The importance of nutrition advice in immunosuppressed solid organ transplant recipients for the prevention of foodborne bacterial infections

Abstract

Introduction – Successful solid organ transplantation (SOT) requires a balance between minimizing graft rejection risk while preserving sufficient immunity to protect against infections. In order to reduce foodborne infection risk, SOT recipients are advised to avoid consuming raw animal products and unpasteurized dairy products. However, recommended strictness and duration of adherence to this advice differ between healthcare centres. In order to come up with an uniform evidence-based guideline, this literature review aims to provide an overview of all literature on the actual impact of foodborne infections, taking patient’s adherence into account.

Methods – Initially, articles published in the last 10 years were searched in PubMed, using search terms such as "organ transplant*" AND ("food" OR "nutrition*") AND "infection". Articles exclusively discussing non-bacterial or non-foodborne infections were excluded. After the first screening of titles and abstracts, relevant articles were selected and accurately read. Main findings were clustered in tables and the contents were evaluated and compared.

Results – The percentages of infected patients in the different study populations were quite similar, which were around 3.0%. Standardized incidence rates (SIR) showed that Campylobacter, Salmonella and Shigella infections occur multiple times more in SOT recipients, compared to the general population. Severity of the infections vary. Nutritional advice was similar among evaluated centres, although recommendations regarding duration of adherence differ. Most SOT recipients did not adhere to all recommendations.

Discussion and conclusion – There is a limited number of studies investigating the actual impact of foodborne infections in SOT recipients. Foodborne infections occur more frequently in SOT recipients and consequences are more severe compared to the general population. Therefore, educating SOT recipients on safe nutrition is important. To clarify confusion about recommended strictness and duration of adherence, further research is needed. In the meantime, health care providers could explain to their patients that many aspects play a role in their individual infectious risk.