Infection In Kidney Transplant Recipients Research Articles

Screening for BK Virus Infection in Kidney Transplant Recipients at Mohamed V Military Teaching Hospital

After kidney transplantation, BK polyomavirus reactivation can manifest as nephropathy in 1% to 10% of patients. PCR testing of urine and blood is commonly used to screen for BK polyomavirus nephropathy. The study aims to detect BK virus infection in kidney transplant patients to prevent tubulointerstitial nephropathy and graft loss. This retrospective study includes 26 patients who underwent kidney transplants between January 2019 and December 2023. We diagnosed BK virus infection by performing real-time PCR on blood and urine samples. BKV DNA was detected in 3 patients. Reducing immunosuppressive therapy led to negative PCR results and favorable clinical and biological outcomes in these 3 patients.

Risk factors and multi-pathogen infections in kidney transplant recipients with omicron variant pneumonia: a retrospective analysis

BackgroundKidney transplant recipients (KTRs) are at an elevated risk of progressing to severe infections upon contracting COVID-19. We conducted a study on risk factors and multi-pathogen infections in KTRs with SARS-CoV-2 Omicron variant.MethodsKTRs were subjected to a thorough etiological evaluation. Whenever feasible, they were also provided with bronchoscopy and bronchoalveolar lavage to enable metagenomic next-generation sequencing (mNGS), ideally within a 48-hour window post-admission. We performed a retrospective analysis for pathogens and risk factors of KTRs with the COVID-19 virus variant Omicron.ResultsWe included thirty patients in our study, with sixteen exhibiting single infection of COVID-19 and fourteen experiencing co-infections, predominantly with Pneumocystis jirovecii. Notably, patients with severe cases demonstrated significantly elevated levels of C-reactive protein (CRP) and interleukin-6 compared to those with moderate cases (P < 0.05). Furthermore, individuals whose conditions progressed had markedly higher baseline serum creatinine levels than those without such progression (P < 0.05). The presence of heart failure, acute exacerbation of renal dysfunction, and a history of opportunistic infections were significantly associated with a higher likelihood of deterioration and hospital admission due to the SARS-CoV-2 Omicron variant, as compared to the control group (P < 0.05). In subsequent follow-up analysis, the all-cause rehospitalization rate was observed to be 21.4%, with Pneumocystis jirovecii infection accounting for half of these cases.ConclusionAmong KTRs, a significant coinfection rate of 47% was observed, with Pneumocystis jirovecii emerging as the predominant pathogen in these cases. The development of heart failure, acute exacerbation of chronic renal dysfunction, and a prior history of opportunistic infections have been identified as potential risk factors that may contribute to clinical deterioration in KTRs. Additionally, Pneumocystis jirovecii infection has been established as a critical factor influencing the rate of all-cause rehospitalization within this patient population.

#2980 The natural history of urinary tract infections in kidney transplant recipients

Abstract Background and Aims Urinary tract infections (UTIs) can occur following kidney transplantation, but research on infection rates and outcomes is inconclusive. We therefore aimed to provide a comprehensive understanding of the natural history of UTIs and the impact on long-term outcomes. Method We performed a single-centre cohort study of kidney-only transplant recipients at the Glasgow Transplant Unit, UK. A standardised protocol for UTI screening and treatment was in use and only treated UTIs were included. We studied the first two years post-transplant as this is the time when UTIs are most likely to occur. Patients were categorised into 3 groups based on number of UTIs: no UTIs, 1-2 UTIs and ≥3 UTIs. Furthermore, patients with highly recurrent UTIs defined as ≥10 UTIs in the first 2 years were compiled and analysed. Proportional odds logistic regression was performed to identify risk factors for having ≥3 UTIs, with adjustment for age, sex, primary renal diagnosis, donor type (live donor, deceased heart beating, deceased non-heart beating) and induction immunosuppression. Results Amongst 1412 transplant recipients studied over a nine-year period, the mean age was 48 years and 563 (39.9%) were female. 1169 (82.8%) of recipients experienced no UTIs, 180 (12.7%) had 1-2 UTIs, and 63 (4.5%) had ≥3 UTIs (Fig. 1). The key risk factors for developing ≥3 UTIs were female sex: adjusted odds ratio (aOR) 1.50 (95% confidence interval 1.13-1.99), induction with anti-thymocyte globulin (ATG): aOR 6.60 (3.05-14.05), and age: aOR for each one-year increase 1.01 (1.00-1.02). There were no primary renal diagnoses (PRD) that demonstrated a significant association with ≥3 UTIs. However, individuals with tubulointerstitial disease, a group which includes structural abnormalities of the urinary tract and reflux nephropathy as a considerable proportion, showed a trend towards heightened risk: aOR 1.47 (0.97-2.22, reference group glomerulonephritis). Recipients with ≥3 UTIs had lower estimated glomerular filtration rates (eGFRs) at two years compared to the no UTI group (49.7 vs. 59.2mL/min/1.73 m2, respectively). However, there was no significant increase in mortality or graft loss between the three groups. In the group of patients with highly recurrent UTIs, consisting of 14 patients (0.01%), we observed that 3 (21%) had a PRD of reflux nephropathy, while 5 (35%) had underlying structural abnormalities of the native renal tract as a PRD. Further to this 5 (35%) of the patients received ATG induction and 5 (35%) patients had a previous transplant. Conclusion We describe a low rate of UTIs requiring treatment in the first two years after kidney transplantation. Females, older recipients and those given ATG induction were at increased risk of recurrent UTIs. There was no impact of UTIs on graft loss or patient mortality. However, eGFR at two years post-transplant was lower amongst those with recurrent UTIs. We also observed that for the patients with highly recurrent UTIs, ATG induction, previous transplants, reflux nephropathy and structural abnormalities of native renal tract may be a risk factor. Recipients at highest risk of UTIs should therefore be screened for UTIs and interventions to reduce this risk should be considered

#580 Pitfalls in valganciclovir prophylaxis dose adjustment based on renal function in kidney transplant recipients

Abstract Background Clinically significant cytomegalovirus infection (csCMVi) is the most frequent viral infection in kidney transplant recipients (KTR). A daily dose of 900 mg valganciclovir (VGC) as primary antiviral prophylaxis (PAP) is frequently administered to KTR at risk for csCMVi, including CMV donor (D)+/recipient (R)− and CMV R+ patients after induction immunosuppression with thymoglobulin (R+/TG) until 6- and 3-months post-transplant, respectively. Dose adjustments for VGC are recommended based on renal function to reduce potential myelotoxicity. There is paucity of real-life data on VGC dose adjustment as PAP and association with clinical outcomes. Method and Aims Bicentric and retrospective Swiss Transplant Cohort Study (STCS)-embedded observational study including all consecutive adult D+/R− and R+/TG KTR between 2010 and 2020, who received PAP with VGC. The primary objective was to describe the proportion of VGC weekly entries, that was inappropriately (either under- or over-) dosed based on the associated renal function. Secondary objectives included the incidence of breakthrough csCMVi, potential associations between breakthrough-csCMVi and cytopenias with VGC dosing. Results Among 178 KTR included in both centres, 131 (73.6%) patients had at least two week entries for the longitudinal data of interest and were included in the outcome analysis. There were 1032 weekly VGC dose entries for 131 patients. Overall, 460 (44.6%) were appropriately dosed, while 234 (22.7%) and 338 (32.8%) were under- and over-dosed, respectively (Table 1). Inappropriate dosing was more frequent among R+/TG (133/214, 62.1%) than D+/R− (92/176, 52.3%, p = 0.05) during the first four weeks post-transplant. Nineteen (14.5%) patients had a breakthrough-csCMVi, without any association between breakthrough-csCMVi and VCG dosing (p = 0.44). Among cytopenias, there was no statistically significant difference in the proportion of weekly leucopenia, neutropenia, or thrombocytopenia values. In contrast, lymphopenia was more frequently observed when VGC was overdosed (p = 0.005, Table 2). Conclusion VGC as PAP in KTR is frequently inappropriately dosed, albeit without meaningful clinical associations, neither in terms of efficacy nor safety.

#2106 Higher daily protein intake can reduce the risk of infections in kidney transplant recipients during the early post-transplant period

Abstract Background and Aims Kidney transplantation (KT) is considered the most effective treatment for end-stage renal disease (ESRD), and it significantly contributes to enhancing the quality of life and extending the survival of patients with ESRD. After kidney transplantation, the early and heavy use of immunosuppressants and glucocorticoids can affect the recipients' immune status to varying degrees, increasing the risk of postoperative infections caused by a wide range of pathogens. Thus, the prevention and management of infectious diseases are major factors contributing to improved outcomes in kidney transplantation. Protein-energy wasting (PEW) is commonly observed in uremic patients, and it may persist even after they have undergone kidney transplantation (KT). And PEW is a significant factor in the progression of chronic kidney disease (CKD). Providing appropriate dietary guidance and intervention is essential for enhancing the immune status of recipients, promoting a positive nitrogen balance in the body, minimizing infections, and safeguarding graft function. This study aimed to investigate the relationship between daily protein intake (DPI) and postoperative infections at 3 months post-transplant, which may establish a foundation for the early postoperative protein intake regimen, reducing the incidence of postoperative infections, and improving the early prognosis of kidney transplantation. Method This is a retrospective observational study. 176 kidney transplant recipients (KTRs) who underwent kidney transplant in West China Hospital from December 2021 to June 2022 were included and followed up regularly. 24-hour urine urea data were collected at months 1 and 3 post-transplant to calculate their DPI. These KTRs were further divided into two groups according to the recommended DPI for KTRs by the 2021 Practice Guidelines for the Nutritional Management of Chronic Kidney Disease, namely high intake group (Group 1, with DPI ≥ 1.4 g/kg·d, n = 66) and low intake group (Group 2, with DPI &amp;lt; 1.4 g/kg·d, n = 110). Occurrence of hospitalization and postoperative infections within 3 months were recorded. Multiple logistic regression was utilized to analyze the association between DPI and early postoperative infections at 3 months post-transplant. Results Mean DPI levels at month 1 post-transplant were 1.58 ± 0.22 g/kg·d in Group 1 and 1.02 ± 0.31 g/kg·d in Group 2, respectively (P &amp;lt; 0.05), this huge difference in DPI between the two groups continued to month 3. There was no significant difference in age, gender, pre-transplant body mass index (BMI), dialysis type and time, donor type, or the ratio of delayed graft function (DGF) between the two groups. There was a statistically significant difference in the percentage of hospitalization between the two groups during the postoperative period of 3 months (P = 0.027). Pneumonia was the most common reason of hospitalization after transplantation, followed by urinary tract infection. The results of multiple logistic regression analysis showed that higher DPI in the early post-transplant period was a protective factor for infection after kidney transplantation. Conclusion In the early post-transplant period, consuming higher levels of dietary protein may reduce the risk of infections and complications, and help preserve the function of the transplanted kidney.

#2736 Higher daily protein intake can reduce the risk of infections in kidney transplant recipients during the early post-transplant period

Abstract Background and Aims Kidney transplantation (KT) is considered the most effective treatment for end-stage renal disease (ESRD), and it significantly contributes to enhancing the quality of life and extending the survival of patients with ESRD. After kidney transplantation, the early and heavy use of immunosuppressants and glucocorticoids can affect the recipients' immune status to varying degrees, increasing the risk of postoperative infections caused by a wide range of pathogens. Thus, the prevention and management of infectious diseases are major factors contributing to improved outcomes in kidney transplantation. Protein-energy wasting (PEW) is commonly observed in uremic patients, and it may persist even after they have undergone kidney transplantation (KT). And PEW is a significant factor in the progression of chronic kidney disease (CKD). Providing appropriate dietary guidance and intervention is essential for enhancing the immune status of recipients, promoting a positive nitrogen balance in the body, minimizing infections, and safeguarding graft function. This study aimed to investigate the relationship between daily protein intake (DPI) and postoperative infections at 3 months post-transplant, which may establish a foundation for the early postoperative protein intake regimen, reducing the incidence of postoperative infections, and improving the early prognosis of kidney transplantation. Method This is a retrospective observational study. 176 kidney transplant recipients (KTRs) who underwent kidney transplant in West China Hospital from December 2021 to June 2022 were included and followed up regularly. 24-hour urine urea data were collected at month 3 post-transplant to calculate their DPI. These KTRs were further divided into two groups according to the recommended DPI for KTRs by the 2021 Practice Guidelines for the Nutritional Management of Chronic Kidney Disease, namely high intake group (Group 1, with DPI ≥ 1.4 g/kg·d, n = 66) and low intake group (Group 2, with DPI &amp;lt; 1.4 g/kg·d, n = 110). Occurrence of postoperative infections events within 3 months were recorded. Multiple logistic regression was utilized to analyze the association between DPI and early postoperative infections at 3 months post-transplant. Results Mean DPI levels at month 3 post-transplant were 1.75 ± 0.56 g/kg·d in Group 1 and 0.98 ± 0.24 g/kg·d in Group 2, respectively. There was no significant difference in age, gender, pre-transplant body mass index (BMI), dialysis type and time, donor type, or the ratio of delayed graft function (DGF) between the two groups. There was a statistically significant difference in the percentage of hospitalization for infections between the two groups during the postoperative period of 3 months (P = 0.027). Pneumonia was the most common reason of rehospitalization after transplantation, followed by urinary tract infection. The results of multiple logistic regression analysis showed that higher DPI in the early post-transplant period was a protective factor for infection after kidney transplantation. Conclusion In the early post-transplant period, consuming higher levels of dietary protein can reduce the risk of infections and complications, and help preserve the function of the transplanted kidney.

#701 Occult hepatitis B infection in kidney transplant recipients and their donors

Abstract Background and Aims Occult hepatitis B infection (occult HBV infection—OBI) in kidney transplant recipients (KTRs) poses a potential risk of transforming into an overt process during immunosuppressive therapy. We aimed to evaluate the frequency of OBI occurrence in KTRs population and in the corresponding cohort of kidney donors. Method We analyzed 1222 consecutive KTRs transplanted between Jan 2012 and Jun 2023 and their 670 deceased donors. The diagnosis of seropositive OBI was based on the presence of anti-HBc antibodies without detectable HBs antigen. In eligible KTRs with pre-transplant OBI, the status of HBV infection was examined including the HBV-DNA and calculated aspartate aminotransferase to platelet ratio index (APRI) and Fibrosis-4 (FIB-4) indexes to assess the degree of liver fibrosis. Results Prior to transplantation, OBI was diagnosed in 178 (14.9%) KTRs [median age 49 (IQR, 38-59) years] and in 72 (10.7%) donors [median age 49 (38-58)]. OBI was significantly more frequent in KTRs than in general population (χ2=6.4, p&amp;lt;0.05). In a long-term follow-up period [median 84 (47-117) months], 5 out of 85 pre-transplant OBI patients (5.9%) presented the negative HBc status, whereas HBV viremia and HBs antigen, as determined using the high-sensitive method, were absent in all subjects. Among 85 pre-transplant OBI subjects, anti-HBs antibodies &amp;gt;10 mIU/ml were present in 84.7% and no liver fibrosis was found by APRI and FIB-4 indexes calculation. Conclusion 1. OBI is still a significant clinical problem not only in KTRs, but also in the general population, despite the widespread access to preventive vaccinations against HBV. 2. A separate analysis is necessary to evaluate the influence of OBI on kidney graft and liver function in KTRs.

Analysis of COVID-19 Infection in Kidney Transplant Recipients

BackgroundThe Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was responsible for higher morbidity and mortality in renal transplant recipients (RTx). The objective of the study was to evaluate the impact of COVID-19 infection on RTx in a single center in Brazil. MethodsA cohort of 135 RTx was evaluated between December 2019 to June 202l and demographics, clinical and, laboratory profiles were analyzed from deceased donors with COVID-19. ResultsDiabetic and RTx from extended criterion donors presented more frequently the severe form of the disease. Serum creatinine (sCr) after 3 months of diagnosis of COVID-19 varied according to the severity of infection. The lethality rate was higher in the group with severe symptoms (65%) compared with those with mild infection (1.5%). ConclusionThe increase in sCr was associated with disease severity. The lethality rate for COVID-19 was 26.6%. These rates are 10 to 20 times higher than those reported in the general population and suggest that rigorous observation, early diagnosis, and disease prevention measures are crucial in RTx.

Report of the Standardized Outcomes in Nephrology-transplant Consensus Workshop on Establishing a Core Outcome Measure for Infection in Kidney Transplant Recipients: Erratum.

Report of the Standardized Outcomes in Nephrology-transplant Consensus Workshop on Establishing a Core Outcome Measure for Infection in Kidney Transplant Recipients: Erratum.

Body fat predicts urinary tract infection in kidney transplant recipients: a prospective cohort study

Body fat predicts urinary tract infection in kidney transplant recipients: a prospective cohort study

Bridging the gap: assessing CMV DNAemia in kidney transplant recipients with previous solid organ transplants.

Cytomegalovirus (CMV) infection poses a significant threat to solid organ transplant (SOT) recipients and can lead to various complications and adverse outcomes. In an effort to prevent CMV infection, it is common to utilize prophylactic strategies, including antiviral medications such as valganciclovir, especially for high-risk patients. Risk factors for CMV infection in kidney transplant recipients (KTRs) include CMV mismatch between donor and recipient (i.e., donor positive, recipient negative), and intensity of immunosuppression, such as the use of T-cell depleting agents. However, little attention has been given to KTRs with a history of prior SOTs, despite their prolonged exposure to immunosuppressive regimens. The aim of this retrospective single-center study was to investigate the incidence and implications of CMV DNAemia in KTRs with prior SOTs. The study included 97 KTRs with prior SOTs and 154 KTRs with no prior transplants as a control group. In the study group, the most common SOT before the current kidney transplantation (KT), was a previous KT. Patients in the KTR group with prior SOTs were more sensitized than those in the control group [calculated panel-reactive antibody > 30%: 49 (50.5%) vs. 30 (19.45%) patients, p = 0.001]. There was a 39.2% incidence of CMV DNAemia in the previous SOT group compared to 48.7% in the control group [non-significant (NS)]. Patients with prior SOTs demonstrated a shorter post-transplant time to CMV DNAemia [median time 1.6 months (interquartile range, IQR 0.7-5.8) in the KTRs with prior SOTs vs. 2.6 months (IQR 1.5-8.1) in the control group (p = 0.001)]. Although the study highlights the need for tailored prophylaxis strategies and vigilant monitoring in KTRs with prior SOTs, its limitations, such as its retrospective nature and single-center design, call for further multicenter research to establish comprehensive guidelines for managing CMV DNAemia in this unique patient population. Despite these limitations, this study underscores the importance of recognizing the heightened risk of CMV infection or reactivation in KTRs overall and the potential benefits of proactive intervention to mitigate associated morbidity and mortality.

Prevention and treatment strategies for kidney transplant recipients in the context of long-term existence of COVID-19.

The sudden outbreak of coronavirus disease 2019 (COVID-19) in early 2020 posed a massive threat to human life and caused an economic upheaval worldwide. Kidney transplant recipients (KTRs) became susceptible to infection during the COVID-19 pandemic owing to their use of immunosuppressants, resulting in increased hospitalization and mortality rates. Although the current epidemic situation is alleviated, the long-term existence of COVID-19 still seriously threatens the life and health of KTRs with low immunity. The Omicron variant, a highly infectious but less-pathogenic strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised concerns among transplant physicians regarding managing KTRs diagnosed with this variant. However, currently, there are no clear and unified guidelines for caring for KTRs infected with this variant. Therefore, we aimed to summarize the ongoing research on drugs that can treat Omicron variant infections in KTRs and explore the potential of adjusting immunotherapy strategies to enhance their responsiveness to vaccines. Herein, we discuss the situation of KTRs since the emergence of COVID-19 and focus on various prevention and treatment strategies for KTRs since the Omicron variant outbreak. We hope to assist physicians in managing KTRs in the presence of long-term COVID-19 variants.

High-dimensional mass cytometry identified circulating natural killer T-cell subsets associated with protection from cytomegalovirus infection in kidney transplant recipients

Cytomegalovirus (CMV) infection is associated with poor kidney transplant outcomes. While innate and adaptive immune cells have been implicated in its prevention, an in-depth characterization of the in vivo kinetics of multiple cell subsets and their role in protecting against CMV infection has not been achieved. Here, we performed high-dimensional immune phenotyping by mass cytometry, and functional assays, on 112 serially collected samples from CMV seropositive kidney transplant recipients. Advanced unsupervised deep learning analysis was used to assess immune cell populations that significantly correlated with prevention against CMV infection and anti-viral immune function. Prior to infection, kidney transplant recipients who developed CMV infection showed significantly lower CMV-specific cell-mediated immune (CMI) frequencies than those that did not. A broad diversity of circulating cell subsets within innate and adaptive immune compartments were associated with CMV infection or protective CMV-specific CMI. While percentages of CMV (tetramer-stained)-specific T cells associated with high CMI responses and clinical protection, circulating CD3+CD8midCD56+ NK-T cells overall strongly associated with low CMI and subsequent infection. However, three NK-T cell subsets sharing the CD11b surface marker associated with CMV protection and correlated with strong anti-viral CMI frequencies in vitro. These data were validated in two external independent cohorts of kidney transplant recipients. Thus, we newly describe the kinetics of a novel NK-T cell subset that may have a protective role in post-transplantation CMV infection. Our findings pave the way to more mechanistic studies aimed at understanding the function of these cells in protection against CMV infection.

Development of a Risk Prediction Model for Infection After Kidney Transplantation Transmitted from Bacterial Contaminated Preservation Solution.

The risk of transplant recipient infection is unknown when the preservation solution culture is positive. We developed a prediction model to evaluate the infection in kidney transplant recipients within microbial contaminated preservation solution. Univariate logistic regression was utilized to identify risk factors for infection. Both stepwise selection with Akaike information criterion (AIC) was used to identify variables for multivariate logistic regression. Selected variables were incorporated in the nomograms to predict the probability of infection for kidney transplant recipients with microbial contaminated preservation solution. Age, preoperative creatinine, ESKAPE, PCT, hemofiltration, and sirolimus had a strongest association with infection risk, and a nomogram was established with an AUC value of 0.72 (95% confidence interval, 0.64-0.80) and Brier index 0.20 (95% confidence interval, 0.18-0.23). Finally, we found that when the infection probability was between 20% and 80%, the model oriented antibiotic strategy should have higher net benefits than the default strategy using decision curve analysis. Our study developed and validated a risk prediction model for evaluating the infection of microbial contaminated preservation solutions in kidney transplant recipients and demonstrated good net benefits when the total infection probability was between 20% and 80%.

Incidence and clearance of cervical and anal high-risk human papillomavirus in kidney transplant recipients: Results from a Danish prospective clinical study

This study investigates the incidence and clearance of cervical and anal high-risk human papillomavirus (hrHPV) infection in kidney transplant recipients (KTRs) compared to immunocompetent controls. During 2016-2017, we enrolled 125 female KTRs and 125 female controls. Liquid-based cervical and anal cytology samples collected at enrollment and follow-up were tested for human papillomavirus (HPV) DNA using the CLART HPV2 test. All participants answered a questionnaire on lifestyle and sexual behavior at both examinations. KTRs had an increased age-adjusted risk of incident cervical hrHPV infection compared to controls (hazard ratio [HR] = 3.6, 95% CI = 1.2-11.2). Probability of cervical hrHPV clearance at 18 months was lower among KTRs (8.3%) than controls (66.7%). There was no statistically significant difference in anal hrHPV incidence between KTRs and controls (HR = 0.9, 95% CI = 0.4-2.0). Clearance of anal hrHPV was similar between KTRs and controls at 18 months. During the total follow-up, a lower anal hrHPV clearance, although not statistically significant, was observed among KTRs (HR = 0.3, 95% CI = 0.06-1.2). KTRs had higher incidence of cervical hrHPV and lower probability of clearance, especially of cervical hrHPV infections, than controls. Our findings support that KTRs are at increased risk of HPV infection and point to the need for targeted HPV prevention strategies, such as cervical cancer screening.

Acute pancreatitis as a complication of acute COVID-19 in kidney transplant recipients.

Acute pancreatitis is a rare extrapulmonary manifestation of coronavirus disease 2019 (COVID-19) but its full correlation with COVID-19 infection remains unknown. To identify acute pancreatitis' occurrence, clinical presentation and outcomes in a cohort of kidney transplant recipients with acute COVID-19. A retrospective observational single-centre cohort study from a transplant centre in Croatia for all adult renal transplant recipients with a functioning kidney allograft between March 2020 and August 2022 to record cases of acute pancreatitis during acute COVID-19. Data were obtained from hospital electronic medical records. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was proven by a positive SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction on the nasopharyngeal swab. Four hundred and eight out of 1432 (28.49%) patients who received a renal allograft developed COVID-19 disease. The analyzed cohort included 321 patients (57% males). One hundred and fifty patients (46.7%) received at least one dose of the anti-SARS-CoV-2 vaccine before the infection. One hundred twenty-five (39.1%) patients required hospitalization, 141 (44.1%) developed pneumonia and four patients (1.3%) required mechanical ventilation. Treatment included immunosuppression modification in 233 patients (77.1%) and remdesivir in 53 patients (16.6%), besides the other supportive measures. In the study cohort, only one transplant recipient (0.3%) developed acute pancreatitis during acute COVID-19, presenting with abdominal pain and significantly elevated pancreatic enzymes. She survived without complications with a stable kidney allograft function. Although rare, acute pancreatitis may complicate the course of acute COVID-19 in kidney transplant recipients. The mechanism of injury to the pancreas and its correlation with the severity of the COVID-19 infection in kidney transplant recipients warrants further research.

Acidic Urine pH and Clinical Outcome of Lower Urinary Tract Infection in Kidney Transplant Recipients Treated with Ciprofloxacin and Fosfomycin.

Different factors, including antimicrobial resistance, may diminish the effectiveness of antibiotic therapy, challenging the management of post-transplant urinary tract infection (UTI). The association of acidic urine pH with microbiological and clinical outcomes was evaluated after fosfomycin or ciprofloxacin therapy in 184 kidney transplant recipients (KTRs) with UTI episodes by Escherichia coli (N = 115) and Klebsiella pneumoniae (N = 69). Initial urine pH, antimicrobial therapy, and clinical and microbiological outcomes, and one- and six-month follow-up were assessed. Fosfomycin was prescribed in 88 (76.5%) E. coli and 46 (66.7%) K. pneumoniae UTI episodes in the total cohort. When the urine pH ≤ 6, fosfomycin was prescribed in 60 (52.2%) E. coli and 29 (42.0%) K. pneumoniae. Initial urine pH ≤ 6 in E. coli UTI was associated with symptomatic episodes (8/60 vs. 0/55, p = 0.04) at one-month follow-up, with a similar trend in those patients receiving fosfomycin (7/47 vs. 0/41, p = 0.09). Acidic urine pH was not associated with microbiological or clinical cure in K. pneumoniae UTI. At pH 5, the ciprofloxacin MIC90 increased from 8 to >8 mg/L in E. coli and from 4 to >8 mg/L in K. pneumoniae. At pH 5, the fosfomycin MIC90 decreased from 8 to 4 mg/L in E. coli and from 512 to 128 mg/L in K. pneumoniae. Acidic urine is not associated with the microbiological efficacy of fosfomycin and ciprofloxacin in KTRs with UTI, but it is associated with symptomatic UTI episodes at one-month follow-up in E. coli episodes.

Utility of the Interferon-Gamma Enzyme-Linked Immunosorbent Spot Assay to Predict Risk of Cytomegalovirus Infection in Kidney Transplant Recipients.

Non-specific interferon-gamma (IFN-γ) enzyme-linked immunosorbent (ELISpot) responses after solid organ transplant (SOT) and their relationship with cytomegalovirus (CMV) reactivation have hardly been investigated. Adult kidney transplant (KT) recipients underwent measurement of IFN-γ-producing T cells using the ELISpot assay before and 1 month after transplantation. Data for CMV infection episodes were collected. Risk factors for post-transplant CMV infection, based on IFN-γ responses, were analyzed using a Cox proportional hazards model. A total of 93 KT recipients were enrolled in the study and 84 evaluable participants remained at 1 month post KT. Thirty-three (39%) recipients developed subsequent CMV infection within 6 months post-transplant. At 1-month post-transplant, IFN-γ-producing T cells with <250 spot-forming units (SFUs)/2.5 × 105 peripheral blood mononuclear cells (PBMCs) were significantly associated with CMV infection (HR 3.1, 95% CI 1.4-7.1, p = 0.007). On multivariable analysis, posttransplant IFN-γ-producing T cells with <250 SFUs/2.5 × 105 PBMCs remained independently associated with CMV infection (HR 3.1, 95% CI 1.2-7.8, p = 0.019). Conclusions: KT recipients with low IFN-γ-producing T cells measured by the ELISpot assay are more likely to develop CMV infection after transplantation. Therefore, measurement of nonspecific cell-mediated immunity ELISpot responses could potentially stratify recipients at risk of CMV infection (Thai Clinical Trials Registry, TCTR20210216004).

Prevalence and Predictive Factors of Urinary Tract Infection in Kidney Transplant Recipients: A 10-Year Study.

Urinary tract infections are the main infectious complications among kidney transplant recipients and are considered as a potential risk factor for poor graft outcomes. However, the risk factors of urinary tract infections are controversial. The purpose of our study was to estimate the incidence and predisposing factors of urinary tract infections in patients undergoing kidney transplant in our teaching hospital of Sahloul, Tunisia. We retrospectively analyzed the charts of 141 consecutive adult kidney transplants that were performed at the Department of Nephrology, University Hospital of Sahloul, Tunisia, between January 2007 and April 2016. Of 141 patients, 72 (51.1%) had urinary tract infections after kidney transplant. Mean age was 32.54 ± 12.1 years; 47.6% were male patients, and 52.4% were female patients. The average time between transplant and early urinary tract infections was 11 days (range, 1-30 days). Among our patient group, 87.8% of urinary tract infections occurred within the first 6 months posttransplant. We collected 205 episodes of urinary tract infections: 66.3% were asymptomatic bacteriuria, 10.2% acute cystitis, and 23.4% pyelonephritis. The estimated risk factors for urinary tract infection included only female sex (P < .05); older age (P = .32), longer duration of catheter (P = .34), and high body mass index (P = .46) were not correlated with urinary tract infection. Despite preventive measures, urinary tract infections remain an important cause of morbidity among kidney transplant recipients. In fact, more than half of kidney transplant recipients had at least 1 urinary tract infection after surgery. Female sex was statistically associated with higher risk of urinary tract infection.

Interventions for preventing urinary tract infections in kidney transplant recipients

Interventions for preventing urinary tract infections in kidney transplant recipients