Travel Practices of Solid Organ Transplant Recipients
Abstract & Commentary
By Maria D. Mileno, MD
Dr. Mileno is Director, Travel Medicine, The Miriam Hospital, Associate Professor of Medicine, Brown University, Providence, RI.
Dr. Mileno reports no financial relationships relevant to this field of study.
Synopsis: New data have identified subgroups of solid organ transplant recipients who are at increased risk for illness during travel. Both men and those persons traveling for the purpose of visiting friends and relatives should be targeted for pre-travel care within this subgroup.
Source: Uslan DZ, Patel R, Virk A. International travel and exposure risks in solid-organ transplant recipients. Transplantation 2008;86:407-412.
The risks for illness acquired during travel are greater in immunocompromised travelers. Solid organ transplantation poses increased potential for acquisition of new fungal infections, given impaired cell-mediated immunity caused by immunosuppressive drug regimens. Impaired immunity also may lead to increased morbidity from bacterial infections common to travelers such as Salmonella sp, Listeria monocytogenes, Mycobacteria, and Legionella sp.
The currently reviewed survey of travel patterns has assessed more than 1100 patients who had undergone solid organ transplantation at Mayo Clinic using a self-administered anonymous questionnaire. Most traveled to low-risk regions and had low rates of travel-associated illness. However, 18% of the group who traveled to high-infection risk destinations such as Asia, Central or South America, Africa, or the Middle East developed illness requiring medical attention during travel. One traveler developed allograft rejection.
Men, in general, and persons who were born outside of the United States and Canada were more likely to travel to high-infection risk destinations. Those traveling for the purpose of visiting friends and relatives are reported to be more likely to contract infections due to longer stays and higher risk-taking behavior.
Of note, preventive measures were inconsistent, with fewer than 50% of these immunocompromised travelers to high-risk destinations reporting use of DEET. Of 1134 respondents, 303 reported travel outside of the United States and Canada after transplantation. Ninety-six percent of these travelers reported that they did not seek pre-travel advice prior to travel. Travel-related illness requiring medical attention occurred at a rate comparable to that of non-immunocompromised persons (8%), except for 49 persons who traveled to high-infection risk destinations. Of this group, 18% experienced severe illness.
Commentary
Travel within the first few months after transplantation is likely to represent the greatest risk period for infectious complications; however, the risk of infection diminishes six months after transplantation. Late-onset infections can include community-acquired pathogens, invasive or endemic fungal infections, or zoonotic infections. The authors acknowledge the limitations of basing broad conclusions on a survey with a 44% response rate and a confined study population. Still, the rate of illness in SOTR traveling to high-risk destinations is compelling, and it underscores the need for pre-travel preparation and access to high-quality medical care during travel for solid organ transplant recipients as well as other immunocompromised travelers.
The risks for illness acquired during travel are greater in immunocompromised travelers.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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