Evaluation of infections in patients with kidney and liver transplantation

Yıl 2023, Cilt: 9 Sayı: 5 - September 2023, 1093 - 1098, 04.09.2023

Sibel Doğan Kaya , Güliz Evik , Münire Deniz , Yeşim Uygun Kızmaz

https://doi.org/10.18621/eurj.1340605

Öz

Objectives: Infection is a frequent complication of organ transplantation and is associated with significant morbidity and mortality.

Methods: Patients who had liver and kidney transplants between 2011 and 2022, who were hospitalized in our hospital, and who were consulted for infectious diseases were retrospectively analyzed from hospital records.

Results: Of the patients included in the study, 9 (28%) were female, 23 (72%) were male, and the mean age was 33.7 ± 11.3 years. Patients had congestive heart failure (87.2%, n = 28, hypertension (43.7%, n = 14), and chronic obstructive pulmonary disease (21.8%, n = 7). Twenty (62.5%) kidney transplant recipients and 12 (37.5%) liver transplant recipients were seen within ten years. The most common infections were urinary tract infection in 8 ( 25%) patients and pneumonia in 11 (34.3%). The other infections were gastrointestinal infections such as diarrhoea, bloodstream infections and COVID-19 and Cytomegalovirus. Culture-isolated organisms in 20 (62.5%) of the 32 patients admitted with infections. The microbiological data were notable for some unusual and opportunistic pathogens, including one case of acute cytomegalovirus viremia. Severe sepsis had been seen in six (18.75%) out of 32 patients with documented infections.

Conclusions: Infection prevention has become a cornerstone of modern transplantation medicine due to the significant incidence of post-transplant infectious complications resulting from improved immunosuppressive therapies and surgical procedures.

Anahtar Kelimeler

Liver transplantation, renal transplantation, infectious disease, post-transplant infections

Kaynakça

• 1. T.C Sağlık Hizmetleri Genel Müdürlüğü Doku, Organ Nakli Ve Diyaliz Hizmetleri Dairesi Başkanlığı. https://shgmorgandb.saglik.gov.tr/
• 2. Levy PE, Khan SS, VanWagner LB. Cardiac evaluation of the kidney or liver transplant candidate. Curr Opin Organ Transplant 2021;26:77-84.
• 3. Torres Soto M, Kotton CN. Infectious disease complications of transplant tourism. Expert Rev Anti Infect Ther 2021;19:671-3.
• 4. Cippà PE, Schiesser M, Ekberg H, vanGelder T, Mueller NJ, Cao CA, et al. Risk stratification for rejection and infection after kidney transplantation. Clin J Am Soc Nephrol 2015;10:2213-20.
• 5. Seok H, Huh K, Cho SY, Kang CI, Chung DR, Huh WS, et al. Invasive fungal diseases in kidney transplant recipients: risk factors for mortality. J Clin Med 2020;9:1824.
• 6. Pappas PG, Alexander BD, Andes DR, Hadley S, Kauffman CA, Freifeld A, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis 2010;50:1101-11.
• 7. Fishman JA. Infection in organ transplantation. Am J Transplant 2017;17:856-79.
• 8. Katabathina V, Menias CO, Pickhardt P, Lubner M, Prasad SR. Complications of immunosuppressive therapy in solid organ transplantation. Radiol Clin North Am 2016;54:303-19.
• 9. Adem K. [Infection risks and frequent infections in solid organ transplanted patients]. İnönü Üniversitesi Sağlık Bilimleri Dergisi 2014;3:41-5. [Article in Turkish]
• 10. Abbott KC, Swanson SJ, Richter ER, Bohen EM, Agodoa LY, Peters TG, et al. Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis 2004;44:353-62.
• 11. Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med 2007;357:2601-14.
• 12. Abdo-Cuza AA, Gómez-Bravo MA, Pérez-Bernal JB, Suárez-López J, Gómez-Peire F, Leiva-Torres JL, et al. Health care-associated infection in solid organ transplant recipients. Transplant Proc 2020;52:509-11.
• 13. Parasuraman R, Julian K; AST Infectious Diseases Community of Practice. Urinary tract infections in solid organ transplantation. Am J Transplant 2013;13 Suppl 4:327-36.
• 14. Khatri B, Maharjan S, Lamsal J, Khatri B, Singh Shah D. Urinary tract infection among post-renal transplant patients in the department of nephrology of a tertiary care centre: a descriptive cross-sectional study. JNMA J Nepal Med Assoc 2022;60:507-10.
• 15. Kaviani A, Ince D, Axelrod D A. Management of antimicrobial agents in abdominal organ transplant patients in intensive care unit. Curr Transplant Rep 2020;7:1-11.
• 16. Guenette A, Husain S. Infectious complications following solid organ transplantation. Crit Care Clin 2019;35:151-68.
• 17. Kalil AC, Syed A, Rupp ME, Chambers H, Vargas L, Maskin A et al. Is bacteremic sepsis associated with higher mortality in transplant recipients than in nontransplant patients? A matched case-control propensity-adjusted study. Clin Infect Dis 2015;60:216-22.
• 18. Bige N, Zafrani L, Lambert J, Peraldi MN, Snanoudj R, Reuter D, et al. Severe infections requiring intensive care unitad mission in kidney transplant recipients: impact on graft outcome. Transpl Infect Dis 2014;16:588-96.
• 19. Chuang P, Parikh C R, Langone A. Urinary tract infections after renal transplantation: a retrospective review at two US transplant centers. Clin Transplant 2005;19:230-5.
• 20. Arslan H, Inci E K, Azap OK, Karakayali H, Torgay A, Haberal M. Etiologic agents of diarrhea in solid organ recipients. Transpl Infect Dis 2007;9:270-5.
• 21. Angarone M, Snydman DR; AST ID Community of Practice. Diagnosis and management of diarrhea in solid-organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019;33:e13550.
• 22. Wongtanasarasin W, Phinyo P. Emergency department visits and hospital admissions in kidney transplant recipients during the COVID-19 pandemic: a hospital-based study. World J Transplant 2022;12:250-8.
• 23. Opsomer R, Kuypers D. COVID-19 and solid organ transplantation: finding the right balance. Transplant Rev (Orlando) 2022;36:100710.
• 24. Raja MA, Mendoza MA, Villavicencio A, Anjan S, Reynolds JM, Kittipibul V, et al. COVID-19 in solid organ transplant recipients: a systematic review and meta-analysis of current literature. Transplant Rev (Orlando) 2021;35:100588.
• 25. Koval CE. Prevention and treatment of cytomegalovirus infections in solid organ transplant recipients. Infect Dis Clin North Am 2018;32:581-97.
• 26. Helanterä I, Kyllönen L, Lautenschlager I, Salmela K, Koskinen P. Primary CMV infections are common in kidney transplant recipients after 6 months valganciclovir prophylaxis. Am J Transplant 2010;10:2026-32.