Diagnosis, Prevention, and Treatment of Infections in Kidney Transplantation.
Infections in kidney transplant recipients follow a predictable timeline reflecting the net state of immunosuppression and remain a major cause of morbidity, mortality, and allograft dysfunction; structured screening, prevention, and management are essential.
Background
Kidney transplant recipients are predisposed to infection by both therapy-related and patient-related risk factors, and these infections are associated with increased morbidity, mortality, and allograft dysfunction. The types of pathogens encountered follow a predictable post-transplant timeline that mirrors the net state of immunosuppression.
Key recommendations
In the early post-transplant period, bacterial infections account for roughly two thirds of infections, followed by viral and fungal causes, and these are generally related to postoperative complications. Opportunistic infections typically occur within the first 6 months and may arise from a new infection, a donor-derived infection, or reactivation of a latent infection. In the later period, when net immunosuppression is minimal, community-acquired pneumonia, upper respiratory tract infections, urinary tract infections, and gastrointestinal infections predominate.
Clinical implications
Assessment should incorporate time since transplant (reflecting the net state of immunosuppression), prior exposures and infections, geography, and seasonal outbreaks. The authors emphasize the need to develop regionally specific guidelines on the screening, prevention, and management of infections after kidney transplantation.
Category
Transplant
Source
Semin Nephrol
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