Etiology and management of early and late peritransplant infections

Subfascial peritransplant infection is a life-threatening complication of renal transplantation with multiple etiologies, early onset, and subtle or catastrophic presentation. Thirteen such deep space infections were encountered in 160 consecutive transplants followed for up to 4 years. Difficult management decisions were required frequently. Three patients presented with acute peritonitis. In each instance the source of infection was obscure until abdominal exploration revealed transperitoneal rupture of an infected peritransplant fluid collection. Gray scale ultrasonography and ultrasound guided needle aspiration of fluid collections proved valuable in the clarification of often confusing clinical situations. The transplant was left in situ, with good function and complete wound healing in 5 cases. Transplant nephrectomy was required in 8 patients. Three patients died despite transplant nephrectomy and discontinuation of immunosuppression.