Infective complications in the renal transplant recipients

Giuseppina Rosso; Maurizio Salvadori

doi:10.33393/gcnd.2024.3017

Authors

Giuseppina Rosso Azienda Usl Toscana Centro, S.O.C. Nefrologia e Dialisi, Firenze I ed Empoli, Nuovo Ospedale San Giovanni di Dio, Firenze – Italy https://orcid.org/0009-0005-1014-9866
Maurizio Salvadori Professore di Nefrologia già Direttore Nefrologia e Trapianto, Azienda Ospedaliera Careggi, Firenze - Italy

DOI:

https://doi.org/10.33393/gcnd.2024.3017

Keywords:

Cytomegalovirus, Infection, Kidney transplantation, Polyomavirus, Recurrent/relapsing urinary tract infections

Abstract

Infections remain a common complication of solid-organ transplantation and are a major factor of morbidity and mortality in renal transplant recipients.

The incidence of infection in renal transplant patients is directly related to the net immunosuppressive effect achieved and the duration of the administration of immunosuppressive therapy.

The major types of infections can be categorized according to the time post-transplant during which they occur: in the first month after transplantation post-surgical bacterial infections and in the period from one to four months post-transplant opportunistic infections, overall cytomegalovirus; late infections, beyond 6-12 months, are community-acquired infections.

Opportunistic infections (like Pneumocystis carini, Listeria monocytogenes, and Aspergillus fumigatus) most frequently occur in the first 12 months post-transplant and can be modulated by prior exposures and the use of prophylaxis.

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References

Avery RK. Infectious disease following kidney transplant: core curriculum 2010. Am J Kidney Dis. 2010;55(4):755-771. https://doi.org/10.1053/j.ajkd.2009.12.029 PMID:20338466 DOI: https://doi.org/10.1053/j.ajkd.2009.12.029

Bige N, Zafrani L, Lambert J, et al. Severe infections requiring intensive care unit admission in kidney transplant recipients: impact on graft outcome. Transpl Infect Dis. 2014;16(4):588-596. https://doi.org/10.1111/tid.12249 PMID:24966154 DOI: https://doi.org/10.1111/tid.12249

Shen T-C, Wang I-K, Wei C-C, et al. The risk of septicemia in end-stage renal disease with and without renal transplantation: a propensity-matched cohort study. Medicine (Baltimore). 2015;94(34):e1437. https://doi.org/10.1097/MD.0000000000001437 PMID:26313801 DOI: https://doi.org/10.1097/MD.0000000000001437

Dharnidharka VR, Agodoa LY, Abbott KC. Risk factors for hospitalization for bacterial or viral infection in renal transplant recipients--an analysis of USRDS data. Am J Transplant. 2007;7(3):653-661. https://doi.org/10.1111/j.1600-6143.2006.01674.x PMID:17250559 DOI: https://doi.org/10.1111/j.1600-6143.2006.01674.x

Fishman JA, Rubin RH. Infection in organ-transplant recipients. N Engl J Med. 1998;338(24):1741-1751. https://doi.org/10.1056/NEJM199806113382407 PMID:9624195 DOI: https://doi.org/10.1056/NEJM199806113382407

Dorschner P, McElroy LM, Ison MG. Nosocomial infections within the first month of solid organ transplantation. Transpl Infect Dis. 2014;16(2):171-187. https://doi.org/10.1111/tid.12203 PMID:24661423 DOI: https://doi.org/10.1111/tid.12203

Kaul DR, Vece G, Blumberg E, et al. Ten years of donor-derived disease: A report of the disease transmission advisory committee. [published online ahead of print July 5, 2020]. Am J Transplant. 2021;21(2):689-702. https://doi.org/10.1111/ajt.16178 PMID:32627325 DOI: https://doi.org/10.1111/ajt.16178

Wolfe CR, Ison MG; AST Infectious Diseases Community of Practice. Donor-derived infections: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13547. https://doi.org/10.1111/ctr.13547 PMID:30903670 DOI: https://doi.org/10.1111/ctr.13547

Miller R, Covington S, Taranto S, et al. Communication gaps associated with donor-derived infections. Am J Transplant. 2015;15(1):259-264. https://doi.org/10.1111/ajt.12978 PMID:25376342 DOI: https://doi.org/10.1111/ajt.12978

van Delden C, Stampf S, Hirsch HH, et al; Swiss Transplant Cohort Study. Swiss Transplant Cohort Study : burden and timeline of infectious diseases in the first year after solid organ transplantation in the Swiss transplant cohort study. Clin Infect Dis. 2020;71(7):e159-e169. https://doi.org/10.1093/cid/ciz1113 PMID:31915816 DOI: https://doi.org/10.1093/cid/ciz1113

Fishman JA, Gans H; AST Infectious Diseases Community of Practice. Pneumocystis jiroveci in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13587. https://doi.org/10.1111/ctr.13587 PMID:31077616 DOI: https://doi.org/10.1111/ctr.13587

Sise ME, Goldberg DS, Kort JJ, et al. Multicenter Study to Transplant Hepatitis C-Infected Kidneys (MYTHIC): an open-label study of combined glecaprevir and pibrentasvir to treat recipients of transplanted kidneys from deceased donors with hepatitis C virus infection. J Am Soc Nephrol. 2020;31(11):2678-2687. https://doi.org/10.1681/ASN.2020050686 PMID:32843477 DOI: https://doi.org/10.1681/ASN.2020050686

Te H, Doucette K. Viral hepatitis: Guidelines by the American Society of Transplantation Infectious Disease Community of Practice. Clin Transplant. 2019;33(9):e13514. https://doi.org/10.1111/ctr.13514 PMID:30817047 DOI: https://doi.org/10.1111/ctr.13514

Ison MG, Hirsch HH. Community-acquired respiratory viruses in transplant patients: Diversity, impact, unmet clinical needs. Clin Microbiol Rev. 2019;32(4):e00042-e19. https://doi.org/10.1128/CMR.00042-19 PMID:31511250 DOI: https://doi.org/10.1128/CMR.00042-19

Le J, Durand CM, Agha I, Brennan DC. Epstein-Barr virus and renal transplantation. Transplant Rev (Orlando). 2017;31(1):55-60. PubMed. Google Scholar. https://doi.org/10.1016/j.trre.2016.12.001 PMID:28089555 DOI: https://doi.org/10.1016/j.trre.2016.12.001

Allen UD, Preiksaitis JK. American Society of Transplantation Infectious Diseases Community of Practice : Post-transplant lymphoproliferative disorders, Epstein-Barr virus infection, and disease in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Disease Community of Practice. Clin Transplant. 2019;33:e13652. https://doi.org/10.1111/ctr.13652 PMID:31230381 DOI: https://doi.org/10.1111/ctr.13652

Kasiske BL, Zeier MG, Chapman JR, et al; Kidney Disease: Improving Global Outcomes. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney Int. 2010;77(4):299-311. https://doi.org/10.1038/ki.2009.377 PMID:19847156 DOI: https://doi.org/10.1038/ki.2009.377

Burns DM, Crawford DH. Epstein-Barr virus-specific cytotoxic T-lymphocytes for adoptive immunotherapy of post-transplant lymphoproliferative disease. Blood Rev. 2004;18(3):193-209. https://doi.org/10.1016/j.blre.2003.12.002 PMID:15183903 DOI: https://doi.org/10.1016/j.blre.2003.12.002

Kotton CN, Kumar D, Caliendo AM, et al; The Transplantation Society International CMV Consensus Group. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2018;102(6):900-931. https://doi.org/10.1097/TP.0000000000002191 PMID:29596116 DOI: https://doi.org/10.1097/TP.0000000000002191

Razonable RR, Humar A. Cytomegalovirus in solid organ transplant recipients-Guidelines of the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13512. https://doi.org/10.1111/ctr.13512 PMID:30817026 DOI: https://doi.org/10.1111/ctr.13512

Karadkhele G, Hogan J, Magua W, et al. CMV high-risk status and posttransplant outcomes in kidney transplant recipients treated with belatacept. Am J Transplant. 2021;21(1):208-221. https://doi.org/10.1111/ajt.16132 PMID:32519434 DOI: https://doi.org/10.1111/ajt.16132

Humar A, Lebranchu Y, Vincenti F, et al. The efficacy and safety of 200 days valganciclovir cytomegalovirus prophylaxis in high-risk kidney transplant recipients. Am J Transplant. 2010;10(5):1228-1237. https://doi.org/10.1111/j.1600-6143.2010.03074.x PMID:20353469 DOI: https://doi.org/10.1111/j.1600-6143.2010.03074.x

Santos CA, Brennan DC, Fraser VJ, Olsen MA. Delayed-onset cytomegalovirus disease coded during hospital readmission after kidney transplantation. Transplantation. 2014;98(2):187-194. https://doi.org/10.1097/TP.0000000000000030 PMID:24621539 DOI: https://doi.org/10.1097/TP.0000000000000030

Kean JM, Rao S, Wang M, Garcea RL. Seroepidemiology of human polyomaviruses. PLoS Pathog. 2009;5(3):e1000363. https://doi.org/10.1371/journal.ppat.1000363 PMID:19325891 DOI: https://doi.org/10.1371/journal.ppat.1000363

Mallat SG, Tanios BY, Itani HS, et al. CMV and BKPyV infections in renal transplant recipients receiving an mTOR inhibitor-based regimen versus a CNI-based regimen: A systematic review and meta-analysis of randomized, controlled trials. Clin J Am Soc Nephrol. 2017;12(8):1321-1336. https://doi.org/10.2215/CJN.13221216 PMID:28576905 DOI: https://doi.org/10.2215/CJN.13221216

Schaub S, Hirsch HH, Dickenmann M, et al. Reducing immunosuppression preserves allograft function in presumptive and definitive polyomavirus-associated nephropathy. Am J Transplant. 2010;10(12):2615-2623. https://doi.org/10.1111/j.1600-6143.2010.03310.x PMID:21114642 DOI: https://doi.org/10.1111/j.1600-6143.2010.03310.x

Johnston O, Jaswal D, Gill JS, Doucette S, Fergusson DA, Knoll GA. Treatment of polyomavirus infection in kidney transplant recipients: a systematic review. Transplantation. 2010;89(9):1057-1070. https://doi.org/10.1097/TP.0b013e3181d0e15e PMID:20090569 DOI: https://doi.org/10.1097/TP.0b013e3181d0e15e

Geetha D, Sozio SM, Ghanta M, et al. Results of repeat renal transplantation after graft loss from BK virus nephropathy. Transplantation. 2011;92(7):781-786. https://doi.org/10.1097/TP.0b013e31822d08c1 PMID:21836535 DOI: https://doi.org/10.1097/TP.0b013e31822d08c1

Hollyer I, Ison MG. The challenge of urinary tract infections in renal transplant recipients. Transpl Infect Dis. 2018;20(2):e12828. https://doi.org/10.1111/tid.12828 PMID:29272071 DOI: https://doi.org/10.1111/tid.12828

Senger SS, Arslan H, Azap OK, Timurkaynak F, Cağir U, Haberal M. Urinary tract infections in renal transplant recipients. Transplant Proc. 2007;39(4):1016-1017. https://doi.org/10.1016/j.transproceed.2007.02.060 PMID:17524879 DOI: https://doi.org/10.1016/j.transproceed.2007.02.060

Säemann M, Hörl WH. Urinary tract infection in renal transplant recipients. Eur J Clin Invest. 2008;38(s2)(suppl 2):58-65. https://doi.org/10.1111/j.1365-2362.2008.02014.x PMID:18826483 DOI: https://doi.org/10.1111/j.1365-2362.2008.02014.x

Goldman JD, Julian K. Urinary tract infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13507. https://doi.org/10.1111/ctr.13507 PMID:30793386 DOI: https://doi.org/10.1111/ctr.13507

Memikoğlu KO, Keven K, Sengül S, Soypaçaci Z, Ertürk S, Erbay B. Urinary tract infections following renal transplantation: a single-center experience. Transplant Proc. 2007;39(10):3131-3134. https://doi.org/10.1016/j.transproceed.2007.10.005 PMID:18089338 DOI: https://doi.org/10.1016/j.transproceed.2007.10.005

Gyssens IC. Antibiotic policy. Int J Antimicrob Agents. 2011;38(suppl):11-20. https://doi.org/10.1016/j.ijantimicag.2011.09.002 PMID:22018989 DOI: https://doi.org/10.1016/j.ijantimicag.2011.09.002

Tamma PD, Cosgrove SE. Antimicrobial stewardship. Infect Dis Clin North Am. 2011;25(1):245-260. https://doi.org/10.1016/j.idc.2010.11.011 PMID:21316003 DOI: https://doi.org/10.1016/j.idc.2010.11.011

Baccarani U, Risaliti A, Adani GL, et al. Arterial rupture as the result of fungal arteritis after renal transplantation. Transplantation. 2003;76(1):266-269. https://doi.org/10.1097/01.TP.0000071951.60122.5F PMID:12865825 DOI: https://doi.org/10.1097/01.TP.0000071951.60122.5F

Laouad I, Buchler M, Noel C, et al. Renal artery aneurysm secondary to Candida albicans in four kidney allograft recipients. Transplant Proc. 2005;37(6):2834-2836. https://doi.org/10.1016/j.transproceed.2005.05.017 PMID:16182825 DOI: https://doi.org/10.1016/j.transproceed.2005.05.017

Revankar SG, Hasan MS, Revankar VS, Sobel JD. Long-term follow-up of patients with candiduria. Eur J Clin Microbiol Infect Dis. 2011;30(2):137-140. https://doi.org/10.1007/s10096-010-1061-5 PMID:20857164 DOI: https://doi.org/10.1007/s10096-010-1061-5