How your body fights infections

After your transplant (and sometimes before), in order to keep your body from rejecting your transplanted organ your doctor will prescribe anti-rejection or immunosuppressive medicines. These medicines are critical to the success of your transplant because they help block your body’s natural defenses.

Your body has a natural way of recognizing what should and should not be in your system. Using its defense system (the immune system), it protects itself from things it identifies to be foreign, such as harmful bacteria and viruses that can cause infections.

When it senses something foreign, certain white blood cells (lymphocytes) produce antibodies (proteins that act like alarm bells) that start your body’s immune response. Another type of lymphocyte cell and other defenders rush to the site to attack the foreign substances, usually preventing infections from occurring. Since your transplanted organ is not your own, your body will recognize this as being foreign and activate your immune system, if not prevented.

Some of the anti-rejection or immunosuppressant medicines you will be prescribed after your transplant will help keep your body from attacking your transplanted organ. However, because parts of your immune system have been blocked, you will be at an increased risk of developing an infection, including dormant and/or opportunistic infections.

Infections and germs

What is a dormant infection?

Sometimes, after infecting the body, viruses may become dormant (go to sleep). Years later, dormant infections can wake up again, or reactivate, even in healthy people. Once they’re back, they can cause a new disease that might have different symptoms from those you experienced before.

What is an opportunistic infection?

An opportunistic infection is caused by organisms that don’t normally cause diseases in healthy people, but now have the chance to do so in someone with a weakened immune system.

You may also more easily catch a bug from other sources such as from other people, from a blood donation, or even from your transplanted organ. Blood and organ donors go through special laboratory tests before donating blood or any organ, helping to reduce the chance of this happening.

Tests for infections

As a transplant patient, you will be at an increased risk of getting an infection. Therefore it helps to be more aware of infections around you.

Your transplant team may carry out a number of tests to find out if you have an infection or how weak your body’s immune system is. This information helps them to determine which medicines to prescribe in order to prevent, help fight off, new infections. Your transplant team also may use vaccines and anti-viral medicines to help your immune system fight off intruders.

Getting to know germs

The herpes family
This group of viruses infects most humans and animals. Most people have been exposed to herpes viruses and have antibodies to herpes simplex virus type 1. Herpes simplex virus type 2 is transmitted through sexual contact.

The polyoma family (BK virus)
The BK virus belongs to a family called the polyoma group. Many people carry the BK virus without symptoms. However, the virus may become active in transplant patients who are taking medicines to prevent organ rejection.

Influenza
Also called "the flu," this virus can affect the entire body. The virus can spread through coughs and sneezes, and from surfaces like doorknobs or countertops touched by infected people. Influenza is a common cause of illness for patients after transplant.

The Centers for Disease Control (CDC) recommends that everyone 6 months of age and older should receive a flu vaccination in the late fall of each year. As per the 2014-2015 flu season, the CDC cautions that people taking medicines that could weaken the immune system should not take the H1N1 nasal-spray live attenuated influenza vaccine (LAIV). Check with your transplant team and with the CDC for updates each flu season.

Remember to call your transplant team:

  • At the first sign of flu symptoms. They can give you anti-viral medication to help make your illness less severe
  • Before receiving any vaccinations. Ask about your chickenpox and MMR (measles, mumps, and rubella) vaccinations
  • Before taking other medicines, including herbal medicines. Taking any other kind of medicine may be dangerous because it could interfere with the medicines you are already taking

Flu vaccination recommendation and caution according to the Centers for Disease Control, www.cdc.gov/flu/about/qa/flushot.htm and www.cdc.gov/flu/about/qa/nasalspray.htm; both accessed October 14, 2014.

Vaccines and medicines

Vaccines

Vaccines, like those for polio and the flu, can help prevent some viral infections. However, vaccines are not available for all infections. Sometimes, even if you received a vaccine, you might develop a mild version of the disease. If you have had a transplant you will be taking anti-rejection or immunosuppressive medicines and therefore you should not be administered any live vaccines.

Anti-viral medicines

Anti-viral medicines can protect against infection, but they may also have side effects.

Your medicine and preventing infections

When discussing medicines with your transplant team, they may use the terms "adherence" and "compliance." These terms mean taking your medicine exactly as directed by your transplant team. Taking medicines exactly as they are prescribed is particularly important for transplant patients.

Follow your medicine regimen as directed by your transplant team.
Taking your medicines as they have been prescribed to you is important because of the way anti-viral medicines work.

Anti-viral medicines attack a virus wherever it lives in your body. If you skip doses because of a medicine’s side effects, or because you’re starting to feel better, viruses may get stronger. Then the medicines may not work as well. When that happens, the virus may become resistant to the medicine. Viral infections can make it difficult for your transplanted organ to work properly, or, if you can’t absorb your medicines properly because of vomiting and diarrhea, the infections may even increase the risk of rejection.

Before taking any non-prescription medicines or supplements, tell your transplant team. For example, sometimes taking medicine for pain or an upset stomach can hide a more serious illness that needs attention.

Everyday prevention

The United Network for Organ Sharing and The Renal Network have some everyday tips that may help you prevent infection:

  • Be mindful of who you touch, or with whom you share food, drinks, or utensils
  • Wash your hands with soap and water often, and try to shower daily to keep your skin clean
  • It’s best to avoid kissing children and shaking hands when possible
  • If you accidentally cut yourself, rinse the area well with running water, and clean the adjacent area with soap and water. Contact your transplant team immediately if the cut is deep or becomes red and warm to touch
  • Remember to contact your transplant team at the first sign of a sore or rash, and at the first sign of flu symptoms
  • Try to eat a healthy diet
  • When preparing food, it’s best to use a different chopping board for raw animal products such as fish, poultry, and meat to other food items. Try to avoid eating raw or undercooked meat or fish
  • Remember to practice safe sex and not to share personal items such as toothbrushes, razors, or hypodermic needles with anyone
  • Try to avoid contact with sick people, children who have been recently immunized, and anyone with a cold
  • Avoid crowded areas for 3 to 6 months after your transplant. For the first 3 months, your transplant team may ask you to wear a mask during clinic visits and when crowded areas are unavoidable
  • Be cautious around animals. Always wash your hands after touching pets and try not to handle animal waste. Avoid farm animals as well as wild, sick, stray, or exotic animals (such as reptiles). Ask your transplant team for advice if you have a pet or are considering getting one
  • Try to avoid working outside or in your garden
  • It’s important to take your medicines as prescribed and go to your follow-up appointments
  • Try to stay up-to-date on your vaccines
  • It may be a good idea to take your temperature regularly and watch for any changes. If you feel or detect a fever, call your transplant team

Tips that may help you avoid infection according to the United Network for Organ Sharing, www.transplantliving.org/after-the-transplant/staying-healthy/infections-and-immunity/ and the Renal Network, www.therenalnetwork.org/services/resources/TransplantBooklet.03.2010.pdf; both accessed October 14, 2014.