Acute infections in kidney transplant recipients
Authors:
Zdeněk Lys 1,3; Klára Dombrovská 1; Jarmila Dědochová 1; Petra Kovářová 2; Ivo Valkovský 1,3; Jan Václavík 1,3
Authors‘ workplace:
Interní a kardiologická klinika, FN Ostrava
1; Krevní centrum, FN Ostrava
2; Lékařská fakulta, Ostravská univerzita
3
Published in:
Vnitř Lék 2022; 68(E-3): 12-17
Category:
Review Articles
Overview
Immunosuppressed kidney transplant recipients have a high risk of infectious complications. A variety of infections of viral, bacterial, or mycotic etiology, including opportunistic infections, occur in this group of patients, but bacterial infections are primarily responsible for the high infection-related mortality. Of the bacterial infections, urinary tract infections and pneumonia are the most common, often requiring hospitalization and temporary reduction of immunosuppressive therapy after consultation of the transplant center. In addition to symptoms due to the location of the infection, fever is often present. The differential diagnosis of fever and/or high inflammatory activity is specific to patients after kidney transplantation. In addition to infectious causes, we consider drug-related fever, a rejection episode, a relapse of systemic disease or in patients with graft failure in dialysis treatment graft intolerance syndrome (“symptomatic graft”). Saving the patient’s life, which often requires a significant reduction in immunosuppressive therapy, always takes precedence over preventing a rejection episode. Infection prevention is an integral part of the care of transplant patients, including the recommendation of vaccination where possible.
Keywords:
kidney transplantation – immunosuppression – antibiotics – rejection – acute infection
Sources
1. Obert R, Olfe AW, Alarie V et al. Comparison of Mortality in All Patients on Dialysis, Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric Transplant. http://dx.doi.org/101056/NEJM199912023412303 [Internet]. 2008 Oct 21 [cited 2021 Dec 12];341(23):1725–30. Available from: https://www.nejm.org/doi/full/10.1056/ nejm199912023412303
2. Kostro JZ, Hellmann A, Kobiela J et al. Quality of Life After Kidney Transplantation: A Prospective Study. Transplant Proc. 2016 Jan 1;48(1):50–4.
3. Statistiky | Koordinační středisko transplantací (KST) [Internet]. [cited 2021 Dec 12]. Available from: https://kst.cz/statistiky/
4. Wohlfahrtová M, Ondřej Viklický LR. Transplantace orgánů v klinické praxi. 1. Praha: Grada Publishing, a. s.; 2021. 416 p. ISBN 978-80-271-0721-6.
5. Jackson KR, Motter JD, Bae S et al. Characterizing the landscape and impact of infections following kidney transplantation. Am J Transplant. 2021 Jan 1;21(1):198–207.
6. Awan AA, Niu J, Pan JS et al. Trends in the Causes of Death among Kidney Transplant Recipients in the United States (1996-2014) Keywords Kidney transplant · Cause‑specific death · Cardiovascular disease · Malignancy. Am J Nephrol [Internet]. 2018 [cited 2021 Dec 12];48:472–81. Available from: www.karger.com/ajn
7. Ying T, Shi B, Kelly PJ et al. Death after kidney transplantation: An analysis by era and time post‑transplant. J Am Soc Nephrol [Internet]. 2020 Dec 1 [cited 2021 Dec 12];31(12):2887– 99. Available from: https://jasn.asnjournals.org/content/31/12/2887
8. Au EH, Chapman JR, Craig JC et al. Overall and site‑specific cancer mortality in patients on dialysis and after kidney transplant. J Am Soc Nephrol [Internet]. 2019 Mar 1 [cited 2021 Dec 12];30(3):471–80. Available from: https://jasn.asnjournals.org/content/30/3/471
9. Kinnunen S, Karhapää P, Juutilainen A et al. Secular trends in infection‑related mortality after kidney transplantation. Clin J Am Soc Nephrol [Internet]. 2018 May 7 [cited 2021 Dec 12];13(5):755–62. Available from: https://cjasn.asnjournals.org/content/13/5/755
10. Fishman JA, Fishman JA. Infection in Organ Transplantation. Am J Transplant. 2017;17(4):856-879. doi:10.1111/AJT.14208
11. Kalil AC, Opal SM. Sepsis in the Severely Immunocompromised Patient. CurrInfect Dis Rep 17, 32 (2015). Available from: https://doi.org/10.1007/s11908-015-0487-4
12. Lubetzky M, Tantisattamo E, Molnar MZ et al. The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients. Vol. 21, American Journal of Transplantation. John Wiley and Sons Inc; 2021. p. 2937–49.
13. Sawyer RG, Crabtree TD, Gleason TG et al. Impact of solid organ transplantation and immunosuppression on fever, leukocytosis, and physiologic response during bacterial and fungal infections. Clin Transplant [Internet]. 1999 Mar 1 [cited 2021 Dec 12];13(3):260–5. Available from: https://onlinelibrary.wiley.com/doi/full/10.1034/j.1399-0012.1999.130307.x
14. Chertow GM, Burdick E, Honour M et al. Acute Kidney Injury, Mortality, Length of Stay, and Costs in Hospitalized Patients. J Am Soc Nephrol [Internet]. 2005 Nov 1 [cited 2021 Dec 13];16(11):3365–70. Available from: https://jasn.asnjournals.org/content/16/11/3365
15. Peeters P, Laecke S Van, Vanholder R. ACUTE KIDNEY INJURY IN SOLID ORGAN TRANSPLANT RECIPIENTS. http://dx.doi.org/101179/acb2007087 [Internet]. 2014 Jan [cited 2021 Dec 13];62(sup2):389–92. Available from: https://www.tandfonline.com/doi/ abs/10.1179/acb.2007.087
16. Moledina DG, Perazella MA. Drug‑ Induced Acute Interstitial Nephritis. Clin J Am Soc Nephrol [Internet]. 2017 Dec 7 [cited 2021 Dec 13];12(12):2046. Available from: /pmc/articles/ PMC5718279/
17. Bafi AT, Tomotani DYV, De Freitas FGR. Sepsis in solid‑organ transplant patients. Shock [Internet]. 2017 [cited 2021 Dec 12];47:12–6. Available from: https://journals.lww.com/ shockjournal/Fulltext/2017/01001/Sepsis_in_Solid_Organ_Transplant_Patients.4.aspx
18. Gupta RK. Opportunistic Infections in Renal Allograft Recipients. Transplant Proc. 2007 Apr 1;39(3):731–3.
19. Santos T, Aguiar B, Santos L et al. Invasive Fungal Infections After Kidney Transplantation: A Single‑ center Experience. Transplant Proc. 2015 May 1;47(4):971–5.
20. Infante B, Rossini M, Leo S et al. Molecular Sciences Recurrent Glomerulonephritis after Renal Transplantation: The Clinical Problem. [cited 2021 Dec 13]; Available from: www. mdpi.com/journal/ijms
21. Al‑Adra D, Al‑Qaoud T, Fowler K et al. De Novo Malignancies after Kidney Transplantation. Clin J Am Soc Nephrol [Internet]. 2021 Mar 29 [cited 2021 Dec 13];17:CJN.14570920. Available from: https://cjasn.asnjournals.org/content/early/2021/02/17/CJN.14570920
22. Terasaki PI, Ozawa M. Predicting Kidney Graft Failure by HLA Antibodies: a Prospective Trial. Am J Transplant [Internet]. 2004 Mar 1 [cited 2021 Dec 12];4(3):438–43. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1600-6143.2004.00360.x
23. Yahav D, Sulimani O, Green H et al. Immunosuppression reduction in kidney transplant recipients during bacterial infection—A retrospective study. Clin Transplant [Internet]. 2019 Oct 1 [cited 2021 Dec 6];33(10):e13707. Available from: https://onlinelibrary.wiley. com/doi/full/10.1111/ctr.13707
24. Säemann M, Hörl WH. Urinary tract infection in renal transplant recipients. Eur J Clin Invest [Internet]. 2008 Oct [cited 2021 Dec 6];38(SUPPL.2):58–65. Available from: https:// onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2362.2008.02014.x
25. Singh R, Geerlings SE, Peters‑Sengers H et al. Incidence, risk factors, and the impact of allograft pyelonephritis on renal allograft function. Transpl Infect Dis [Internet]. 2016 Oct 1 [cited 2021 Dec 6];18(5):647–60. Available from: https://onlinelibrary.wiley.com/doi/ full/10.1111/tid.12568
26. Maanaoui M, Baes D, Hamroun A et al. Association between acute graft pyelonephritis and kidney graft survival: A single‑ center observational study. Am J Transplant [Internet]. 2021 Nov 1 [cited 2021 Dec 6];21(11):3640–8. Available from: https://onlinelibrary.wiley. com/doi/full/10.1111/ajt.16703
27. Korth J, Kukalla J, Rath P‑M et al. Increased resistance of gram‑negative urinary pathogens after kidney transplantation. BMC Nephrol 18, 164 (2017). https://doi.org/10.1186/ s12882-017-0580-z
28. Lee JR, Bang H, Dadhania D et al. Independent risk factors for urinary tract infection and for subsequent bacteremia or acute cellular rejection: A single‑center report of 1166 kidney allograft recipients. Transplantation [Internet]. 2013 Oct 27 [cited 2021 Dec 6];96(8):732–8. Available from: https://journals.lww.com/transplantjournal/Fulltext/2013/10270/Independent_ Risk_Factors_for_Urinary_Tract.9.aspx
29. Kara S, Sen N, Kursun E et al. Pneumonia in renal transplant recipients: A single‑ center study. Exp Clin Transplant. 2018 Mar 1;16:122–5.
30. Guidelines | Pneumologie [Internet]. [cited 2021 Dec 14]. Available from: http:// www.pneumologie.cz/guidelines/?potvrzeni1=1 & potvrzeni2=1 & potvrdit=ANO% 0D%0 A%0D%0A++++Vstoupit#
31. Transplant Recipient – KDIGO [Internet]. [cited 2021 Dec 13]. Available from: https:// kdigo.org/guidelines/transplant‑recipient/
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
![Issue E-3](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/1f7e4297f6025ac1036632d34e048b2c.jpg)
2022 Issue E-3
Most read in this issue
- Adrenal incidentaloma
- Acute infections in kidney transplant recipients
- Detection, examination and therapy of sexual dysfunctions in patients with diabetes
- The mortality risk of patients hospitalized for ischemic stroke between 2003 and 2019