Bacterial and Viral Infection and Sepsis in Kidney Transplanted Patients

Abstract

Kidney transplanted patients are a unique population with intrinsic susceptibility to viral and bacterial infections, mainly (but not exclusively) due to continuous immunosuppression. In this setting, infectious episodes remain among the most important causes of death, with different risks according to the degree of immunosuppression, time after transplantation, type of infection, and patient conditions. Prevention, early diagnosis, and appropriate therapy are the goals of infective management, taking into account that some specific characteristics of transplanted patients may cause a delay (the absence of fever or inflammatory symptoms, the negativity of serological tests commonly adopted for the general population, or the atypical anatomical presentation depending on the surgical site and graft implantation). This review considers the recent available findings of the most common viral and bacterial infection in kidney transplanted patients and explores risk factors and outcomes in septic evolution.

Keywords: bacterial infection; kidney transplantation; sepsis; viral infection.

Figure 1

A schematization of immune system prevalent activation during viral and bacterial infection and different effects of common immunosuppressants. T-cell activation is crucial in viral infection control, whereas the innate immune system prevalently mediates response against bacteria. Immunosuppressive drugs have multiple effects on the immune system, with prevalent inhibition of T-cells (i.e., CNI) or innate system (i.e., Eculizumab), and consequent careful reduction during infective episodes should take into account their different profile. CNI: calcineurin inhibitors; MMF: mycophenolate mofetil; ATG: anti-thymocyte globulin; mTORi: mammalian target of rapamycin inhibitors. This figure was created with BioRender.com.