ABSTRACT
This chapter reviews the basics of transplantation immunity and mechanism of action of immunosuppressive agents and complications and strategies of prevention and management. The essential determinants of risk of infection are the dose, duration, and sequence of immunosuppression therapies. The totality of factors such as immunosuppressive therapy, previous therapies, presence of catheters or drains, neutropenia, lymphopenia, underlying immunodeficiencies, metabolic conditions, and viral infections all refer to the net state of immunodeficiency. During the late period, most transplant patients are stable and are at reduced levels of immunosuppression; thus, the risk of infection typically decreases. Short-term patient survival rates have progressively improved with the introduction of new immunosuppressive drugs to the levels where it is difficult to establish differences in survival among the immunosuppressive agents used. Long-term studies are required to confirm the short-term results. The nature of common pathogens changes during the intermediate period and is characterized by local epidemiology, anecdotal immunosuppressive strategies, and use of antimicrobial prophylaxis.
