Increasing Trend in Infection-Related Death-Censored Graft Failure in Renal Transplantation

Parasuraman, Ravi; Abouljoud, Marwan; Jacobsen, G K; Reddy, Gopal; Koffron, Alan J.; Venkat, K. K.

doi:10.1097/tp.0b013e3181fdd96c

Cited by 32 publications

(25 citation statements)

References 29 publications

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“…This is especially true for our lung recipients (including a substantial number of out‐of‐province residents) who had the highest rates of hospitalization for infectious complications. Previous reports confirm this shift in burden from graft failure and cardiovascular disease to infectious disease as a primary cause of hospitalization as well as death during the first year post‐transplantation . The increase in the burden of infectious complications may be related to the concurrent use of more potent immunosuppressive agents early post‐transplantation along with more aggressive maintenance immunosuppressive strategies to prevent acute graft dysfunction .…”

Section: Discussionmentioning

confidence: 75%

Clinical and microbiological epidemiology of early and late infectious complications among solid-organ transplant recipients requiring hospitalization

et al. 2016

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SUMMARYThere is limited literature describing the clinical and microbiological characteristics of solid-organ transplant recipients requiring hospitalization for infectious complications. This study reports on the rate and timing of these syndromes and describes the associated microbiological epidemiology. This prevalence cohort study evaluated solid-organ transplant recipients requiring hospitalization during 2007-2011. We reported infectious complications requiring hospitalization in 603 of 1414 readmissions at a rate of 0.43 episodes per 1000 transplant-days (95% CI, 0.40-0.47), with 85% occurring >6 months post-transplantation. The most frequent infectious complications were as follows: respiratory (27%), sepsis or bacteremia (13%), liver or biliary tract (12%), genitourinary (12%), and cytomegalovirus related (9%). Approximately 53% presented without fever, 45% had no pathogen isolated, and multidrug-resistant organisms were isolated in 27% of those with an identified microbiological etiology. Infectious-related complications continue to pose a high clinical burden on our acute care center, with the majority occurring in the late transplant period. Clinicians are faced with the difficult task of prescribing adequate antimicrobial therapy.

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Section: Discussionmentioning

confidence: 75%

Clinical and microbiological epidemiology of early and late infectious complications among solid-organ transplant recipients requiring hospitalization

et al. 2016

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“…BKPyV-associated disease is a major problem in the care of kidney transplant recipients for whom no antiviral treatment is available (1,2,10,32). Because timely reduction of immunosuppression is the only effective treatment to date (11,12), all recipients are currently screened for BKPyV viremia on a regular basis after transplantation (10)(11)(12)16).…”

Section: Discussionmentioning

confidence: 99%

Pretransplantation Donor–Recipient Pair Seroreactivity Against BK Polyomavirus Predicts Viremia and Nephropathy After Kidney Transplantation

Wunderink

Meijden

Brouwer

et al. 2017

American Journal of Transplantation

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Kidney transplant donors are not currently implicated in predicting BK polyomavirus (BKPyV) infection in kidney transplant recipients. It has been postulated, however, that BKPyV infection originates from the kidney allograft. Because BKPyV seroreactivity correlates with BKPyV replication and thus might mirror the infectious load, we investigated whether BKPyV seroreactivity of the donor predicts viremia and BKPyV‐associated nephropathy (BKPyVAN) in the recipient. In a retrospective cohort of 407 living kidney donor–recipient pairs, pretransplantation donor and recipient sera were tested for BKPyV IgG levels and correlated with the occurrence of recipient BKPyV viremia and BKPyVAN within 1 year after transplantation. Donor BKPyV IgG level was strongly associated with BKPyV viremia and BKPyVAN (p < 0.001), whereas recipient BKPyV seroreactivity showed a nonsignificant inverse trend. Pairing of high–BKPyV‐seroreactive donors with low‐seroreactive recipients resulted in a 10‐fold increased risk of BKPyV viremia (hazard ratio 10.1, 95% CI 3.5–29.0, p < 0.001). In multivariate analysis, donor BKPyV seroreactivity was the strongest pretransplantation factor associated with viremia (p < 0.001) and BKPyVAN (p = 0.007). The proportional relationship between donor BKPyV seroreactivity and recipient infection suggests that donor BKPyV seroreactivity reflects the infectious load of the kidney allograft and calls for the use of pretransplantation BKPyV serological testing of (potential) donors and recipients.

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“…If the number of cases of malakoplakia really has decreased, there is no clear explanation for this. Although the overall risk of opportunistic infections is higher when tacrolimus and mycophenolate are used , data in the literature suggest that azathioprine plays a specific role in the pathogenesis of this disease. Streem was the first to suggest this, after having reviewed all cases of malakoplakia in kidney transplant recipients and perceiving that the maintenance of azathioprine was associated with a worse prognosis.…”

Section: Discussionmentioning

confidence: 99%

Malakoplakia after renal transplantation in the current era of immunosuppressive therapy: case report and literature review

Leão

Duarte

Gamba

et al. 2012

Transplant Infectious Dis

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Malakoplakia is a rare chronic granulomatous disease of unknown cause. It is thought to be caused by an acquired bactericidal defect of macrophages. Malakoplakia is associated with chronic infections and immunosuppression. Although it occurs mainly in the urinary tract, it has already been reported in almost every organ system. The isolation of bacteria, especially Escherichia coli, is common in malakoplakia patients. Here, we present a case of primary cutaneous malakoplakia in a kidney transplant recipient who had been taking prednisone, tacrolimus, and mycophenolate. Culture of a lesion grew Burkholderia cepacia complex. Treatment with high doses of trimethoprim-sulfamethoxazole was successful. We also present a systematic review of the literature, identifying 4 previously reported cases of malakoplakia after renal transplantation under similar immunosuppressive therapy, most occurring in the urinary tract or perineum and following benign courses to cure. Data in the literature suggest that malakoplakia has become even rarer since changes were made in the immunosuppressive therapy employed after kidney transplantation.

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Increasing Trend in Infection-Related Death-Censored Graft Failure in Renal Transplantation

Abstract: Infection is increasingly contributing to DCGF in recent years and warrant reevaluation of current immunosuppression protocols, especially in older recipients.

Cited by 32 publications

References 29 publications

Clinical and microbiological epidemiology of early and late infectious complications among solid-organ transplant recipients requiring hospitalization

Clinical and microbiological epidemiology of early and late infectious complications among solid-organ transplant recipients requiring hospitalization

Pretransplantation Donor–Recipient Pair Seroreactivity Against BK Polyomavirus Predicts Viremia and Nephropathy After Kidney Transplantation

Malakoplakia after renal transplantation in the current era of immunosuppressive therapy: case report and literature review

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