Infection in Renal Transplant Recipients

Cardiovascular complications after COVID-19 in chronic kidney disease, dialysis and kidney transplant patients

The coronavirus disease 2019 (COVID-19) is associated with increased mortality in patients with chronic kidney disease (CKD), dialysis patients and kidney transplant recipients (KTR). Cardiovascular complications, such as sudden arrhythmias, thromboembolic events, coronary events, cardiomyopathies and heart failure, may present in about 10–20% of patients with COVID-19. Patients with CKD, dialysis patients and KTR are all at increased cardiovascular risk and present with more cardiovascular complications after COVID-19 compared to the general population. During the pandemic, health care giving has rapidly changed by reducing elective outpatient reviews, which may refrain these high-risk patients from the appropriate management of their medical conditions, further increasing cardiovascular risk. Importantly, acute kidney injury (AKI) is another common complication of severe COVID-19 and associates with increased mortality. A large proportion of the AKI patients need renal replacement treatment, while 30% of them may not present renal function recovery and remain dialysis-dependent after discharge, thereby having potentially increased future cardiovascular risk. This review summarizes current knowledge regarding the cardiovascular events and mortality in patients with CKD or undergoing hemodialysis and in KTR.

[Types of infectious complications exciters in recipients of related kidneys]

AIM

To investigate the nature of microflora causing an infectious-inflammatory complications in recipients of related kidney in the early postoperative period and to substantiate the effectiveness of antibiotic prophylaxis and antibiotic therapy depending on pathogen type with the determination of its sensitivity to antimicrobial agents.

MATERIAL AND METHODS

The medical records of 255 patients who underwent kidney transplantation from a living related donor from 2007 to 2014 were analyzed. Foci of infection were sanitized preoperatively to prevent infectious complications in post-transplantation period. Immunosuppression induction was achieved using 2-fold administration of Kempas or Simulect. Corticosteroids, ciclosporin, prograf, advagraf, myfortic, neoral, sertican were used for routine immunosuppression. Complications after kidney transplantation were detected in 65 (25.5%) patients including 38 (14.9%) infectious and 27 (10.6%) non-infectious complications. The material for microbiological examination included blood, urine, sputum, wound discharge, bronchial lavage. Extraction and identification of microorganisms were carried out according to conventional techniques as well as using automatic Vitec-2 Compact analizer («BioMeriex», France). Sensitivity to antibiotics was determined using Vitek-2 Compact analyzer. The functional aspects of transplanted kidney were studied in 255 patients. Normal and decreased function of kidney was observed in 221 (86.6%) and 30 (11.8%) cases respectively. Transplantant did not function in 4 (1.57%) patients.

RESULTS

The probability of infection is highest in the early postoperative period. Risk factors were inadequate and prolonged antibiotic therapy, unrecognized infection postoperatively. The main problem in renal transplant recipients is urinary tract infection (90% of patients).

[Infectious complications after kindred kidney allotransplantation]

It was analyzed the medical records of 231 patients who underwent living kindred donor kidney transplantation. Early postoperative complications were observed in 51 (22%) patients including infectious events in 30 cases namely pyelonephritis (13), pneumonia (6), sepsis (5), wound infection (3), pulmonary tuberculosis (2) and esophageal mycosis (1). Microflora investigation revealed predominantly gram-negative bacteria including enterobacteriaceae (K. pneumoniae, E. coli and E. cloacae) and nonfermentable bacteria (P. aeruginosa, Acinetobacter spp.). Analysis of 7-year antibiotic susceptibility showed that polymyxin, imipenem, cefoperazone/sulbactam and amikacin preserve their activity against enterobacteriaceae and pseudomonas; linezolid, vancomycinum and moxifloxacin--against staphylococcus; voriconazole, amphotericinum B and fluconazole--against Candida spp. These medicines are preferred for antibiotic prevention of perioperative and early postoperative infectious complications.