CLINICAL,EPIDEMIOLOGIAL AND MICROBIOLOGICAL PROFILE AND OUTCOME OF PULMONARY INFECTIONS IN RENAL ALLOGRAFT RECIPIENTS. A 4 YEAR STUDY AT BANGLADESH MEDICAL COLLEGE HOSPITAL

Introduction:

Renal transplantation, a treatment option for patients with End stage renal disease (ESRD) offers a good quality of life .Pulmonary Infection recognized as the most common cause of infection related mortality in Renal Allograft recipients  A brief knowledge about spectrum of the microorganism involved in pulmonary infection, an appropriate empirical treatment ,an aggressive diagnostic approach including the use of invasive tests are required for instituting timely and appropriate therapy . So this study done to assess microbiological profile involved in pulmonary Infection.

Methods:

This prospective observation study done among 79 Renal Allograft recipients with sign symptoms suggestive of pulmonary infection from April 2020 to June 2024 at Bangladesh Medical College Hospital. After initial evaluation all patients underwent detailed and necessary investigations like sputum and nasopharyngeal swab for microbiology . Chest X-ray done in all patients and HRCT chest according to clinical suspicion .CT guided FNAC and Broncho alveolar Lavage were done in few patients. Epidemiological ,Clinical, microbiological profile and outcome were evaluated .

Results:

Total 79 patients with 85 episodes of infection were observed with mean age 37.2years (range 22-59 years) and 74%  were male. Median time from transplantation was 39 months. Most common primary disease was chronic GN (46%) followed by diabetic nephropathy (18%),CIN, Hypertensive nephropathy, Polycystic kidney disease . All were live related donor with 67 % Male. Total 72% received induction therapy with majority ATG and were on  triple immunosuppressive regimen (steroid, CNI,MMF).Twenty nine percent patients were diabetic  before transplantation . Total  eighteen patient had episode of acute rejection received methylprednisolone. Total  11 patient developed NODAT. Fever (79%)was most common clinical feature followed by dyspnea (39%),chest pain (62%).Hemoptysis was presenting feature of 8 patients and 21 patients  had low oxygen saturation during hospitalization . On Radiological analysis among 85 episodes 51.1%  had air space opacity and 14.1 % pleural effusion and 11 patients had both. Eight of all developed hilar lymphadenopathy and air fluid level.  CT chest done in 18 episodes and found ground glass opacity ,consolidation in 8 cases fungal ball. After evaluating sputum culture sensitivity ,RT PCR from nasopharyngeal swab , BAL done in 18 patients and CT guided FNAC done in 7 patients .Total 28 patients found  bacterial pneumonia among them 23 single episode and 5 multiple episodes. Klebsiella (35%) and staphylococcus (28.5%) were most common among them followed by enterococcus, E. coli, Enterobacter, Pseudomonas and Acinatobacter. Among all bacterial pneumonia  five patients with bacterial pneumonia  died from MOF .

Total 20 patients suffered from covid 19 pneumonia and 8 patients had concomitant bacterial and fungal infection . Covid 19 were major organism causing viral pneumonia due to pandemic period followed by CMV pneumonia (n=12).Among all CMV pneumonia 5 had associated bacterial infection and 8 patients developed type II respiratory failure and 6 patients with septic shock and finally six patients expired.

Total 8 patients were infected by Mycobacterium Tuberculosis being 10% of all infection . Four patients had pulmonary tuberculosis and 4 patients developed tubercular pleural effusion .Among Fungal infection 3 patients suffered from candida , 2 from PCP ,1 from pulmoinary aspergilosis and one diabetic patient who had previous history of Covid 19 infection  were diagnosed Mucormycosis (Black fungus ) after 1.5 years of covid 19 pneumonia and further undergone lobectomy . Total 18 patients( 22%) developed graft dysfunction and 8 required HD.

Conclusions:

Pulmonary infection being a major cause of morbidity and mortality in RAR. Aggressive diagnostic should be implemented for establishing appropriate diagnosis. Empirical regimens should cover a wide range of microorganism. Timely interventions would reduce mortality .

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.