[Infectious complications after renal transplantation]

Abstract

Infections still represent a major clinical issue in the field of renal transplantation, impacting on graft and patient survival. Post-surgical complications in the immediate post-transplantation period, and immunosuppression (related to the use of new drugs such as mycophenolate mofetil, rapamicin, sirolimus and tacrolimus, and of increasingly aggressive immunosuppressive regimens) in later phases entail an increased risk for infection. Bacteria (in particular Enterobacteriaceae, non-fermenting Gram-negative bacilli and Enterococcus spp) and Candida spp are a frequent cause of urinary tract infection in the early post-transplantation phase. Cytomegalovirus (CMV) is a frequent infectious complication (20-60% of patients) whose risk is enhanced by mycophenolate mofetil. It can cause a variety of diseases: organ or disseminated acute disease, acute graft rejection, chronic allograft nephropathy, graft glomerulopathy, renal artery stenosis, induction of secondary bacterial or mycotic disease. Monitoring CMV antigenemia (pp65) allows a strategy based on pre-emptive therapy among patients with evidence of virological activity. BK virus (BKV) is a polyomavirus associated to various clinical syndromes in severely immunocompromised patients, such as haemorrhagic cystitis, ureteral stenosis and others. The variety and severity of infectious complications in this field mandate a multidisciplinary approach involving, next to the nephrologist and the surgeon, an infectious disease consultant and a clinical microbiologist.