ISSN: 1305-3876
Hakkında: Özel sayılar şeklinde yayınlanır.
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Infectious Complications Of Kidney Transplantation
Dr. Halis AKALINa
aKlinik Bakteriyoloji ve Enfeksiyon Hastalıkları AD, Uludağ Üniversitesi Tıp Fakütltesi, BURSA
The primary factors that influence the development of infection in transplant receivers are the intensity of exposure to potential pathogens (epidemiologic exposure) and susceptibility of the patient to infection (degree of immunosuppression). The spectrum of causative agents in infections developing after various solid organ transplantations is similar. Three posttransplantation periods were identified each with a higher frequency of specific microorganisms with respect to others. At posttransplant 1 month (early perioperative stage), infections are usually associated with surgical complications. Such infections are bacterial and Candida spp. related surgical area infections, pneumonitis, urinary system infections, catheter related infections, and they are similar to nosocomial infections developing in other patients who underwent surgical intervention. In the 2nd period from 2-6 months, immunosuppression is maximal (immunosuppressive period) and most common infections are opportunistic such as CMV, Pneumocystis jirovecii, Aspergillus spp, Nocardia spp, Toxoplasma gondii and Listeria monocytogenes infections. In the 3rd period after 6 months (3rd stage, late stage), allograft function is adequately stabile in most patients and thus, the intensity of immunosuppressive therapy may be reduced. Infections at this stage are similar to those occurring in the normal population.
Urinary system infections are the most common infections occurring in renal transplant patients. The most common viral agent in all solid organ transplant receivers is CMV. The highest risk of infection is in settings where the receiver is CMV negative and the donor is CMV positive. The risk of infection is also high in patients receiving immunosuppressive regimens including steroids, OKT-3 or polyclonal anti-lymphocyte globulins. It should be noted that CMV infection and CMV disease are different entities.
In a transplant patient receiving immunosuppressive therapy, fever may not be a sign of infection. However, fever is the most common manifestation of infection in such patients. In a patient with fever, infection and rejection should be immediately differentiated.Keywords: Renal transplantation, transplantation and infectionTurkiye Klinikleri J Surg Med Sci 2006, 2(21):70-78
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