Common Infections in Kidney Transplant Recipients

Karuthu, Shamila; Blumberg, Emily A.

doi:10.2215/cjn.04410512

Cited by 221 publications

(173 citation statements)

References 92 publications

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“…Preventing acute rejection has been the principal aim in transplantation medicine for several decades, and the success of transplantation was, to a significant extent, related to the development of effective immunosuppressive therapy (1). However, intense immunosuppression inevitably increases susceptibility to infections and malignancies, some of which are infection triggered (2)(3)(4). As a result, the relevance of infection episodes and infection-associated allograft failures progressively increased in the last decades, and balancing the beneficial and deleterious effects of immunosuppressive therapy emerged as a critical aim in the modern transplantation era (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Risk Stratification for Rejection and Infection after Kidney Transplantation

Cippà¹,

Schiesser²,

Ekberg

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Definition of individual risk profile is the first step to implement strategies to keep the delicate balance between under-and overimmunosuppression after kidney transplantation. Results Despite different temporal dynamics, rejections and severe infections had similar overall incidences in the first year after transplantation (23.4% and 25.5%, respectively), and infections were the principal cause of death (43.2% of all deaths). Recipient older age, deceased donor, higher number of HLA mismatches, and high risk for cytomegalovirus disease were associated with infection; deceased donor, higher number of HLA mismatches, and immunosuppressive therapy including cyclosporin A (compared with tacrolimus), with rejection. These factors were integrated into a two-dimensional risk stratification model, which defined four risk groups: low risk for infection and rejection (30.8%), isolated risk for rejection (36.1%), isolated risk for infection (7.0%), and high risk for infection and rejection (26.1%). In internal validation, this model significantly discriminated the subgroups in terms of composite end point (low risk for infection/rejection, 24.4%; isolated risk for rejection and isolated risk for infection, 31.3%; high risk for infection/rejection, 54.4%; P,0.001), rejection episodes (isolated risk for infection and low risk for infection/rejection, 13.0%; isolated risk for rejection and high risk for infection/ rejection, 24.2%; P=0.001), and infection episodes (low risk for infection/rejection and isolated risk for rejection, 12.0%; isolated risk for infection and high risk for infection/rejection, 37.6%; P,0.001). External validation confirmed the applicability of the model to an independent cohort.Conclusions We propose a two-dimensional risk stratification model able to disentangle the individual risk for rejection and infection in the first year after kidney transplantation. This concept can be applied to implement a personalized immunosuppressive and antimicrobial treatment approach.

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Section: Introductionmentioning

confidence: 99%

Risk Stratification for Rejection and Infection after Kidney Transplantation

Cippà¹,

Schiesser²,

Ekberg

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…One of the risk factors for urinary tract infection is receiving a kidney from a donor after brain death. 9 Of 164 isolates, we had 135 cases isolated from patients who received transplants from donors after brain death, which was statistically significant (P = .01). One way to prevent infections after transplant is prophylaxis with antibiotics such as co-trimoxazole.…”

Section: Discussionmentioning

confidence: 96%

Untitled

Mansury

Khaledi²,

Ghazvini³

et al. 2018

Exp Clin Transplant

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Objectives: Over the past 2 decades, significant advances have been made in the management of infections after transplant; however, transplant recipients are still at high risk of infectious complications. This study aimed to evaluate the prevalence of bacterial infections and antimicrobial resistance patterns in kidney transplant recipients. Conclusions:Because of the high prevalence of infection among transplant patients, infection prevention should receive more attention, and antibiotic susceptibility should be determined before treatment. Key words: Antibiotic resistance, Coagulase-negative Staphylococcus, Escherichia coli, Renal transplantation IntroductionOne of the primary and major aims in organ transplant is the effective prevention and treatment of infections. During the previous 2 decades, significant advances have been made in the management of infection after transplant. However, transplant recipients are still at high risk of infectious complications, due to the surgical interventions, immunosuppressive therapy, and exposure to the environment. 1 In transplant patients, there are generally 3 times the incidences of infections after transplant, which are usually divided as those that occur during the first month posttransplant, those that occur 2 to 6 months posttransplant, and those that occur more than 6 months posttransplant.Most infections in the first month, especially the first 2 weeks after transplant, occur in relation to technical and operative factors. These infections include pneumonia, wound infection, those related to intravenous catheter, and urinary tract infection. 2 In addition are complications that result from infections causing the death of organ transplant recipients and in some cases organ transplant rejections, especially infections that are caused by drug-resistant bacteria. [2][3][4] Urinary tract infections are the most common problem after kidney transplant. Almost 70% of these infections are caused by gramnegative bacteria, especially Escherichia coli and Klebsiella pneumoniae. 4 In addition to gram-negative bacteria, some gram-positive bacteria, including

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“…In order to prevent graft dysfunction or rejection, early diagnosis is essential for the antiviral treatment or to adjust the immunosuppressive therapy. Regular screening for both viruses is required after transplantation [13] .…”

Section: Introductionmentioning

confidence: 99%

The Impact of BK Virus and Cytomegalovirus Infections on Graft in Renal Transplant Patients: Experience of a Tertiary Hospital in Turkey

Köse¹,

Atalay²,

Ulu³

et al. 2018

mjima

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Introduction: BK virus (BKV) and cytomegalovirus (CMV) infections are common in renal transplant patients. In this retrospective study, we investigated the frequency of BKV and CMV infections and their effects on graft. Materials and Methods:The data of 118 renal transplant recipients who were transplanted and followed-up between January 2010 and January 2011 were reviewed. Demographic characteristics, biochemical data, BKV and CMV DNA levels by polymerase chain reaction (QIAGEN, Hilden, Germany) were investigated. The patients were followed-up monthly in the first six months and then every three months. Results: A total of 118 patients were included in the study. BK viraemia was detected in 12 (10.2%) patients and the DNA level of BKV was >10 4 copies/mL in five cases. Three patients with elevated creatinine and compatible renal biopsy findings were considered to have BKV-associated nephropathy (BKVAN). With the reduction of immunosuppressive treatment, viraemia was reduced and creatinine levels decreased within normal levels. Cytomegalovirus DNA was found to be positive in 23 (19.5%) patients, and was >500 copies/mL in 4 (3.4%) patients. The viraemia in these four patients has decreased after antiviral therapy. No CMV related disease were found in any of the patients. Cytomegalovirus DNA positivity at low levels were also detected in three patients who were diagnosed with BKVAN. None of the patients developed rejection. Conclusion: BK and CMV infections in kidney transplant patients are common and can be seen together. However, graft dysfunction and rejection rates are low with close monitoring, early diagnosis and treatment. Randomized, controlled studies with larger patient groups are necessary in order to determine the viral threshold levels associated with graft dysfunction or rejection, to decide the optimal management and to explain the role of concomitant infection. Keywords: BK, kidney, transplantation, infection, ciprofloxacinGiriş: BK virüs (BKV) ve sitomegalovirüs (CMV) enfeksiyonları böbrek nakli hastalarında yaygın olarak görülür. Bu retrospektif çalışmada BKV ve CMV enfeksiyon sıklığı ve greft üzerine etkileri araştırılmıştır. Gereç ve Yöntem: Ocak 2010 ve Ocak 2011 tarihleri arasında böbrek nakli uygulanan ve takip edilen 118 böbrek nakil alıcısının verileri retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, biyokimyasal veriler ve polimeraz zincir reaksiyonu (QIAGEN, Hilden, Germany) yöntemiyle BKV ve CMV DNA seviyeleri araştırıldı. Hastalar önce altı ay aylık olarak, daha sonra üç aylık periyotlarla izlenmiştir. Bulgular: Çalışmaya toplam 118 hasta alınmıştır. BK viremisi 12 (%10,2) hastada saptanmış olup, beş olguda BKV DNA düzeyi >10 4 kopya/mL olarak tespit edilmiştir. Kreatinin yüksekliği de olan ve biyopsi bulguları uyumlu bulunan üç hasta, BKV ile ilişkili nefropati olarak değerlendirilmiştir. İmmünsüpresif tedavinin azaltılması ile viremi gerilemiş ve kreatinin seviyeleri normal düzeye gelmiştir. Sitomegalovirüs DNA, 23 (%19,5) hastada pozitif, dördünde (%3,4) ise >...

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Common Infections in Kidney Transplant Recipients

Cited by 221 publications

References 92 publications

Risk Stratification for Rejection and Infection after Kidney Transplantation

Risk Stratification for Rejection and Infection after Kidney Transplantation

Untitled

The Impact of BK Virus and Cytomegalovirus Infections on Graft in Renal Transplant Patients: Experience of a Tertiary Hospital in Turkey

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