Infection in kidney transplant recipients in Tunisia

Abstract EN

To determine the patterns of infectious complications in the renal transplant recipients in our center, we evaluated 18 patients (13 males and five females) who were transplanted between 1994-1998.

The average age of the patients was 28 years.

Sixteen (88%) and 2 (12%) transplants were from living-related and cadaver donors, respectively.

Post-transplant immunosuppression consisted of azathioprine, prednisone, antithymocyte globulin (ATG) and cyclosporine.

The acute rejection episodes were treated with pulse doses of methylprednisolone; steroid resistant rejection was treated with ATG or muromonab (OKT3).

All patients received prophylaxis with sulfadoxin-pyrimethamine; none received prophylaxis against cytomegalovirus (CMV) infection.

Thirteen (72%) recipients developed 44 confirmed episodes of infection; 19 (43%) episodes occurred in the early postoperative period, 16 (36%) in the first month and nine (20%) after six months.

According to the type of infection, there were 12 urinary tract, 12 CMV, four herpal, five general septic, three fungal, two pneumonia, one disseminated nocardial and five miscellaneous episodes.

All six (100%) patients who had acute rejection episodes developed infection compared with 7 / 12 (58%) who did not have rejection (p < 0.01).

There was a significant correlation between CMV disease and acute rejection.

CMV infection occurred after the additional immunosuppressive treatment for acute rejection in 6 / 6 (100%) patients.

We conclude that CMV infection was the most frequent opportunistic pathogen in our renal transplant population and related to the intensive antirejection therapy, followed by urinary tract infection, which occurred within three months after surgery.