POS-782 INFECTIOUS COMPLICATIONS IN KIDNEY TRANSPLANTATION

Abstract

Gaining long-term graft function and patient survival remain a critical challenge following kidney transplantation. Infectious Complications are associated with complications in kidney allograft recipients. Therefore, we conducted a study in a kidney transplant population which aimed to delineate the risk factors associated with infectious complications and could affect the allograft outcome. We conducted a cross sectional study carried out by the nephrology department in the university hospital of Sousse Sahloul from November 2007 to September 2015. We included in our study patients who received tacrolimus in maintenance therapy. Over the study period, 170 kidney transplant were performed and 81 patients (47%) were included in the study of the total transplanted patients. The average age of the adults was 32.84±9,176 [17 - 55] years while the mean age of the children was 12.95±2.91 [7 - 16] years. The sex ratio was 1.5. The average age of kidney donors was 38.68 ± 10.607 years. Renal transplantation was performed from a cadaveric donor in 4 cases and in 77 cases it was from a living donor. The induction therapy for kidney transplant recipients was based on the antithymocyte immunoglobulin in 60% of cases and the anti-interleukin-2 receptor antibodies in 40 % of cases. The mean initial dose of tacrolimus was 8.52 ± 1.9 mg/d which corresponds to 0,17 ± 0.065 mg/kg/d. Infectious complications were observed in 66 patients (82.7%). Among our patients, 52 patients had urinary tract infection, 23 patients had BK virus infections,16 patients had gastrointestinal infection, 14 patients had cytomegalovirus infection, 6 patients had Candidiasis and 5 patients had a common germ pulmonary infection. In our series, 11 patients (13.6%) presented allograft dysfunction during their follow-up, 5 patients (6.2%) had lost their allograft and 5 patients (6.2%) have died. The comparative analysis revealed that dose weight of tacrolimus at the first year was significantly associated with the infectious complications. In fact, the patients who had infectious complications required higher doses of tacrolimus at first year (p=0.028). We found that patients who had two or more infections were exposed to more risk of allograft rejection (p=0.006). We found that patients who had at least two infections presented an unfavourable outcome (p=0.026). We noted that the antithymocyte immunoglobulin was associated with a higher risk of infections (p=0.035) than basiliximab (p=0.026). Renal transplantation is an effective treatment for an end-stage kidney disease, however, post-transplant complications remain its major challenge. A deeper understanding of the different infectious complications can help clinic to connect the organ outcomes, including graft survival, inflammation, infection, rejection, alloreactivity and fibrosis.