Infectious complications are fairly common after transplantation, particularly in the early posttransplant period, when the highest doses of immunosuppressive medications are employed. The infectious complications after cardiac transplantation are similar to those following all types of solid-organ transplantation and those in other immunocompromised hosts.8 The infections most commonly encountered are listed in Tab.!e.ii„56z5. Prophylactic regimens are employed by most transplant centers. Pretransplantation, patients are vaccinated with pneumococcal, Haemophilus influenzae, and hepatitis B vaccines. Peri-operatively, routine antistaphylococcal antibiotics are used. Postoperatively, mycostatin mouthwash is used to prevent oral and esophageal candidiasis while the patients are on high-dose steroids and is reinstituted when augmented steroid therapy is required to treat rejection. Toxoplasma gondii can infect the transplanted heart; it may result from reactivation of a latent recipient infection or be transmitted with the donor organ. Toxoplasma titers are measured in all recipients and donors, and pyrimethamine is administered prophylactically for 6 weeks posttransplantation if titers are elevated. Beginning approximately 2 months posttransplantation, trimethoprim/sulfamethoxazole (Septra, Bactrim) is used as prophylaxis against Pneumocystis carinii pneumonia (PCP). Antibiotic prophylaxis for any invasive procedure (e.g., dental work, endoscopy, or surgical procedures) is recommended for the lifetime of the patient. Annual flu shots are recommended. Live attenuated virus vaccines such as those for measles, mumps, and rubella are contraindicated in transplant recipients.
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