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이식 환자의 감염 예방

Infection Prevention in Transplant Recipients

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키워드

주제분류내과학

초록

간이식 환자의 경우, 종종 비장절제술이 이루어지기도 하는데, 이 경우 사전에 비장절제술을 계획한다면, 고형장기이식환자에게 필요한 예방접종 이외에 추가로 비장절제환자에게 필요한 예방접종도 시행하도록 한다. 현재 국내에서는 뇌수막균 백신으로 멘비오(Menveo®) 주사제가 사용 가능하다. 이식 전에 시행하는 모든 예방접종은 늦어도 이식 2주 전에 완료되도록 한다. 환자 본인 이외에도 환자의 가족 및 의료인 역시 예방접종이 필요한 경우가 있는데, 특히 인플루엔자 백신은 반드시 가족도 함께 접종하도록 한다.

Abstract

Opportunistic infections are major causes of morbidity and mortality in hematopoietic stem-cell transplant and solid organ transplant recipients. The epidemiology and incidence of opportunistic infections in those patients have been dramatically changed with use of potent immunosuppressive agents as well as routine prophylaxis against various microorganisms such as common bacterial pathogens, fungi, cytomegalovirus, Pneumocystis jirovecii, and so on. Because transplant recipients are at the greatest risk for infection during early phase (1-3 months) after transplant, safe and effective prevention strategies should be implemented in this period. Moreover, beyond early phase, recipients are often susceptible to infections due to prolonged immunosuppressive therapy for graft rejection or chronic graft-versus-host diseases. Therefore, clinicians should assess a recipient’s risk of infection on the basis of concomitant graft function, intensity of immunosuppression, and other factors that may contribute to susceptibility to infections. We discussed infection prevention strategies among recipients of hematopoietic stem-cell and solid organ transplantation against various opportunistic pathogens. Vaccinations should also be recommended for pre-transplant candidates and post-transplant recipients for the best prevention of infections.

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