Table 1.

Regimens and targets for prophylaxis in the posttransplant period

Infections	Target Groups	Prophylaxis Regimens/Comments	Suggested Duration of Prophylaxis
Bacterial infection (postoperative wound infection and sepsis)	All recipients	Perioperative antimicrobials regimens vary depending on organ, nature of surgery, and recipient factors (eg, selected regimens for cystic fibrosis)	48–72 h
Herpes simplex	Seropositive recipients	Acyclovir	3 months
CMV	Stratification of risk based on CMV donor/recipient serostatus	Intravenous ganciclovir (with/without intravenous immune globulin in some centers) Emerging data for valganciclovir in low- to intermediate-risk older children	Typically 3 months; some centers use prophylactics for shorter periods (2 weeks) or longer (6 months)
EBV	High-risk patients are D+R− patients	No established regimens; preemptive reduction in immune suppression in response to rising EBV load in peripheral blood in use by growing number of centers; ganciclovir with/without immune globulin used in some centers	Duration variable if antivirals with/without immune globulin used
Candida species	All recipients	Fluconazole selectively; lipid amphoterin B products selectively; nystatin often used	Up to 4 weeks depending on risk factors
Aspergillus	Lung/heart-lung recipients	Voriconazole; intraconazole; amphotericin B products	Duration variable; up to 4–6 months depending on risk
Pneumocystis jiroveci	All recipients	Trimethoprim-sulfamethoxazole	Typically 6–12 months; for lung and small bowel transplant recipients, as well as any transplant patient with a history of prior PCP infection or chronic CMV disease, lifelong prophylaxis may be indicated
Toxoplasma gondii	Heart/heart-lung recipients	Pyrimethamine/sulfa for D+R− patients Trimethoprim/sulfa of some value for R+ patients	6 months