Infectious disease evaluation of infants and children awaiting solid organ or hematopoietic stem cell transplant

Abstract: Pediatric candidates for solid organ and hematopoietic transplant should receive a thorough infectious disease evaluation as an essential first step in mitigating the risk of infection both before and after transplant. The basic objectives of this evaluation are to identify key elements of the medical history that may affect peritransplant infection risk and to devise infection prevention strategies. Screening tests to be performed depend on the type of transplant, the age of the transplant candidate, local geography/epidemiology, and the past medical history and exposures of the transplant candidate. The evaluation should be family-based and should review potential household exposures, as well as immunization histories for both the transplant candidate and their household contacts. Just as immunization remains the cornerstone of preventative health for children without transplants, it is equally critical to ensure that pediatric transplant candidates and their household contacts are appropriately immunized before transplant. Future studies are needed not only to investigate the immunogenicity of vaccines in transplant candidates with chronic illness but to also determine the utility of screening for colonization with multidrug-resistant bacteria and infection with respiratory viruses in asymptomatic transplant candidates.