organ trans-
plantation. Clin Immunol. 2008;128(3):287–93. https://doi.org/10.1016/j.clim.2008.06.011.
52. Beeching NJ, Carratalà J, Razonable RR, Oriol I, Vilela EG.Traveler's Diarrhea recommen-
dations for solid organ transplant recipients and donors. Transplantation. 2018;102(2S Suppl
2):S35–41. https://doi.org/10.1097/TP.0000000000002015. PMID: 29381576.
53. Athar M, Walsh SB, Kopelovich L, Elmets CA. Pathogenesis of nonmelanoma skin can-
cers in organ transplant recipients. Arch Biochem Biophys. 2011;508(2):159–63. https://doi.
org/10.1016/j.abb.2011.01.004.
54. Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med.
2003;348(17):1681.
55. Greenberg JN, Zwald FO.Management of Skin Cancer in solid-organ transplant recipients: a
multidisciplinary approach. Dermatol Clin. 2011;29(2):231.
56. Chung CL, Nadhan KS, Shaver CM, Ogrich LM, Abdelmalek M, Cusack CA, Malat GE,
Pritchett EN, Doyle A.Comparison of Posttransplant dermatologic diseases by race. JAMA
Dermatol. 2017;153(6):552–8. https://doi.org/10.1001/jamadermatol.2017.0045.
57. Moloney FJ, Comber H, O'Lorcain P, O'Kelly P, Conlon PJ, Murphy GM.A population-based
study of skin cancer incidence and prevalence in renal transplant recipients. Br J Dermatol.
2006;154(3):498.
58. Krynitz B, Olsson H, Lundh Rozell B, Lindelöf B, Edgren G, Smedby KE.Risk of basal cell
carcinoma in Swedish organ transplant recipients: a population-based study. Br J Dermatol.
2016;174(1):95–103. Epub 2015 Dec 21.
59. Garrett GL, Blanc PD, Boscardin J, Lloyd AA, Ahmed RL, Anthony T, Bibee K, Breithaupt
A, Cannon J, Chen A, Cheng JY, Chiesa-Fuxench Z, Colegio OR, Curiel-Lewandrowski C,
Del Guzzo CA, Disse M, Dowd M, Eilers R Jr, Ortiz AE, Morris C, Golden SK, Graves MS,
Grifn JR, Hopkins RS, Huang CC, Bae GH, Jambusaria A, Jennings TA, Jiang SI, Karia PS,
Khetarpal S, Kim C, Klintmalm G, Konicke K, Koyfman SA, Lam C, Lee P, Leitenberger JJ,
Loh T, Lowenstein S, Madankumar R, Moreau JF, Nijhawan RI, Ochoa S, Olasz EB, Otchere
E, Otley C, Oulton J, Patel PH, Patel VA, Prabhu AV, Pugliano-Mauro M, Schmults CD,
Schram S, Shih AF, Shin T, Soon S, Soriano T, Srivastava D, Stein JA, Sternhell-Blackwell K,
Taylor S, Vidimos A, Wu P, Zajdel N, Zelac D, Arron ST.Incidence of and risk factors for skin
cancer in organ transplant recipients in the United States. JAMA Dermatol. 2017;153(3):296.
60. Park CK, Fung K, Austin PC, Kim SJ, Singer LG, Baxter NN, Rochon PA, Chan AW.Incidence
and risk factors of keratinocyte carcinoma after rst solid organ transplant in Ontario, Canada.
JAMA Dermatol. 2019;155:1041. https://doi.org/10.1001/jamadermatol.2019.0692. [Epub
ahead of print].
61. Kang W, Sampaio MS, Huang E, Bunnapradist S.Association of Pretransplant Skin Cancer
with Posttransplant Malignancy, graft failure and death in kidney transplant recipients.
Transplantation. 2017;101(6):1303.
62. Athar M, Walsh SB, Kopelovich L, Elmets CA.Pathogenesis of nonmelanoma skin cancers in
organ transplant recipients. Arch Biochem Biophys. 2011;508(2):159.
63. Williams K, Mansh M, Chin-Hong P, Singer J, Arron ST.Voriconazole-associated cutane-
ous malignancy: a literature review on photocarcinogenesis in organ transplant recipients.
K. O’Connor and C. J. Wong