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Kidney Transplantation in Sensitized Patients pp 53–62Cite as

Postoperative Management

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Abstract

For successful kidney transplantation in sensitized patients, more immunosuppressive method such as rituximab and plasmapheresis are used. Therefore, proper prevention and monitoring of infectious disease is very important in sensitized kidney transplantation.

Although the infectious risks might be different according to the desensitization protocols and the methods of prophylaxis, higher incidences of urinary tract infection, pneumocystis pneumonia, and viral infections such as BK virus, cytomegalovirus, and herpes virus have been reported (Morath et al., Front Immunol. 8:234, 2017). Our center data showed that cytomegalovirus infection and pneumonia occurred more often in ABO-incompatible kidney transplant recipients than ABO-compatible kidney transplant recipients (Baek et al., Nephron Extra. 2(1):66–75, 2012; Kwon et al., Medicine. 95(32):e4249, 2016). However, infectious risk was not increased in ABO-incompatible and HLA-sensitized kidney transplantation after modification of immunosuppressive protocol with reducing immunosuppression (Baek et al., BMC Nephrol. 16:201, 2015). In a recent meta-analysis study (de Weerd and Betjes. Clin J Am Soc Nephrol 13:1234–43, 2018), severe non-viral infection such as sepsis, pneumonia, and fungal infection was more common in ABO-incompatible kidney transplant recipients (RR, 1.44; 95% confidence interval, 1.13–1.82; P = 0.003; I2 = 39%; P = 0.06). CMV viremia and BK viremia occurred more often in ABO-incompatible kidney transplantation (RR, 1.20; 95% confidence interval, 1.04–1.37; P = 0.01; I2 = 17%; P = 0.26 for CMV viremia and RR, 1.70; 95% confidence interval, 1.14–2.56; P = 0.01; I2 = 45%; P = 0.03 for BKV viremia).

More delicate monitoring and preventive strategies might be necessary for sensitized kidney transplantation. Because there is no guidelines for this special group, modification and applying general guidelines to sensitized patients according to individualized clinical situation is necessary. In addition, common medical problems such as hypertension, dyslipidemia, and hyperglycemia should be controlled well for better transplantation outcomes. In this chapter, postoperative infection monitoring and management and general medical care were reviewed.

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Chung Hee Baek

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  1. Department of General Surgery, Asan Medical Center, Seoul, Korea (Republic of)

    Duck Jong Han

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Baek, C.H. (2020). Postoperative Management. In: Han, D. (eds) Kidney Transplantation in Sensitized Patients. Springer, Singapore. https://doi.org/10.1007/978-981-10-7046-4_5

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  • DOI: https://doi.org/10.1007/978-981-10-7046-4_5

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