Background: Counseling is commonly provided to transplant candidates and recipients concerning “strategies for safer living”, including ways to minimize infection risk.

Methods: Patients enrolled in a prospective single-center cohort study of post-transplant infectious complications were asked to participate in an additional survey study that focused on potential recreational risks.

Results: 61 patients (42 SOT, 19 HSCT) responded to the survey, with median post-transplant followup of 20 mos. Of these, 33 indicated that they preferred indoor recreation, 15 preferred walking, and 13 preferred outdoor activities including biking, hiking, camping, hunting; other common activities included gym/exercise (6), arts and crafts (6), and golf (6). While only 5 listed gardening as a hobby, almost half (29/61, 48%) reported contact with garden, lawn work, composting, soil, dirt or plants. Non-occupational construction or home repair was practiced by 24/61 (39%). Swimming included 39% swimming in pools, 34% in ocean/bay/river/lake, and 15% in hot tubs/saunas. 20% were caregivers for children or incapacitated adults. Pets included dogs in 24/61 (39%), cats in 14/61 (23%), fish (5), birds (4), snake (1), rabbit (1), and guinea pigs (1). Of these, 21% were new pets after transplant. Infections in this cohort included only one invasive fungal infection (aspergillosis in an HSCT patient with relapse), and no mycobacterial or nocardial infections nor suspected zoonoses were identified.

Conclusions: Despite counseling, transplant recipients engage in a wide variety of activities and animal exposures that carry infection risk, including some that violate current guidelines. In this cohort, infections specifically related to these activities were not identified, but larger studies and longer followup are needed. Modifications or refresher courses for “strategies for safer living” counseling may be appropriate, especially at transition points to wider activity.

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