COMPLICATIONS - INFECTIONS

S. Sural, S.K. Bhattacharya, C.S. Panja
Nephrology, PEERLESS HOSPITAL&B K ROY RESEARCH CENTER, KOLKATA/INDIA

Body: INTRODUCTION – The prevalence of pulmonary infections in kidney transplant recipients continues to be high and varies from country to country. The infections are usually bacterial in origin during the first month after transplant whereas beyond one month they are often due to non bacterial pathogens. The causes seem to be changing in part because of the prophylactic strategies used. Most of these pulmonary infection episodes require hospitalization and remain a leading cause of mortality and morbidity. The aim of this study was to evaluate the etiological spectrum and outcome of severe pulmonary infections requiring hospitalization beyond one month after live related kidney transplant on the current immunosuppressive protocols. PATIENTS AND METHODS – The study group comprised of 208 patients who received a live related allograft between January 2005 to May 2009, and had a minimum follow up of six months. Sixty seven received Tacrolimus , Azathioprine + Prednisolone, 72 received Tacrolimus, MMF + Prednisolone, 45 received Cyclosporine ,MMF + Prednisolone, 24 received Cyclosporine, Azathioprine + Prednisolone. The clinical data was prospectively collected at the time of infection episodes. It included the date of transplant, physical findings, age, immunosuppressive therapy, prophylactic antiviral and antifungal treatment, hematology, renal function, sputum culture with stain, blood culture, chest skiagrams and serology testings. CT scan, fibreoptic bronchoscopy, bronchoalveolar culture, and percutaneous transthoracic procedures were done whenever necessary. The frequency of pulmonary infections in patients who received Azathioprine vs. those who received MMF was compared. RESULTS- The mean age was 45.7 ± 13.8 years and there were 152 males and 56 females. Of 208 recipients 24 patients were admitted with one or more episodes (total – 31 episodes) of pulmonary infections beyond one month after kidney transplant. Bacterial infection was the commonest (13/31,41.9%) followed by fungal(5/31,16.1%), mycobacterium tuberculosis (4/31, 12.9% ), mixed infection ( 3/31,9.7% ) , Cytomegalovirus ( 2/31, 6.5% ) . In 4 patients pathogenic organisms could not be identified. Twenty four (77.4%) of the infectious episodes occurred between1 to 6 months after transplant. Of the pathogenic bacteria 9 (69.2 %) were gram negative. Among the fungal infections Aspergillus species was commonest followed by Candida species. Four patients died. Among the non survivors 1 suffered from fungal infection and 3 had bacterimia leading to multi organ failure. The frequency of pulmonary infection was similar in patients who received MMF (13/117, 11.1%) as compared to those who were on Azathioprine (11/91, 12.1%) based maintenance protocol. CONCLUSION – Pulmonary infection remains one of the most common and dangerous infections in kidney transplant recipients. Bacterial infection continues to be the commonest infection beyond one month after kidney transplant. This is followed by fungal infection and tubercular infection in our setup. With proper prophylactic therapy and optimum use of newer immunosuppressants the morbidity and mortality from pulmonary infection can be reduced.

Disclosure: All authors have declared no conflicts of interest.