INFECTIOUS DISEASES ASSOCIATED WITH RENAL HOMOTRANSPLANTATION

Abstract

Infectious diseases occurred in 26 of 30 renal homotransplantation patients and contributed to eight of the 12 deaths in this series. There were 52 infections, 17 occurring before and 35 after transplantation. Infections were produced primarily by staphylococci, Pseudomonas species, and the enteric gram-negative bacilli. Staphylococcal infections occurred in 17 of 19 carriers of this organism and in only one of 11 noncarriers. Thirty-three of the 35 postoperative infections followed the intensification of immunosuppressive therapy for treatment of attempted homograft rejection. Granulocytopenia, steroid-induced diabetes, and hypogammaglobulinemia, from suppressive drug therapy, routinely preceded the onset of these complications. The infections, largely of endogenous origin, occurred when the host’s defense mechanisms were depressed.

Fig 1

Time of appearance of infections following renal transplantation. Majority occurred after homograft rejection crisis when actinomycin C and prednisone 100–200 mg daily are added to basic azathioprine immunosuppressive regimen.

Fig 2

(case 2).—Course and treatment after renal homotransplantation.

Fig 3

(case 3).—Chest roentgenogram taken on day prior to death. Tuberculous cavity in the right lower lobe and Esch coli pneumonia in left lower lobe.

Fig 4

(case 4).—Lateral lumbar spine view. Note erosion of the L1–L2 articular surfaces.