Immunosuppressive Agents and Infectious Risk in Transplantation: Managing the “Net State of Immunosuppression”

Author:

Roberts Matthew B1,Fishman Jay A12

Affiliation:

1. Transplant Infectious Disease and Compromised Host Program and Transplant Center, Massachusetts General Hospital, Boston, Massachusetts, USA

2. Harvard Medical School, Boston, Massachusetts, USA

Abstract

Abstract Successful solid organ transplantation reflects meticulous attention to the details of immunosuppression, balancing risks for graft rejection against risks for infection. The “net state of immune suppression” is a conceptual framework of all factors contributing to infectious risk. Assays that measure immune function in the immunosuppressed transplant recipient relative to infectious risk and allograft function are lacking. The best measures of integrated immune function may be quantitative viral loads to assess the individual’s ability to control latent viral infections. Few studies address adjustment of immunosuppression during active infections; thus, confronted with infection in solid organ recipients, the management of immunosuppression is based largely on clinical experience. This review examines known measures of immune function and the immunologic effects of common immunosuppressive drugs and available studies reporting modification of drug regimens for specific infections. These data provide a conceptual framework for the management of immunosuppression during infection in organ recipients.

Funder

National Institute of Allergy and Infectious Diseases

National Institutes of Health

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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