Early infections in children following renal transplantation

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Tahar Gargah
Aymen Labessi
Mondher Ounissi
Amine Derouiche
Zarrouk Chokri
Monique Trabelsi
Taeb Ben Abdallah
Mohamed Chebil
Mohamed R Lakhoua

Abstract

Background: Infections following renal transplantation in children are a major cause of severe morbidity and mortality. Surgery is complex and performed in a subject whose immunological mechanisms are impaired by end stage renal failure and immunosuppressive drugs.
Aim: To evaluate the incidence and the risk factors of early infectious following renal transplantation in children.
Methods: Infectious complications were retrospectively monitored in 37 children receiving renal transplantation at our center from 1992 to 2008.
Results: Infectious complications identified were dominated by urinary tract infections occurred in 12 patients. The clinical symptomatology is dominated by fever and decrease in health. In 4 patients the urinary infection was asymptomatic. Three patients had pneumonia; the diagnosis was suspected clinically and confirmed by the chest radiography. Three other patients developed sepsis. In one of them, the etiology was a peritonitis related to dialysis catheter.
Two transplant showed a herpetic cheilitis and one patient developed a parvovirus infection that evolved well after two transfusions. In all cases, the outcome was favourable with no deaths or impact on graft function.
Conclusion: After renal transplantation, the disturbance of inflammatory reactions explains the often latent or delayed infectious process making early diagnosis difficult. It is imperative to monitor infectious to minimize morbidity and mortality.

Keywords:

Child, kidney transplantation, infections complications, urinary tract infection

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References

  1. Rubin RH. Infectious disease complications of renal transplantation. Kidney Int 1993 ;79 :221-36.
  2. Höcher B, Tönshoff B. Treatment strategies to minimize or prevent chronic allograft dysfunction in pediatric renal transplant recipients: an overview. Paediatr Drugs 2009; 11: 381-96.
  3. Yoshimura N, Oka T. Medical and surgical complications of renal transplantation: diagnosis and management. Med Clin North Am 1990; 74: 1025-37.
  4. San Juan . incidence of infection in renal transplantation. Am J Transpl 2007; 7: 964-71.
  5. Pourmand G, Salem S, Mehrsai A, Taherimahmoudi M, Ebrahimi R, Pourmand MR Infectious complications after kidney transplantation: a single-center experience. Transpl. Infect Dis 2007; 9:302-9.
  6. Takai K., Aoki A, Suga A et al. Urinary tract infections following renal transplantation. Transplant Proc 1998; 30:3140.
  7. Giral M, Pascuariello G, Karam. Acute graft pyelonephritis and longterm kidney allograft outcome. Kidney Int 2002;61:1880-6.
  8. Chuang P, Parikh C, Langone A et al. Urinary tract infections after renal transplantation: a retrospective review at two US transplant centers. Clin Transplant 2005; 19: 230-33.
  9. Rabkin DG, Stifelman MD, Birkhoff J et al. Early catheter removal decreases incidence of urinary tract infections in renal transplant recipients. Transplant Proc 1998; 30: 431-34.
  10. Derouich A, Hajri M, Pacha K, Ben Hassin L, Chebil M, Ayed M. Impact de l'utilisation de la sonde JJ lors de la transplantation rénale sur l'incidence des complications urologiques et de l'infection urinaire. Progrès en urologie 2002; 12 : 1209-12.
  11. Hetet JF, Rigaud J Karam G. Faut-il mettre une sonde double J de façon systématique lors d'une transplantation rénale ? Ann Urol (Paris) 2006; 40: 241-46.
  12. Linares L, Cervera C, Cofán F et al. Epidemiology and outcomes of multiple antibiotic-resistant bacterial infection in renal transplantation. Transplant Proceed 2007; 39: 2222-4.
  13. Khosroshahi HT, Mogaddam AN, Shoja MM. Efficacy of high-dose trimethoprim-sulfamethoxazol prophylaxis on early urinary tract infection after renal transplantation. Transplant Proc 2006; 38: 2062.
  14. Reichenberger F, Dickenmann M, Binet I et al. Diagnostic yield of bronchoalveolar lavage following renal transplantation Transpl Infect Dis 2001; 3: 2-7.
  15. Sileri P, Pursell KJ, Coady NT et al. A standardized protocol for the treatment of severe pneumonia in kidney transplant recipients. Clin Transplant 2002;16:450-4.
  16. Pizzo PA, Hathorn JW, Hiemenz J. A randomized trial comparing céftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N Engl J Med 1986; 315: 552-8.
  17. Elting LS, Bodey GP, Keefe BH. Septicemia and shock syndrome due to viridans streptococci: a case-control study of predisposing factors. Clin Infect Dis 1992;14:1201-7.
  18. Mermet F, Beuhorry-Sassus E, Talon D, et al. Greffes et septicémies : problèmes et perspectives diagnostiques. Med Mal Infect. 1992; 22: 923-7.
  19. Fox BC, Sollinger HW, Belzer FO et al. A prospective randomized, double-blind study of trimethoprim-sulfamethoxazole for prophylaxis of infection in renal transplantation: clinical efficacy, absorption of trimethoprim-sulfamethoxazole, effects on the microflora, and the cost-benefit of prophylaxis. Am J Med 1990; 89: 255-74.
  20. Capocasale E, Mazzoni MP, Tondo S et al. Antimicrobial prophylaxis with ceftriaxone in renal transplantation. Chemotherapy 1994; 40: 435-40.
  21. Stephan RN, Munschauer CE, Kumar MSA. Surgical wound infection in renal transplantation. Arch Surg 1997; 132: 1315-9.
  22. Yeung JS., Tong KL., Chan H.W.H. Clinical pattern, risk factors, and outcome of CMV infection in renal transplant recipients: local experience. Transplant Proc 1998;30: 3144-5.
  23. Rerolle JP, Helal I, Morelon E. Infection à parvo-virus B19 et transplantation rénale. Néphrologie 2003;24:307-13.
  24. Gallinella G, Manaseri E, Venturoli S, Grazi G, Musiani M, Zerbini M. Occurence and clinical role of active parvovirus B19 in transplant recipients. Eur J Clin Microbiol Inf Dis 1999;18:811-3.