Safe living after transplantation or chemotherapy

Abstract: Ideally, children undergoing transplantation are able to live as full and rich a life as possible with a new organ or bone marrow. Likewise, in the ideal world children with cancer are able to enjoy life outside the hospital setting. However, cancer therapy or immunosuppression used to maintain graft function or avoid graft-versus-host disease puts the child at increased risk for infections that could otherwise be benign. Although transplantation is not meant to put a child in a bubble, it is critical for caregivers and the patient to understand exposure risks in the environment so that they can take precautions against many of the potential microbes. This chapter reviews some of the types of infection that can occur via direct contact, aerosolization, or ingestion and provides suggestions for preventive strategies to help children who have undergone solid organ transplantation or hematopoietic stem cell transplant thrive once they leave the hospital. Many of these same concepts can be applied to children undergoing cancer treatments. Extrapolation from adults and common sense are often relied on when definitive pediatric studies are not available to help inform the recommendations.