Differential diagnosis of infection following renal transplantation
- John Vella, MD, FACP, FRCP, FASN
John Vella, MD, FACP, FRCP, FASN
- Associate Professor of Medicine
- Tufts University School of Medicine
- Section Editor
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
Infections are the leading cause of morbidity and mortality in the early posttransplant period as more than 80 percent of recipients suffer at least one episode of infection in the first year. Infection and allograft dysfunction caused by rejection are closely interrelated through the use of immunosuppressive therapy . The level of overall immunosuppression used for induction therapy, maintenance therapy, and the treatment of acute rejection episodes is the major risk factor for posttransplant infection, rather than the use of a specific immunosuppressive agent .
In addition, patterns of opportunistic infections after transplantation have been altered by routine antimicrobial prophylaxis for Pneumocystis carinii (also called P. jirovecii) and cytomegalovirus (CMV). These patterns are changing due to the emergence of new clinical syndromes (such as polyoma virus allograft nephropathy) and by infections due to organisms with antimicrobial resistance. New quantitative molecular and antigen-based microbiologic assays detect previously unrecognized transplantation-associated pathogens such as lymphocytic choriomeningitis virus. These assays are used in the management of common infections such as those due to CMV and Epstein-Barr virus (EBV) .
The risk of infection is influenced by a variety of other factors including [1,4,5]:
●Environmental exposure to an infecting agent, reactivation of a previously latent infection, or (rarely) active infection transmitted with the allograft.
●Presence of indwelling catheters.
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