Infection In Renal Transplant Recipients Research Articles

SARS-CoV-2 Omicron infection in acohort of hospitalized kidney transplant recipients: Risk factors ofseverity.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron is a major coronavirus variant, which was prevalent in China at the end of 2022 and caused widespread infection. As an immunosuppressed group, renal transplant recipients with SARS-CoV-2 infection are prone to developing serious pneumonia or an adverse outcome event if the infection is not treated in time. Here, we analyze the possible risk factors of infection severity. 92 cases of moderate and severe SARS-CoV-2 infection after renal transplantation were collected. Statistical methods, including Fisher's tests, F test, Spearman relative values, and multi-parameter logistic regression models, were used to analyze the risk factors for severe SARS-CoV-2 infection in renal transplant recipients. 44 cases complicated with hypertension were observed in the study cohort, among whom 30 were severe (OR: 4.63, p<0.001). Out of 51 male patients infected with Omicron, 30 male patients presented with severe SARS-CoV-2 (OR: 2.45, p=0.039). In renal transplant patients, hypertension comorbidity was closely correlated with clinical presentation (R = 0.369, p<0.001). Blood routine test, chemistries, and additional indices showed increased neutrophils and C-reactive protein in patients with severe disease compared with the moderate group according to one-way analysis of variance (p= 0.004), while CD3 (p = 0.02) and CD4 (p = 0.04) showed lower expressional levels. We also observed meaningful correlations between neutrophil levels and hypertension comorbidity (R = 0.222, p = 0.034) and between interleukin-6 (IL-6) levels and diabetes comorbidity (R = 0.315, p = 0.011), with IL-6 considered a key factor in the context of coronavirus disease. Renal transplant recipients were generally susceptible to infection with the Omicron variant, with a more pronounced incidence of severe illness observed in the group with hypertension comorbidity.

Comprehensive Review of Urinary Tract Infections in Renal Transplant Recipients: Clinical Insights and Management Strategies.

Urinary tract infections (UTIs) pose a significant challenge in the care of renal transplant recipients. This comprehensive review explores this population's multifaceted landscape of UTIs, emphasizing the importance of early diagnosis and tailored management strategies. Renal transplant recipients face an elevated risk of UTIs due to immunosuppression, altered urinary tract anatomy, and complex comorbidities. Complications of UTIs can lead to graft dysfunction and systemic illness, underscoring the need for effective management. The emergence of multidrug-resistant uropathogens adds complexity to treatment, highlighting the importance of targeted antibiotic therapy. Antibiotics are the most commonly prescribed drugs for UTIs, with nitrofurantoin, fosfomycin, amoxicillin, and amoxicillin-clavulanate potassium being some of the commonly used antibiotics. However, the emergence of multidrug-resistant uropathogens has led to the exploration of alternative treatments, such as bacteriophage therapy, as a potential alternative against multidrug-resistant uropathogenic bacteria. Analgesics such as phenazopyridine can be prescribed to relieve discomfort associated with UTIs. Estrogen therapy has also been suggested as a potential treatment option for UTIs, particularly in postmenopausal women. Trimethoprim-sulfamethoxazole or trimethoprim is recommended as first-line therapy for uncomplicated UTIs. The choice of drug and therapy for UTIs depends on the severity of the infection, the causative organism, and the presence of antibiotic resistance.Preventive measures encompass pre-transplant evaluation, perioperative strategies, post-transplant follow-up, and vaccination. A multidisciplinary approach involving transplant specialists, infectious disease experts, pharmacists, and patient engagement is vital for successful care. The future of UTI management lies in ongoing research, exploring personalized medicine, novel therapies, and innovative prevention strategies. By implementing these strategies and advancing research, healthcare providers can improve graft and patient survival, enhancing the quality of care for renal transplant recipients.

The Relationship between Acute Rejection, Hemoglobin Level, and BK Virus Infection Among Renal Transplant Recipients.

This study aimed to explore the risk factors for BK virus (BKV) infection in renal transplant recipients (RTRs) routinely treated with tacrolimus. Forty-two cases with BKV infections and 51 patients without BKV infections were enrolled in the study. Eighty-seven healthy individuals and 77 patients undergoing dialysis were randomly included as controls. A logistic regression model was used to analyze potential variables in order to evaluate factors related to BKV infection in the renal transplant recipients. The number of individuals with acute rejection in BKV positive RTRs is significantly higher than that in BKV negative RTRs. Hemoglobin levels in BKV positive RTRs were significantly lower than those in BKV negative RTRs (109.61 ± 20.11 vs. 130.16 ± 26.297, p < 0.001). There was a positive correlation between tacrolimus levels and hemoglobin concentration in RTRs (r = 0.329, p = 0.023). The results of a multivariate regression analysis indicated that a history of acute rejection (OR = 4.157, p = 0.031) and low hemoglobin (OR = 0.963, p < 0.001) were risk factors for BKV infection. Acute rejection and low hemoglobin were risk factors for BKV infection after renal transplantation.

Risk Factors and Outcome of Gram-Negative Bloodstream Infection in Living-Donor Renal Transplant Recipients: A Case-Control Study From Pakistan.

Gram-negative rods are the most common cause of bloodstream infection in renal transplant recipients. Acute rejection, urologic abnormalities, and ureteral stents are risk factors. Graft dysfunction is independently associated with gram-negative rod bloodstream infection. Our aim is to investigate the incidence, risk factors, and outcome among living donor renal transplant recipients from Pakistan. In this case-control study, we reviewed the medical records until June 2021 of renal transplant recipients seen from 2015 to 2019 for gram negative bacteremia. For every case, controls were matched by age, date of transplant, and sex. Demographics, risk factors, graft function, and mortality were compared. Clinical features, immunosuppression, source of blood stream infection, and microbiology were noted in cases. Of 1677 renal transplant recipients, 44 developed gram negative bacteremia. The incidence was 5.9 per 1000 person-years. Median time since transplant was 5 months. The most common source was urinary tract infection. On univariate analysis, antithymocyte globulin, urinary tract infection, and recurrent urinary tract infections were associated with gram negative bacteremia. On multivariate analysis, urinary tract infection (adjusted odds ratio = 3.46; 95% CI, 1.27-9.37) and recurrent urinary tract infections (adjusted odds ratio = 4.03; 95% CI, 1.15-14.15) were significant risk factors. We found no difference in 30-day mortality and estimated glomerular filtration rate on last follow-up between cases and controls. Kaplan-Meier survival curves showed significant differences in graft survival in patients with gram negative bacteremia. Escherichia coli was the most common organism, with 75% ceftriaxone and 13% imipenem resistance. The most significant risk factor for gram negative rod bloodstream infection was recurrent urinary tract infections. Timely treatment and prevention of recurrent urinary tract infections areimperative for prevention of gram negative bacteremia.

#5095 THE CURIOUS CASE OF GAS IN THE GRAFT KIDNEY

Abstract Background and Aims Emphysematous pyelonephritis (EPN) denotes a severe infection of renal parenchyma resulting in necrosis and gas accumulation in the renal and perirenal tissue. Risk factors for urinary tract infections in renal transplant recipients include advanced age, female gender, reflux nephropathy prior to transplantation, diabetes mellitus, deceased donor kidney, kidney–pancreas transplant, retransplantation, antibody induction for immunosuppression, urinary bladder catheterisation, history of allograft rejection with subsequent escalation of immunosuppressive therapy and use of ureteral stents. There are no definite guidelines for management of EPN in renal allografts. If unstable and deteriorating, graft nephrectomy should be undertaken as soon as possible. Any delay in surgical intervention, be it percutaneous drainage or nephrectomy may result in death. Method A 25-year old male, diagnosed with IgA Nephropathy (IgAN) received a living donor renal transplant from his mother in 2013 after a dialysis vintage of 3 years. He received Basiliximab induction followed by maintenance immunosuppression with Tacrolimus, Mycophenolate mofetil and Prednisolone. He had no history of UTI in the immediate post-transplant period. His blood glucose levels were within normal limits and he had not had any urological intervention. In 2019, patient was diagnosed with IgAN recurrence as a cause of chronic renal allograft injury. His Creatinine at last follow up in July 2022 was 4.1 mg/dL. He presented in September 2022 with fever, chills, vomiting, pain in the right iliac fossa and inability to extend his right leg. At presentation, his BP was 86/60mmHg, with pyrexia and tachycardia. Ultrasonography revealed an ill-defined collection superomedial to the graft kidney with doubtful posterior extension and air foci. Non-contrast CT study revealed a large subcapsular collection, extending posteriorly into the right iliac fossa involving the right psoas major and inferiorly into the pelvis, with air foci and no evidence of any urinary tract obstruction suggestive of Acute Emphysematous pyelonephritis with ruptured abscess. He was started on broad-spectrum iv antibiotics- Meropenem and Levofloxacin. Immunosuppression was reduced. Laboratory investigations revealed total leucocyte count of 37,000 cells/mm3, Creatinine of 11 mg/dL, urine routine microscopy revealed field full of pus cells. Blood and urine cultures grew ESBL Escherichia coli. He was taken up for urgent urological intervention in the form of percutaneous drain insertion. Frank pus was aspirated and 200mL drained instantaneously, cultures of which demonstrated the same organism. Within 24 hours of pus drainage, patient became afebrile and had pain relief. He was given 3 weeks of culture-appropriate iv antibiotics, to continue another 3 weeks of oral Carbapenem. However, his graft dysfunction persisted, with no recovery and he became dialysis-dependent. Discussion EPN of the renal allograft is a rare occurrence. A study of EPN in renal transplant recipients by Alexander et al from 2012 revealed 18 out of 22 patients were diabetics, 9 necessitated graft nephrectomy and 7 required percutaneous drainage in addition to antibiotics4. Till date, up to 30 cases of graft EPN have been reported in English literature. The striking feature is that more than 90% of these cases were diabetic. Conclusion The complete pathogenesis of renal allograft EPN, especially in patients with no apparent traditionally described risk factors remains yet to be understood. A high degree of suspicion and early intervention may help to save the allograft.

Urinary Tract Infection in Renal Transplant Recipients: Incidence, Microbiological Profile and Predisposing Factors in India

Renal transplant recipients (RTR) commonly encounter urinary tract infection (UTI) as the prevalent bacterial infection. In our geographical area, one-fourth of RTRs are susceptible to UTI during the post-transplant period. The improvement in surgical techniques and increased immunosuppression have enhanced graft survival. However, the subsequent escalation of infectious complications is concerning. Thus, we aimed to evaluate the frequency, predisposing factors, and microbiological characteristics of UTI among RTR.

Incidence of and Risk Factors for Recurrent Urinary Tract Infections in Renal Transplant Recipients

BackgroundRecurrent urinary tract infections (rUTIs) are common after renal transplantation (RTx), and the impact on graft and patient survival remains controversial. ObjectiveIn this study, we investigate the incidence and risk factors for rUTIs in a cohort of RTx recipients and evaluate the effect on graft and patient survival. Design, setting, and participantsA retrospective cohort of adult patients who underwent RTx at Rigshospitalet, Denmark, between 2014 and 2021 was evaluated in this study. Outcome measurements and statistical analysisRisk factors for rUTIs were explored with a multivariable cause-specific Cox proportional hazard analysis. The Kaplan-Meier estimate was used to assess overall survival. Results and limitationsA total of 571 RTx recipients were included. The median age was 52 yr (interquartile range: 42–62 yr). Of the cases, 62% were deceased donor RTx. A total of 103 recipients experienced rUTIs. We found increasing age (hazard ratio [HR]: 1.02 per year increase, 95% confidence interval [95% CI]: 1.00–1.04, p = 0.02), female gender (HR: 2.1, 95% CI: 1.4–3.3, p < 0.001), history of lower urinary tract symptoms (HR: 2.3, 95% CI: 1.4–3.5, p = 0.001), and a UTI within 30 d of surgery (HR: 3.5, 95% CI: 2.1–5.9, p < 0.001) were associated with rUTIs. No influence of rUTIs on overall or graft survival was observed. ConclusionsOne in six patients experience rUTIs after RTx. Pre- and postoperative variables affect the risk of rUTIs, but none are easily modifiable. In this cohort, rUTIs did not affect the graft function or survival. The etiology of rUTIs remains poorly understood, and there is a continuous need to study how rUTIs can be reduced and treated optimally. Patient summaryIn this study, we looked at the risk factors for recurrent urinary tract infections in patients after kidney transplantation. We conclude that 21.5% of patients experience recurrent urinary tract infections 5 years after kidney transplantation. Multiple risk factors were found and should be taken into consideration by clinicians.

Spectrum of COVID-19 infections in renal transplant recipients: A single-center case series

Objective: COVID-19 infection can be mild to devastating in renal transplant recipients. We looked at the clinical course in all the renal transplant recipients who attended our hospital for COVID-19 infection. Study Design: Case series - This was a retrospective observational study of renal transplant recipients infected with varying degrees of COVID-19 infection, who sought care in our hospital. COVID-19 infection was defined as mild, moderate, or severe based on the guidelines issued by the Ministry of Health and Family Welfare, Government of India. Settings and Participants: The study included all renal transplant recipients with a functioning graft, who attended our hospital for COVID-19 infection between July 2020 and January 2022. Their data were obtained from electronic records. Results and Observations: A total of 18 renal transplant recipients sought care at our center for COVID-19 infection. There were 19 episodes of COVID infection in these 18 patients (one reinfection). Seven of these were transplanted at our center and 11 were transplanted elsewhere and were following up at our center. Of the 18 patients, 12 (66.67%) had mild infection, 2 (11.11%) had moderate COVID-19 infection, and 4 (22.22%) had severe or critical disease. Two of the severe cases died with a functioning graft, one had graft loss, and one recovered. Acute kidney injury occurred in 22.22% of cases (n = 4). The most common presenting symptom was fever (77.78%). The most common comorbidity was hypertension. The source of infection was predominantly the community (17/18 patients). The number of renal transplants during the above period at our center was 24. The infection rate and mortality rate among these patients were 29.16% (n = 7) and 42/1000 (n = 1), respectively. Limitations: The study was based on the availability of data in our electronic records. There was no standard immunosuppression protocol followed. The retrospective design and small numbers are added limitations of our study. As we included all renal transplant recipients with COVID-19 infection irrespective of the time and place of transplant, the infection rate and mortality rate could not be computed on all 18 patients using a common denominator. Conclusion: Transplant patients have a variable outcome after COVID-19 infection. There may be an inherent individual susceptibility in addition to risk factors such as immunocompromised state and diabetes.

Spectrum of infections in renal transplant recipients, factors affecting long term patient and graft outcomes over 10 years including COVID pandemic periods

Introduction: Multiple factors including infections affect graft and patient outcomes in Renal Allograft Recipients. Survival data from tropical countries is scarce, especially during the COVID 19 pandemic. Subjects and Methods: In this ambispective study, records of KTRs between 2011 to 2019 and prospective follow up of subsequent transplants up till 2021 was done. Infection rate, etiology, and patient and graft outcomes were studied with appropriate investigations. Univariate and multivariate analysis was done to assess the predictors of patient and graft outcomes. Results: A total of 249 patients were studied, of which 218 episodes of infection occurred in 129 patients (49.79%). Bacterial infections were the most common (40.50%), followed by viral (35.20%), mycobacterial (11%), and fungal (8.10%). Of all infections, 52.3% of cases occurred within the 1st 6 months. Infections led to patient mortality in 14.7% of cases. Infections were significantly associated with graft rejection and chronic graft dysfunction. Donor age, cytomegalovirus (CMV) infection, and graft rejection were independent predictors of chronic graft dysfunction. Recipient age and graft rejection were independent predictors of graft loss. Graft survival was 88.53%, 73.75%, and 44.90% at the end of 1, 3, and 5 years, respectively, with average 18% of total graft losses occurring during the pre-COVID era as compared to 39% in COVID period. Conclusion: Invasive fungal infections and tuberculosis are more common in late transplant period. Recipient and donor age, graft rejection, CMV infection, and COVID pandemic period affected graft and patient outcomes. COVID pandemic period led to a disproportionately higher occurrence of graft loss.

Sporotrichosis in a Renal Transplant Patient: A Rare Case Report with a Review of the Literature

Sporotrichosis is a rare form of subacute and chronic fungal infection in renal transplant recipients caused by the ubiquitous fungus Sporothrix schenckii. It is usually described in renal allograft recipients who have not been treated with antifungal prophylaxis. We report a rare case of cutaneous sporotrichosis in a 39-year-old renal allograft recipient already on antifungal prophylaxis, who presented with skin lesions. The diagnosis was made from a skin biopsy. The patient had increased tacrolimus levels after starting treatment with itraconazole, which was later changed to terbinafine and cryotherapy. The patient responded to treatment with regression of his lesions.

Impact of Immunosuppression on the Severity of SARS-CoV-2 Infection in Renal Transplant Recipients

Resumen: Los pacientes transplantados renales presentan una elevada tasa de letalidad después de la infección por síndrome respiratorio agudo grave 2(Sars-CoV-2). Además de esto, la respuesta inmune de vacuna es menor y menos duradera, lo que los torna más susceptibles a formas graves, incluso cuando están vacunados. Las evidencias sugieren que, además de la edad avanzada y de la elevada prevalencia de comorbilidades frecuentemente asociadas a un peor pronóstico, como diabetes, obesidad y enfermedades cardiovasculares, la inmunosupresión prolongada ejerce un efecto independiente sobre los resultados. De hecho, la respuesta inmune adaptativa celular y humoral, la cual está inhibida por la inmunosupresión, es un paso fundamental para la resolución de la infección por Sars-CoV-2. Por otro lado, la inhibición linfocitaria podría modular la producción aberrante de citoquinas proinflamatorias que resultan en el grave comprometimiento pulmonar, amenizando la gravedad del cuadro. Además de esto, algunos fármacos inmunosupresores poseen propiedades antivirales, potencialmente aplicables al coronavirus. Esta revisión narrativa tuvo como objetivo discutir las evidencias disponibles sobre el impacto de los fármacos inmunosupresores sobre los resultados del Covid-19 en transplantados renales

Impact of Immunosuppression on the Severity of SARS-CoV-2 Infection in Renal Transplant Recipients

Abstract: Kidney transplant patients have a high case fatality rate following severe acute respiratory syndrome 2 (SARS-CoV-2) infection. In addition, the vaccine immune response is lower and less durable, which makes them more susceptible to severe forms, even when vaccinated. Evidence suggests that in addition to advanced age and the high prevalence of comorbidities often associated with worse prognosis, such as diabetes, obesity, and cardiovascular disease, prolonged immunosuppression exerts an independent effect on outcomes. In fact, the cellular and humoral adaptive immune response, which is inhibited by immunosuppression, is a key step in resolving SARS-CoV-2 infection. On the other hand, lymphocyte inhibition could modulate the aberrant production of proinflammatory cytokines that result in severe lung impairment, mitigating the severity of the condition. In addition, some immunosuppressive drugs have antiviral properties, potentially applicable to coronavirus. This narrative review aimed to discuss the available evidence on the impact of immunosuppressive drugs on COVID-19 outcomes in kidney transplant recipients

Risk Factors for Polyomavirus, Cytomegalovirus, and Viruria Co-Infection for Follow-Up of Renal Transplant Patients.

BACKGROUND The interaction of viral infection may be associated with increased morbidity after renal transplantation. This study aimed to identify the incidence and risk factors of viruria infections in renal transplant recipients. MATERIAL AND METHODS In this longitudinal study, 502 episodes recorded in 81 kidney transplant patients from 1/2019 to 12/2021 in a hospital in Vietnam were included. BK, JC polyomaviruses, CMV, EBV, and HSV were detected. Multivariable Cox regression analysis was performed to evaluate risk factors for the viruria infection. RESULTS Fifty-six patients (69.1%) had viruria co-infection. The incidence of JC, CMV, and BK infection was the most common viruria, with 67.9%, 61.7%, and 56.8%, respectively. Cox regression revealed that the risk factors for JC were single infection, dose of MMF (HR 1.002), corticoid (HR 1.02), hypertension (HR 1.65), and hematuria (HR 2.03); risk factors for CMV infection were male sex (HR 1.92) and eGFR (HR 0.98); risk factors for BK single infection were hypertension (HR 1.67), proteinuria (HR 3.80), higher tacrolimus trough level (HR 1.17), and dose of MMF (HR 1.002). Hypertension (HR 1.68), fasting plasma glucose (HR 1.13), proteinuria (HR 6.01), tacrolimus trough level (HR 1.12), and dose of MMF (HR 1.004) were independent risk factors for the viruria co-infection. CONCLUSIONS Kidney function was associated with the incidence of viruria. Higher tacrolimus trough level and dose of MMF were associated with higher risk of BK, JC, and co-infection.

Correlation between CYP3A5 gene polymorphism and BK virus infection in kidney transplant recipients

BackgroundCytochrome P450 3A5 (CYP3A5) includes two active genotypes, namely CYP3A5*1/*1 or *1/*3 with the fast metabolic activity and CYP3A5*3/*3 with slow metabolic. We retrospectively analyzed the correlation between CYP3A5 gene polymorphism and the susceptibility to the BK virus (BKV) infection in renal transplant recipients. MethodsAccording to the inclusion/ exclusion criteria, we selected 134 recipients who received kidney transplantation at the Renmin Hospital of Wuhan University from January 2019 to December 2019. Based on the pre-operative CYP3A5 sequencing results, 134 recipients were divided into two groups: those expressing the fast metabolic CYP3A5*1/*1 or *1/*3 genotype; and, those expressing slow metabolic CYP3A5*3/*3 genotype. These two recipient groups were then analyzed for the BKV infection rate with different metabolic types to establish the potential relationship between CYP3A5 gene polymorphism and BKV infection. ResultsThe overall incidence of BKV viruria was 37.3%, whereas BKV viremia was 4.5% among all 134 recipients. The fast metabolism group had 9.1% incidence of BKV viremia and 49.1% incidence of BKV viruria. In contrast, the slow metabolism group had only 1.3%incidence of BKV viremia (P = 0.031) with only 29.1% BKV viruria (P = 0.011). The incidence of low levels of urinary BKV in the fast metabolism group was higher than that in the slow metabolism group (P = 0.005), while no significant statistical difference in the incidence of high levels of urinary BKV and high and low levels of blood BKV. ConclusionAfter kidney transplantation, CYP3A5 gene polymorphism of recipients present a certain relationship with the occurrence of BKV infection, which may be of value for the prediction and prevention of BKV infection.

P8.016: Gram Negative Blood Stream Infection in Renal Transplant Recipients: Risk Factors and Outcome From a Transplant Center in Pakistan

Background: Gram-negative bacteremia (GNB) is a common cause of bloodstream infection in renal transplant recipients (RTR). The risk factors are cytomegalovirus infection (CMV), pre-transplant dialysis, acute rejection, urological abnormalities, and ureteral stent. The mortality rate is 2.5 to 11%. Considering the huge impact on morbidity and mortality, our aim is to analyze the characteristics and outcomes of GNB in RTRs. Methods: A case-control study at Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan. The files of all renal transplant recipients who had documented GNB from January 2015 to December 2017 were reviewed till December 2020. The controls were matched with age, sex, and date of transplant. The first episode of GNB was taken. Clinical features, received anti-thymocyte globulin (ATG) or solumederol and cytomegalovirus infection (CMV) 90 days pre or post bacteremia, recurrent urinary tract infections (UTI), source of bacteremia and microbiology, all-cause mortality at day 28 and graft function at the last follow up were noted. Results: Out of 1009 RTR, 33 (3.3%) episodes of GNB occurred. The mean age was 30±11.85years, 61% males. Around 48% developed bacteremia within 6 months post-transplant. The most common source was UTI (75.8%). Fever in 48% and only 39% had leukocytosis. Around 9% were admitted in the intensive care unit. E-coli was the most common organism (70%) (Table 1). Stone disease at the time of transplant was significantly associated with bacteremia (p=0.029). There was no difference in receiving ATG or solumeredol and CMV before bacteremia. A significant number of patients received solumeredol for rejection (p=0.035) and had CMV (p=0.044) within 90 days after bacteremia. Recurrent UTI is significantly associated with bacteremia (p<0.001). The graft function at the last follow-up (2 years) was significantly deranged in patients with bacteremia (p=0.0001). Conclusion: Gram-negative bacteremia was found in 3% of RTR and half of them developed within 6 months post-transplant. UTI was the most common source and recurrent UTI was significantly associated with bacteremia. The stone disease was the most significant risk factor. Patients develop rejection and CMV infection within 3 months post bacteremia. There was a significant graft dysfunction among patients with bacteremia at a mean follow-up of 2 years. We need to focus on the management of recurrent UTIs to prevent bacteremia and graft dysfunction in renal transplant recipients.

210.1: Immunosuppression Minimization During COVID Infection: Is It Safe?

Introduction: Managing post-transplant COVID-19 patients has proven challenging. On one hand, they are more vulnerable due to their immunocompromised status, and on the other hand, reducing immunosuppression (IS) may result in graft rejection and formation of de-novo donor specific antibodies (DSA). Here, we share our experience of balancing disease treatment and the risk of rejection in a cohort of renal post-transplant recipients. Methods: We retrospectively collected data on 136 renal transplant recipients who were diagnosed with COVID-19 between May 2020 and December 2021. Clinical information, demographics and HLA antibody data were extracted from patients’ medical records. Results: The median time from transplant to COVID-19 diagnosis in our cohort was 4.1 years (range 13 days to 30.8 years). The average age at diagnosis was 50.5 and 63% were males. 28% of the patients were hospitalized and 13.2% had died as a result of their infection. The most common therapies included Monoclonal antibodies (39.7%), Dexamethasone (22%) and Remdesivir (18.4%). IS modulation, which primarily included holding off the anti-metabolite, was done in 98/136 patients (72%), and was later resumed in 70 of the 98 patients with a median time of 8.6 days (range 2-204) from holding off to resuming IS. 25 patients had pre- and post-infection DSA data. Despite the modulation in IS, 23 out of the 25 patients did not exhibit a change in DSA status (within a median time follow up of 70 days) nor a significant change in sensitization status as determined by calculated panel reactive antibody (cPRA). Only two patients developed de-novo DSA post COVID-19 infection, however a biopsy performed on one patient did not show acute rejection. Four patients progressed to graft failure post infection - Two due to worsening chronic antibody mediated rejection, one had renal injury due to direct effects of COVID-19 infection, and one had failing graft before COVID-19, suffered a severe disease including intubation and lost his graft shortly after recovering. Conclusions: Reduction of the anti-metabolic immunosuppressive therapy for a short period of time did not seem to correlate with development of de-novo DSA or increased rates of acute rejection in our expanded cohort. Studies on larger cohorts will help further determine the impact of IS reduction on transplant outcomes following COVID-19 infection in renal transplant recipients.

POS-083 CLINICAL, RADIOLOGICAL, MICROBIOLOGICAL PROFILE AND OUTCOMES OF PULMONARY INFECTIONS IN RENAL TRANSPLANT RECIPIENTS: A PROSPECTIVE STUDY

Pulmonary infections in renal transplant recipients (RTR) may range from diverse forms lung parenchyma and pleura involvement with different typical and atypical bacteria, viruses, fungi and mycobacteria. Radiological and microbiological diagnosis is essential to plan management. This study assesses the clinico-radiological, microbiological and outcomes of pulmonary infections in RTR.

COVID-19 Infection in Renal Transplant Recipients at Dubai Hospital: Incidence, Clinical Profile, and Outcome

Background: Renal transplant recipients are at risk to acquire COVID-19 infection quite frequently, owing to their immunocompromized state. Nevertheless, data on the effects of this infection on patients and graft function are sparse from the Arab world. Methods: This retrospective cohort study was conducted in Dubai Hospital from April 1, 2020, to August 1, 2021. We analyzed 42 COVID-19-positive renal transplant recipients’ data. Information concerning demographics, comorbidities, medications, clinical and laboratory data, and outcomes was collected from the electronic medical records. Univariate analyses were performed to determine the association of acute kidney injury (AKI) with in-hospital mortality. Results: Median age was 47.46 (17–66) years; about 59% of patients were male. Eleven (26.19%) patients developed AKI during hospitalization. On admission high ferritin, C-reactive protein, creatinine, and low absolute lymphocyte count are identified risk factors for in-hospital AKI. Seven (21.87%) patients had their calcineurin inhibitor levels touch a toxic peak possibly due to an interaction with antivirals. Mortality was 14.28%, and the same number of patients required mechanical ventilation during treatment. Conclusion: A significant number of renal transplant recipients suffered from AKI during COVID-19 infection, and the mortality rate in this study population was less than in studies from other countries in the region. More insights are required to manage this infection in renal transplant recipients.

Frequency of urinary tract infections in renal transplant recipients with common bacteria and its sensitivity

Objective: To determine the frequency of urinary tract infection and its common pathogens with antibiotic sensitivity among renal transplant recipients.&#x0D; Materials and methods:&#x0D; This Cross sectional descriptive study was conducted at Institute of Kidney Diseases (IKD) Hayatabad, Peshawar from January 2008 to December 2012. The cross section included 74 live related renal transplant recipients. Each renal transplant recipient was followed up for 3mpnths for developing urinary tract infection.&#x0D; Results: &#x0D; A total of 74 patients were followed after renal transplant. Among them 12 (16.22%) were females and 62 (83.78%) were males respectively. They were all live related renal transplant. UTI developed in 27/74 (36.48%) patients at first 3 months after transplantation (60 ± 15 days). Female patients were more susceptible to UTI than male patients (5 female 41.66%; 22 male 35.48%). On univariate analysis, older age (p?=?0.015), female gender (p?&lt;?0.001), hyperglycaemia (p?=?0.037) and acute rejection episodes (p?=?0.046) were all risk factors for developing urinary tract infection. Isolated bacteria were Escherichia coli (59.25%), Candida albicans (18.51%), Klebsiella (11.11%), Enterococcus spp. (7.40%), followed by Pseudomonas aeruginosa 3.70%. Antibiotic resistance was 26% for ciprofloxacin and 33% for ampicillin.&#x0D; Conclusion: Urinary tract infection is a major problem in renal transplant recipients. The female gender, increasing age and uncontrolled hyperglycemia are the risk factors for UTI in renal transplant recipients. There is high resistance to ampicillin and quinolones in renal transplant recipients.&#x0D; &#x0D;

Unusual Presentation of Disseminated Mycobacterium kansasii Infection in Renal Transplant Recipients and Rapid Diagnosis Using Plasma Microbial Cell-free DNA Next-generation Sequencing.

Unusual Presentation of Disseminated Mycobacterium kansasii Infection in Renal Transplant Recipients and Rapid Diagnosis Using Plasma Microbial Cell-free DNA Next-generation Sequencing.