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Infections in Kidney and Pancreas Transplantation

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Principles and Practice of Transplant Infectious Diseases

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.

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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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Authors and Affiliations

  1. University of Maryland School of Medicine, Institute of Human Virology/Department of Infectious Diseases, Baltimore, MD, USA

    Megan K. Morales

  2. MedStar Georgetown Transplant Institute, Washington, DC, USA

    Matthew Cooper

  3. MedStar Georgetown University Hospital, MedStar Georgetown Transplant Institute, Washington, DC, USA

    Peter Abrams

  4. MedStar Georgetown University Hospital, Division of Infectious Diseases and Travel Medicine, Washington, DC, USA

    Joseph G. Timpone Jr.

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  1. Megan K. Morales
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  4. Joseph G. Timpone Jr.
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Correspondence to Megan K. Morales .

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  1. Clinical Associate Professor of Medicine, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, USA

    Amar Safdar

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Morales, M.K., Cooper, M., Abrams, P., Timpone, J.G. (2019). Infections in Kidney and Pancreas Transplantation. In: Safdar, A. (eds) Principles and Practice of Transplant Infectious Diseases. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-9034-4_4

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