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[Infectious complications in the early phase following kidney transplantation]
M Spielberger1, T Schmid, P Sandbichler
1Abteilung für Transplantationschirurgie, I. Universitätsklinik für Chirurgie, Innsbruck.
Abstract:
A retrospective analysis of 533 patients receiving kidney transplantation was performed to study the incidence of infection in the early postoperative period. Mostly localized in the lungs and renal system, bacterial complications arose in 133 patients. As compared with the unproblematic management of the urinary tract infections, 45 pulmonary infections were characterized by difficulties in diagnosis and treatment. Poor graft function was closely related to pulmonary infections: mean creatinine was 2.4 mg% (in patients without pneumonia - 1.5 mg%). Out of 45 patients with pneumonia, the graft failed in 16 patients. 6 patients died as a result of pneumonia. Rapid detection of the pathogenic organism is required, if necessary by invasive diagnosis. The administration of erythromycin before identification of the responsible pathogen may be indicated, in view of the fatal outcome in several patients subsequently diagnosed as having Legionella infection.
Insights
Postoperative pulmonary infections after kidney transplantation are common and linked to poor graft function and graft failure. Early detection and treatment are crucial, especially for Legionella.
Area of Science:
- Nephrology
- Infectious Diseases
- Transplant Surgery
Context:
- Kidney transplantation is a life-saving procedure.
- Early postoperative infections pose significant risks to transplant recipients.
- Bacterial complications are a concern in the early post-transplant period.
Purpose:
- To investigate the incidence and impact of early postoperative infections following kidney transplantation.
- To analyze the relationship between pulmonary infections and graft function.
- To assess outcomes, including graft failure and mortality, associated with these infections.
Summary:
- A retrospective analysis of 533 kidney transplant recipients identified bacterial complications in 133 patients.
- Pulmonary infections, unlike urinary tract infections, presented diagnostic and treatment challenges.
- Pulmonary infections correlated with poorer graft function (mean creatinine 2.4 mg% vs. 1.5 mg%) and led to graft failure in 16 of 45 patients.
- Six deaths were attributed to pneumonia, highlighting the severity of these complications.
Impact:
- Emphasizes the critical need for rapid pathogen detection, potentially via invasive diagnostics.
- Suggests considering early empirical antibiotic treatment, such as erythromycin, for suspected severe infections like Legionella.
- Highlights the significant morbidity and mortality associated with early pulmonary infections post-kidney transplant.