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Infections in Kidney and Pancreas Transplantation

  • Megan K. MoralesEmail author
  • Matthew Cooper
  • Peter Abrams
  • Joseph G. TimponeJr.
Chapter

Abstract

The optimal treatment for patients with chronic kidney disease (CKD) requiring renal replacement therapy/dialysis is kidney transplantation. Additionally, pancreas transplantation alone or simultaneous pancreas-kidney transplantation offers improved quality of life as well as reversion or prevention of complications seen in patients with type 1 diabetes mellitus. Patients with CKD on dialysis are at increased risk for bacterial and blood-borne viral pathogens. During the initial first month posttransplantation period, kidney and kidney-pancreas transplant recipients are at increased risk for healthcare-acquired infections and complications associated with surgery. Over the next 6 months, during the period of maximal immunosuppression, these patients are at increased risk for opportunistic infections such as BK polyomavirus and cytomegalovirus. Anti-infective prophylactic strategies have been developed to decrease rates of specific opportunistic infections during this time period. Beyond 6 months, patients are at increased risk for community-acquired infections, including bacterial and fungal infections such as invasive molds, endemic mycoses, as well as the complications of chronic immunosuppressive therapy. This chapter provides a brief overview of kidney and pancreas transplantation with regard to types of transplantations, selection criteria, surgical procedures, and immunosuppressive regimens. It will then focus on infectious complications encountered in patients on dialysis and the pretransplantation evaluation for patients awaiting organs. Infectious complications that are specific to kidney and pancreas transplantation are reviewed in detail, including the role of anti-infective prophylaxis. Specific infectious etiologies and syndromes that are related to kidney and pancreas transplantation will also be presented.

Keywords

Kidney transplant Pancreas transplant Chronic kidney disease Transplant evaluation Immunosuppressive therapy Healthcare-acquired infections Opportunistic infections Donor-derived infections Antimicrobial prophylaxis Urinary tract infection/pyelonephritis 

Abbreviations

AB

Asymptomatic bacteriuria

ATG

Antithymocyte globulin

BKPyV

BK polyomavirus

CDI

Clostridium difficile infection

CMV

Cytomegalovirus

CNI

Calcineurin inhibitors

CRAB

Carbapenem-resistant Acinetobacter baumannii

DAA

Direct-acting agent

EBV

Epstein-Barr virus

eGFR

Estimated glomerular filtration rate

EIA

Enzyme immunoassay

FDA

Food and Drug Administration

FQ

Fluoroquinolone

HBV

Hepatitis B virus

HCV

Hepatitis C virus

HIV

Human immunodeficiency virus

HLA

Human leukocyte antigen

HRD

High infectious risk donor

HSV

Herpes simplex virus

ICU

Intensive care unit

IGRA

Interferon-gamma release assay

INH

Isoniazid

IPA

Invasive pulmonary aspergillosis

IVIG

Intravenous immunoglobulin

KDIGO

Kidney disease: improving global outcomes (clinical practice guidelines sponsored by the National Kidney Foundation)

KPC

Klebsiella pneumoniae carbapenemase

KS

Kaposi sarcoma

MDR

Multidrug resistant

MDRO

Multidrug-resistant organism

mTOR

Mammalian target of rapamycin

NAT

Nucleic acid testing

OI

Opportunistic infection

OKT3

Muromonab-CD3

OPO

Organ procurement organization

OPTN

Organ Procurement and Transplantation Network

PAK

Pancreas after kidney

PCP

Pneumocystis pneumonia

PCR

Polymerase chain reaction

PEP

Postexposure prophylaxis

PF

Perfusion fluid

PPFC

Peripancreatic fluid collection

PTA

Pancreas transplant alone (i.e., not combined with renal transplantation)

PTLD

Posttransplant lymphoproliferative disorder

QALY

Quality-adjusted life year

RNA

Ribonucleic acid

SOT

Solid organ transplant

SPK

Simultaneous pancreas-kidney transplant

SRTR

Scientific Registry of Transplant Recipients

SVR

Sustained virologic response

TB

Tuberculosis

TMP-SMX

Trimethoprim-sulfamethoxazole

UNOS

United Network for Organ Sharing

UTI

Urinary tract infection

VZV

Varicella-zoster virus

WNV

West Nile virus

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Megan K. Morales
    • 1
    Email author
  • Matthew Cooper
    • 2
  • Peter Abrams
    • 3
  • Joseph G. TimponeJr.
    • 4
  1. 1.University of Maryland School of Medicine, Institute of Human Virology/Department of Infectious DiseasesBaltimoreUSA
  2. 2.MedStar Georgetown Transplant InstituteWashington, DCUSA
  3. 3.MedStar Georgetown University Hospital, MedStar Georgetown Transplant InstituteWashington, DCUSA
  4. 4.MedStar Georgetown University Hospital, Division of Infectious Diseases and Travel MedicineWashington, DCUSA

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