Abstract
Introduction: Infections are a major cause of morbidity and mortality in pediatric patients undergoing kidney transplantation (KT). Aim and Methods: To determine the patterns of infectious complications during the first 6 months post transplantation, we report our single center experience with data from pediatric kidney recipients transplanted between 2006 and 2011. Results: Thirty-two children (20 males) were submitted to KT. The most common cause of end-stage renal disease (ESRD) was congenital anomalies of the kidney and urinary tract (CAKUT) accounting for 62%. Over the first 6 months post-transplant period, twenty-eight (87.5%) children developed a total of 77 infections, mainly urinary tract infections (UTI) (64.9%). CAKUT etiology of ESRD and UTI before KT increased the risk to develop more than one episode of UTI [71.4% vs. 14.3% and 81.8% vs. 18.2%, respectively; p < 0.05]. Twenty-three (29.9%) viral infections occurred. Cytomegalovirus (CMV) was the most common opportunistic pathogen, occurred in 11 patients and was more frequently in those with a donor (D)+/recipient (R)- CMV sero-status [74.5% vs. 25.5% (p < 0.05)]. A polyomaviruses (BKV) disease with nephropathy and meningitis was registered. The majority of infectious episodes had mild or moderate severity. No deaths occurred. Conclusion: A significant number of patients presented infectious complications during the first 6 months post transplantation. UTI are the most common type of infection, followed by viral infections, particularly CMV. Recognition, prevention and early treatment of infections are of major importance.
Highlights
Infections are a major cause of morbidity and mortality in pediatric patients undergoing kidney transplantation (KT)
Cytomegalovirus (CMV) infections have been prominent in kidney transplant recipients since the 1980s, followed by Ebstein-Barr virus (EBV)-induced post transplantation lymphoproliferative disorder (PTLD) since the 1990s, and BK-virus-associated allograft nephropathy (BKVAN) in the last 10 years [5]
CMV is the most common opportunistic organism encountered during this period [6] [9], and causes significant morbidity by direct infection and its immunomodulatory effects predispose to other infectious complications [5]
Summary
Infections are a major cause of morbidity and mortality in pediatric patients undergoing kidney transplantation (KT). During the first post-transplant month, the most frequent categories of infection are related to technical problems (including surgical site infections), urinary tract infections, vascular access infections, and pulmonary infections [7] During this period, more than 90% of all infections are caused by bacteria and fungi and opportunistic infections are unusual [7] [8]. The greatest risk of life-threatening infection occurs between 1 and 6 months post transplantation, when the effects of immunosuppressive therapy peak [8] [9] During this period, most common infections are opportunistic agents: virus like cytomegalovirus (CMV), polyomaviruses (BKV), Epstein-Barr Virus (EBV) and fungi (aspergillus). CMV is the most common opportunistic organism encountered during this period [6] [9], and causes significant morbidity by direct infection and its immunomodulatory effects predispose to other infectious complications [5]
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