Management of Pulmonary Infections in Kidney Transplant Patients

Abstract

Kidney transplantation is a cost-effective alternative for the treatment of end-stage renal disease, with clear survival and quality of life benefits. Infection is an important drawback in kidney transplantation and is second only to cardiovascular disease as a cause of death. Pulmonary infections occur in 8%-16% of all kidney transplant patients, with mortality ranging from 12%-16% in more recent studies. Bacteria as a group, Cytomegalovirus, Pneumocystis carinii, Legionella, and fungi, are the main agents. Although noninvasive methods are recommended for etiologic diagnosis, bronchoscopy or open lung biopsy is mandatory in the great majority of the cases. Both transbronchial biopsy and open lung biopsy provide more information about the etiologic agent compared with bronchoalveolar lavage alone, and open lung biopsy has a higher diagnostic yield, although it may be associated with more frequent and serious adverse events. Broad-spectrum empiric antimicrobial therapy should be instituted at the same time as an invasive diagnostic method is performed and treatment adjusted according to subsequent results. Empiric antimicrobial treatment and the invasive diagnostic method should be selected according to the severity of respiratory impairment, time of onset of disease after transplantation, the radiologic pattern, and specific epidemiological factors.

Evaluation of Infectious Complications in the First Year After Kidney Transplantation

“…The incidence of pulmonary infections in our study were similar to other recent reports [11,16,17]. Surgical wound infection and intraabdominal infection incidence were low, which likely is the result of improvement in surgical technique, good management of the wound, and prophylactic antibiotics.…”

Infectious complications after kidney transplantation: a single‐center experience

“…Pulmonary infection occurs in 4.5^16% of all kidney recipients (2,17,19,29). The main causative agents are Streptococcus pneumonia, P. aeruginosa, Staphylococci, Pneumocystis jiroveci, Legionella, M. tuberculosis, CMV, and fungi (1,2,29).…”

“…Pulmonary infection occurs in 4.5^16% of all kidney recipients (2,17,19,29). The main causative agents are Streptococcus pneumonia, P. aeruginosa, Staphylococci, Pneumocystis jiroveci, Legionella, M. tuberculosis, CMV, and fungi (1,2,29). P. jiroveci, with an infectious rate of 1.61 1.5%, is an extracellular pathogen that causes infection in kidney transplant recipients by reactivation and direct person-to-person transmission (1,13,29).…”

The diagnostic yield and complications of open lung biopsies in kidney transplant patients with pulmonary disease

“…Moreover, the diagnostic yield of flexible bronchoscopy may be lowest in critically ill patients, in exams performed late in the course of pulmonary infiltrates assessment and after initiation of antimicrobial therapy (47). There is a general belief that OLB should be the preferred method for lung biopsy in kidney transplant recipients with severe respiratory impairment (54). Actually, the likelihood that a procedure provides the information needed to establish a diagnosis probably depends on the diagnostic workup used by pathologists and microbiologists rather than on the methods used to obtain the tissue sample (54).…”

“…There is a general belief that OLB should be the preferred method for lung biopsy in kidney transplant recipients with severe respiratory impairment (54). Actually, the likelihood that a procedure provides the information needed to establish a diagnosis probably depends on the diagnostic workup used by pathologists and microbiologists rather than on the methods used to obtain the tissue sample (54).…”