Infections of Renal Transplantation Recipients in Cyclosporin Era

Kim, Seong Hoon; Min, Seung Kee; Ahn, Moon Sang; Huh, Seung; Ha, Jongwon; Chung, Jung Kee; Oh, Myoung Don; Choe, Kang Won; Kim, Sang Joon

Abstract

Adding to the previous reports about the infectious complications in renal transplant recipients in azathioprine era, we conducted this retrospective study to analyse the incidence and pattern of posttransplant infections in cyclosporin era and its impact on graft and patient survival. Among 482 patients who performed renal transplantation (tpl) from Mar. 1985 to Dec. 1997 at Seoul National University Hospital, 133 infections developed in 105 patients (21.8% incidence). These infections were grouped into 3 categories; Perioperative (infection within first month after tpl: N=19), Early (infection between 1 to 6 months after tpl: N=24), and Late (infection more than 6 months after tpl: N=87). According to the anatomical site of infection, skin (49 cases) was the most common site of infection, followed by lung (36), oropharynx (13), urinary tract (12). Regarding the etiologic organisms of microbiologically documented 108 infections, viral infections were most common (60.2%), followed by bacterial (22.2%), fungal (14.8%), and others (2.8%). In viral infections, Varicella zoster virus infection was most common (58%). Bacterial infections included 12 Mycobacteral infections, 10 Gram (-), and 2 Gram (+) bacterial infections. In fungal infections, tinea was most common in 8 cases, followed by candidiasis in 3, cryptococcosis in 2, and aspergillosis in 1. Incidence of rejection episode was statistically higher in patients with infection than those without infection (40.0% vs 28.4%; p=0.023). Among 28 mortalities, infection-related deaths were 7. In conclusion, aggressive diagnostic strategies including invasive procedures to characterize the organisms and specific treatment is the best way to reduce the morbidity and mortality.