Infectious disease risks in pediatric renal transplantation

Abstract

Renal transplantation is a vital treatment option in children with ESRD with more than 10,000 pediatric kidney transplants and survival rates of greater than 80% at 10 years post-transplant in the USA alone. Despite these advances, infection remains a significant cause of morbidity in pediatric recipients. Screening potential organ donors and recipients is imperative to identify and mitigate infectious risks in the transplant patient. Despite the unique risks of each patient, the timing of many infections post-transplant is predictable. In early post-transplant infections (within 30 days), bacterial and fungal pathogens predominate with donor-derived events and nosocomial infections. In the intermediate period (31-180 days after transplant), latent infections from donor organs, such as EBV and CMV, develop. Late infections occurring > 180 days after the transplant can be due to latent pathogens or community-acquired organisms. Approaching an infectious evaluation in a pediatric kidney recipient requires finesse to diagnose and treat this vulnerable population in a timely manner. The following article highlights the most relevant and common infections including clinical manifestations, risk factors, diagnostic techniques, and treatment options.

Outcome of a thorough screening of lower urinary tract function in all pediatric kidney recipients

“…There is no consensus on the effect of UTI on pediatric graft function and survival. Some studies report that there is no deleterious effect of UTIs on graft function, 39,40 whereas others do show a greater risk of graft loss, especially for UTIs early after transplantation and those accompanied by fever 30,40‐42 …”

Approach to acute kidney injury following paediatric kidney transplant

“…In the year immediately following transplant, the risk of UTI is especially high, likely due to indwelling catheters and ureteral stents in the peritransplant period and higher levels of immune suppression. [32][33][34][35][36].…”

Antibody‐mediated rejection after kidney transplantation in children; therapy challenges and future potential treatments

“…The lower exposure to viral infection, with a lower rate of CMV and EBV seropositivity, increases the risks associated with a primo‐infection and the risk of presenting post‐transplant lymphoproliferative disease (PTLD). At the same time, one‐third of children have a positive BK bacteriuria, 14 and the increased immunosuppression used in AMR could increase the risk of BK nephropathy 15 …”

“…At the same time, one‐third of children have a positive BK bacteriuria, 14 and the increased immunosuppression used in AMR could increase the risk of BK nephropathy. 15 …”