Infections in Kidney and Pancreas Transplantation

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


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.


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 



Asymptomatic bacteriuria


Antithymocyte globulin


BK polyomavirus


Clostridium difficile infection




Calcineurin inhibitors


Carbapenem-resistant Acinetobacter baumannii


Direct-acting agent


Epstein-Barr virus


Estimated glomerular filtration rate


Enzyme immunoassay


Food and Drug Administration




Hepatitis B virus


Hepatitis C virus


Human immunodeficiency virus


Human leukocyte antigen


High infectious risk donor


Herpes simplex virus


Intensive care unit


Interferon-gamma release assay




Invasive pulmonary aspergillosis


Intravenous immunoglobulin


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


Klebsiella pneumoniae carbapenemase


Kaposi sarcoma


Multidrug resistant


Multidrug-resistant organism


Mammalian target of rapamycin


Nucleic acid testing


Opportunistic infection




Organ procurement organization


Organ Procurement and Transplantation Network


Pancreas after kidney


Pneumocystis pneumonia


Polymerase chain reaction


Postexposure prophylaxis


Perfusion fluid


Peripancreatic fluid collection


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


Posttransplant lymphoproliferative disorder


Quality-adjusted life year


Ribonucleic acid


Solid organ transplant


Simultaneous pancreas-kidney transplant


Scientific Registry of Transplant Recipients


Sustained virologic response






United Network for Organ Sharing


Urinary tract infection


Varicella-zoster virus


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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