Emerging Transplant Infections: Clinical Challenges and Implications

The field of transplant medicine has evolved significantly since the first kidney transplant was performed in 1954. Innovations in transplant immunosuppression have lowered the risk of organ rejection so that infectious complications are now the leading cause of hospitalization and mortality after solid organ transplant. Infection is also cited as the leading cause of non-relapse mortality after stem cell transplantation. As transplant centers have recognized the importance of transplant specific expertise in patient outcomes, the field of transplant infectious diseases has expanded into a recognized and highly valued subspecialty. International growth in solid organ and stem cell transplantation has outpaced access to such expertise, with some centers employing microbiology laboratory directors and transplant nephrologists as their lead infectious diseases consultants. This has been a particular challenge as the use of novel immunosuppressive regimens in new geographic and immigrant populations have fueled the emergence of new infection syndromes, with the initial presentation sometimes occurring in this most vulnerable patient population.

This digital-first book is designed to meet the needs of practitioners engaged in transplant infectious disease practice who need more depth than they are able to find in UpToDate. It provides an overview of emerging infectious disease challenges with clinically relevant information regarding the epidemiology, diagnosis, management, and prevention of infections in solid organ and stem cell transplant recipients. Each chapter focuses on a clinical syndrome or pathogen with new or emerging implications for transplant patients.

Given the rapidly evolving nature of emerging infections and topics in transplant infections, no resource has been published on these increasingly notorious issues; this this text is written by top, global experts who regularly update the material to ensure that readers will always have access to the most cutting edge material available.

The editorial team consists of three experienced leaders in the field, all of whom have a strong record of scholarship and publication, as well as an international reputation. All three have focused their academic careers on emerging infectious diseases in transplantation, including a current and a past president of various infectious diseases and transplantation societies. The editors are also experienced reviewers and authors who have collaborated on multiple previous projects. All are committed to this project as a unique opportunity to make an important contribution to their field.

Michele I. Morris, M.D., FACP, FIDSA, FAST
Professor of Clinical Medicine
Director, Immunocompromised Host Service
Division of Infectious Diseases
University of Miami Miller School of Medicine
1120 N.W. 14th St., Suite 842 (R-21)
Miami, FL 33136

Camille Nelson Kotton MD, FIDSA, FAST

Clinical Director, Transplant and Immunocompromised Host Infectious Diseases
Infectious Diseases Division
Massachusetts General Hospital
Harvard Medical School
55 Fruit Street, Cox 5
Boston, MA 02114 USA

Dr Cameron R.Wolfe MBBS(Hons), MPH, FIDSA

Associate Professor of Medicine
Transplant Infectious Disease
DUMC #102359, Rm 159,
Hanes House, Trent Drive
Durham, NC, 27710

Michele I. Morris, M.D., FIDSA, FAST, is Professor of Clinical Medicine and Director of the Immunocompromised Host Service in the Division of Infectious Diseases at the University of Miami Miller School of Medicine. She has spent the last 17 years of her career focusing her clinical practice and research efforts on transplant infectious diseases, with special attention to the area of emerging infections in transplant. Dr. Morris is also Medical Director of Infection Control and Antimicrobial Stewardship at Sylvester Cancer Center, and Fellowship Director of the Transplant Infectious Diseases fellowship at the University of Miami/Jackson Memorial Hospital. She has published over 90 peerreviewed articles and 8 book chapters. Dr. Morris has delivered numerous presentations at national and international meetings, including invited lectures on five continents. She is a past president of the Transplantation Society's Transplant Infectious Disease Section. She is an active member of the American Society of Transplantation's Infectious Diseases Community of Practice (ID-COP), and a previous executive board member.

Acknowledgments: I am privileged to be a member of the international community of transplant infectious disease specialists whose outstanding teamwork is demonstrated in this textbook. An enormous thanks to Camille Kotton and Cameron Wolfe - your dedication and incredible collaboration made this project possible. Thanks also to my daughters Elana and Kayla, who somehow taught me more about life and love (and popular culture) than I could ever teach them. And to my husband, Joel Fishman, who has been there since the beginning, xiii thank you for sharing your life with me. Your unwavering love and support has shaped my growth as a physician and a person. Finally, from all of us in the field of Transplant Infectious Diseases, thank you to our amazing patients for your resilience and optimism and to transplant donors everywhere for making it all possible.

Camille Nelson Kotton, M.D., FIDSA, FAST, is Clinical Director of the Transplant Infectious Disease and Immunocompromised Host Program at the Massachusetts General Hospital and Associate Professor of Medicine, Harvard Medical School, Boston, Massachusetts. She was chair of the Infectious Disease Community of Practice of the American Society of Transplantation (2012-2018). From 2007 to 2013, she was the president of the Transplant Infectious Disease Section of The Transplantation Society. Highlights of her time as president include the development of international guidelines on CMV management after solid organ transplant, published in Transplantation (2010, 2013, 2018). She is the first transplant infectious disease specialist to be a councilor of The Transplantation Society (2020). Her clinical interests include cytomegalovirus, donor-derived infections, zoonoses, and travel and tropical medicine in the transplant setting. She would very much like to thank her family for their wonderful support over the years, including her sons Benjamin and David, and her husband Darrell, both for extensive homework projects like this one, and for strength during the COVID-19 pandemic

Dr. Cameron R. Wolfe is an Associate Professor of Medicine in the Division of Infectious Disease at Duke University, specializing in transplant infectious diseases emerging pathogens, HIV, and viral hepatitis. He grew up and trained in Australia, and has research interests in the management of pandemic disease in the general community and especially respiratory viruses in the immunocompromised. He lectures at the University of North Carolina, School of Public Health, as well as the Duke University Medical School. More than anything, Cameron is proud of the grace shown by his two sons, Callum and Lachlan, and his wife, Sarah, as this project has come to fruition!