INFECTIONS IN KIDNEY TRANSPLANT RECIPIENTS :SINGLE CENTER EXPERIENCE FROM TERTIARY CARE CENTER IN SOUTH INDIA

ABSTRACT

Introduction: Infections occurring in the post transplant period are the major cause of morbidity and mortality in renal transplant recipients. Early infections (within the first month) are more likely to be due to nosocomially acquired pathogens, surgical issues, and donor-derived infections. Opportunistic pathogens occur after 6 months, reflects the greater impact of immunosuppressive therapies. Late infections may be secondary to opportunistic pathogens or conventional ones. Methods: It is a retrospective observational study.All hospitalised patients with infections were included between November 2019 to march 2022 excluding covid 19 infections.Infections were categorised based on time line of infection into less than one month, 1-6 months and more than 6 months and sub categorised based on type of organisms and source of infection.All baseline characteristics, labs, microbiological including serology, PCR and cultures, radiological findings and histopathological findings were noted.Complications including graft dysfunction and need for various supports such as O2, ionotropes, ventilator and dialysis and treatment details and in hospital patient outcomes were analysed using descriptive statistics. Results: 53 patients admitted with infection in the given period were included in the study.Among them 88.67% were males and 11.33% females. In the study population 66.03 % underwent live related renal transplant and 33.97% underwent deceased donor transplantation. Mean age of the study population was 35.2 years. There were 118 events of infection identified during the study period.UTI was the most common post-transplant infection and occurred in 36.44 % of total events. There were 13 events of post-transplant infection in the first month. Most common infection in early post-transplant period was UTI, 53.84 % of events of UTI occurred followed by pneumonia in 23.07% of total events. E coli was isolated in 57.14 % of events There were 48 events of infections in the period of 1- 6 months.UTI was the most common infection (37.5 % of total events ) and E coli was the most common organism isolated(44.44 %). Pneumonia was the second commonly occurred event in 18.75 % of total events and Klebsiella was the most common isolated ( 55.56 % ).CMV disease was identified in 10.41% events, 40 % had tissue invasive CMV, 60% presented with cytopenia. There were 57 events of infections after 6 months, UTI was the most common infection(31.57% events) and E coli was the most common organism (44.00%).Pneumonia occurred in 19.29% followed by skin and soft tissue infection (13.94 %)herpes zoster ( 8.75% ) gastroenteritis(7.01%), BKVN (5.26%),oral candidiasis (3.50%)CMV disease (3.50%), tuberculosis(3.5%), meningitis (1.75%) and dengue(1.75%). 95.76% of infectious event was associated allograft dysfunction and 22.64 % of the study population had PTDM. In 15.25 % of events, patients had septic shock at presentation.Amongst them 44.44% had urosepsis, 33.33% had pneumonia, 22.22% had acute gastroenteritis. 18.86 % expired during hospital stay,amongst them 60 % had pneumonia and 30% had urosepsis and 10% had acute gastroenteritis. [Formula presented] [Formula presented] [Formula presented] [Formula presented] Conclusions: Patients who undergo renal transplantation are subjected to immunosuppression which increase the burden of infections in the post-transplant period.Early and accurate diagnosis is the key to prevent morbidity and mortality of renal transplant recipients No conflict of interest