Pulmonary complications within the first year after renal transplantation

Abstract

Background The lungs are commonly involved after renal transplantation, with many complications, either infectious or noninfectious. The infectious complications significantly increased morbidity and mortality. Several risk factors were involved, such as old age, smoking status, comorbid diseases, pretransplant peritoneal dialysis, cadaveric renal transplantation, heavy immunosuppression, and treatment of graft rejection. Aim To study the predisposing risk factors, etiologic factors, and the timeline of pulmonary complications within the first year after renal transplantation (either infectious or noninfectious complications). Patients and methods We conducted this prospective observational study in the Organ Transplant Center in Kuwait from March 2016 to October 2019. The kidney recipients were followed up for 1 year after transplantation. For suspected infectious pulmonary complications, the patients were subjected to blood, sputum, and or bronchoalveolar lavage within the first 24 h after admission; all samples were subjected to microbiological and serological examinations. Results We had 60 patients who developed postrenal transplant pulmonary complications. A total of 42 patients developed infectious pulmonary complications and 54 patients developed noninfectious complications. The most common infectious pulmonary complications were bacterial pneumonia (42 patients), opportunistic fungal infection (47 patients), and viral pneumonia (37 patients). The most common noninfectious pulmonary complications were pulmonary congestion (51 patients), pleural effusion (29 patients), and pulmonary embolism (16 patients). In the first 6 months, surgery-related complications and opportunistic fungal infection predominated owing to heavy immunosuppression. After 6 months, infections were due to community-acquired pathogens. The mortality rate was 38%. Bacterial pneumonia was the main cause of death (39%) followed by viral pneumonia (26%) and Pneumocystis jiroveci pneumonia (13%). Septic shock and respiratory failure were the leading causes of death. Conclusion Renal transplant was associated with infectious and noninfectious pulmonary complications. Infections were highly prevalent in the first year after transplantation. Old age, smoking status, comorbid diseases, pretransplant peritoneal dialysis, cadaveric renal transplantation, heavy immunosuppression, and treatment of graft rejection were the main risk factors for posttransplant pulmonary complications. Sepsis and respiratory failure represented the commonest causes of death.