Infections represent an important source of morbidity and mortality in solid organ
transplant recipients due to the state of immunosuppression associated with the use
of anti-rejection treatments. Infection control and eviction of exposure risks is an
important strategy for post-transplant management in these patients. Food-borne
pathogens are one source of disease which is commonly targeted by strict guidelines
on food avoidance and behaviors to adopt in order to minimize the risk of infection.
However, these guidelines are not evidence-based, but are rather based on common
sense, expert opinion, or knowledge of mechanisms of transmission of specific
pathogens. Moreover, adherence of transplant patients to these guidelines is largely
unexplored. Thus, it remains unknown if protection strategies are at all effective, or
even if patients apply them in their daily lives.
In this study, we used a self-report survey approach to ask whether 197 transplant
patients treated the University Hospital of Lausanne (CHUV) applied the foodassociated
behaviors prescribed by physicians, and whether sub-populations of
patients could be differentiated by such behaviors. In particular, we asked if guideline
adherence differed between recipients of different organs, or between patients at
different time-points after transplantation, notably in the first year post-transplant or
later. We found that over 90% of patients had consumed risk-associated food (RAF)
on at least one occasion since the transplant, and that 74% reported occasional or
frequent consumption of one or several RAFs. In contrast, hygiene recommendations
were followed in a more reliable manner, with almost 70% reporting following them all
of or most of the time. Finally, a series of hypothetical situations where participants
were again tested on their general knowledge of risks associated with foods and
behaviors to adopt showed that 71% of patients were unable to identify all situations
where risk may be present. In general, higher levels of adherence to guidelines
seemed to be associated with early post transplant period.
In conclusion, transplant recipients frequently consume risk associated food,
particularly late after transplantation and they follow appropriate measures of food
hygiene. Whether this behavior is associated with increase infection rates needs to be
further investigated.