Infections and bowel transplants

This is partly due to the immunosuppressant medicines you need to take after a transplant. The immunosuppressant medicines reduce the risk of you rejecting your transplanted organ, but they will also dampen down your immune system’s ability to fight infections.

Any surgery involving the bowel is linked with a higher risk of infections. The bowel is in contact with the outside world through food and liquid taken by mouth, so it is easier for bacteria and viruses to attack the transplant itself.

Infections can occur in your chest, tummy (abdomen), urine, around the plastic tubes inserted through your skin (lines), or in your surgical wound. More serious infections can spread to your bloodstream. Sometimes, if there is infected fluid around the transplant or in the wound, you might need to go back to the operating theatre to have the fluid washed out or have a drain inserted by the X-ray doctors.

Most infections can be treated with antibiotics. If a virus or fungus is thought to be causing the infection, you may need specialist anti-viral or anti-fungal medications. These may have strong side-effects.

Thorough checks are done to prevent infections being passed on with the donated organ. However, it is impossible to be completely sure that the donor and their organ are free of infection. Infections that can be transmitted from the donor include bacterial, viral, fungal or other infections.

> Learn about risks from the donated bowel

It is rare to get a serious infection such as hepatitis B, hepatitis C or HIV from a transplant. This chance is less than 1 in 1,000. Serious infections like HIV or hepatitis B or hepatitis C now have effective treatments. It is possible to transmit other viruses such as human herpesvirus-8 (HHV-8) through transplantation.

CMV infection

It is common that infections such as cytomegalovirus (CMV) are passed on with the donated organ. This infection is often fairly straightforward to diagnose, treat and monitor.

More than half of healthy people will have been exposed to CMV (similar to the shingles virus). After the initial infection it remains dormant in the body. Sometimes the CMV does not come from the donor organ but is dormant within the transplant patient, becoming active after the transplant as a result of the patient’s weakened immune system.

CMV infection causes fevers, fatigue and diarrhoea with low white cell-count (neutropenia) and/or abnormal liver tests. If you develop CMV infection, you will be treated with antiviral medication either orally or intravenously. If you are at increased risk of CMV infection you will receive preventative (prophylactic) treatment with a medication such as valganciclovir.

EBV infection

Sometimes, the Epstein-Barr virus (EBV) can be passed on with the transplanted bowel. EBV causes glandular fever, which is common in young people. The virus can lie dormant within cells inside the bowel transplant. With immune-suppression, the virus can reactivate. In some transplant patients this can cause problems that are similar to glandular fever (swollen glands in the neck and armpit and groin, fevers, feeling unwell).

Sometimes, lymph node cancers can occur with EBV infections (post-transplant lymphoproliferative disorders – PTLD). PTLD can occur in about 15 in 100 people after a bowel transplant. These are serious illnesses and require specialist treatment. PTLD can usually be successfully treated with a medication called rituximab.

Sometimes, the transplant team know that the donor was being treated for an infection at the time of their death. If this is an infection that is usually straightforward to treat, it may be quite safe to transplant the donor’s organ and give antibiotics or anti-viral medication to the transplant recipient.

If your transplant team believe that the chances of transmitting a serious disease with the new organ, they will discuss this with you before the transplant.

Even serious infections like HIV or hepatitis B or hepatitis C now have effective treatments.

Antibiotics are used to treat infections caused by bacteria. Antibiotics, and anti-fungal and anti-viral treatments carry risks such as allergic reactions (rashes and breathing problems), diarrhoea, and other side effects. Some anti-viral drugs can reduce your white cell count (neutropaenia) and you may need other treatments to support you. Your transplant team will discuss these with you.