Infectious complications after kidney transplantation: current epidemiology and associated risk factors

Clin Transplant. Jul-Aug 2006;20(4):401-9. doi: 10.1111/j.1399-0012.2006.00519.x.

Abstract

Background: The impact of newer immunosuppressive and antimicrobial prophylactic agents on the pattern of infectious complications following kidney transplantation has not been well studied.

Methods: This is an observational study in 127 adult recipients transplanted from 2001 to 2004. Patients received thymoglobulin (ATG) (50%) or basiliximab (50%) for induction and were maintained on mycophenolate mofetil, either tacrolimus (73%) or sirolimus (SRL) (27%), and prednisone (79%). Antimicrobial prophylaxis included perioperative cefazolin, trimethoprim/sulfamethaxazole for six months, valganciclovir for three months and nystatin for two months. Regression models were used to examine the association of various factors with infections.

Results: We observed 127 infections in 65 patients, consisting of urinary tract infection (UTI) (47%), viral infections (17%), pneumonia (8%) and surgical wound infections (7%). UTI was the most common infection in all post-transplant periods. Enterococcus spp. (33%) and Escherichia coli (21%) were the most prevalent uropathogens. Of six patients with cytomegalovirus infection, none had tissue-invasive disease. There were no cases of pneumocystis pneumonia or BK nephropathy. Six patients developed fungal infections. Two deaths due to disseminated Rhizopus and Candida albicans accounted for a 1.5% infection-related mortality. Retransplantation and ureteral stents were independently associated with UTI (OR=4.5 and 2.9, p=0.06 and 0.03, respectively), as were ATG and SRL with bacterial infections (OR=3.3 and 2.5, p=0.009 and 0.047, respectively).

Conclusion: This study suggests that the use of newer immunosuppressive agents in recent years is associated with some changes in the epidemiology of post-transplant infections. Enterococci have become the predominant uropathogen. Invasive fungal infections, although rare, are often fatal.

MeSH terms

  • Adult
  • Antibodies, Monoclonal / therapeutic use
  • Basiliximab
  • Female
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use
  • Immunosuppressive Agents / therapeutic use
  • Infections / epidemiology*
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / immunology
  • Kidney Transplantation / statistics & numerical data
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology*
  • Radiography, Thoracic
  • Recombinant Fusion Proteins / therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Surgical Wound Infection / epidemiology
  • Tissue Donors / statistics & numerical data
  • Urinary Tract Infections / epidemiology

Substances

  • Antibodies, Monoclonal
  • Immunoglobulins, Intravenous
  • Immunosuppressive Agents
  • Recombinant Fusion Proteins
  • Basiliximab