SPECTRUM OF INFECTIONS IN RENAL ALLOGRAFT RECIPIENTS: CLINICAL,EPIDEMIOLOGICAL,MICROBIOLOGICAL PROFILE, A THREE YEAR PROSPECTIVE 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. The survival and good outcome after transplantation is determined by multiple factors ,including pre-transplant comorbidities, immunosuppression .Infectious disease constitute the most common after transplantation and the second most common cause of death. So this study was to evaluate a brief idea about spectrum of microorganisms infect a Renal transplant recipients.

Methods:

This prospective observational study was conducted among 171 renal allograft recipients admitted with sign symptoms suggestive of infection from June 2021 to July 2024. After initial evaluation, detailed and appropriate investigations including radiological and some invasive investigations(BAL, CT guided lung biopsy, LN biopsy). After evaluating all microbiological profile, patient clinical profile, graft and overall outcome were assessed.

Results:

Total 171 patients suffered at least one episode of infection with definite organism. Male 69.5 % with  mean age 41.2(range 25-59years). Median time of transplantation 2.4 years (range 8 months -22 yrs).CGN most common primary disease 47% ,followed by Diabetic nephropathy 19%, CIN, hypertensive nephropthy . All recipient underwent  live related donor with male donor 67%. Among all 65% received induction therapy  majority ATG. About 32% had pre-tranplant DM. Twenty two percent patients had at least one episode of acute rejection required anti-rejection therapy. All patient were on triple immunosuppressive regimen  (steroid, CNI ,MMF/azathioprine). Total 19% patients developed tacrolimus toxicity and around 9% developed NODAT.

Urinary tract was most common site for bacterial infection comprising 51.5 % of all bacterial infection. E. coli 32.1% and klebsiella 28% most common organism .Followed by bacterial pneumonia 27.72%.Total 13.1%(n=13) developed blood stream bacterial  infection. Four patients developed multiple abscess and ulcerative lesion over body and culture sensitivity of wound swab found positive to staphylococcus aureus .

Cytomegalovirus (CMV) was most common single organism among all infections comprising 18.71%of all infections (Pneumonitis 7%,Gastritis 2.3%,CMV Viraemia 9.3%).Four patient developed BK virus nephropathy .Total 8 (4.67% )patient developed Herpes zoster ,followed by one patient with  viral wart. Five patient presented covid 19 pneumonia in this study period .

Among all 7 % patients were infected from Mycobacterium Tuberculosis .Pulmonary33.3%of all tubercular infection and 33.33% developed tubercular pleural effusion,16.6% tubercular lymphadenopathy.

Ten patients suffered from different fungal infection. Respiratory tract was most common site for fungal infection (n=5). Total 2 patients developed PCP infecton, followed by pulmonary candidiasis ,Aspergilosis .one patient developed Mucormycosis with previous history of covid 19 infection further under gone lobectomy. One patient developed chromoblastomycosis

Among all 34 (19.88%) suffered multiple episode of infection. Recurrent UTI (11.7%) most common cause of repeated hospital admission .Repeated bacterial pneumonia occurred in 12 patients. Total 21 patient died (12.2%) from MOF followed by septic shock and type II respiratory failure. Total 15 patient required hemodialysis and 6 patient remained dialysis dependent.

Conclusions:

 Different infection , a significant factor effecting quality of life in RAR  and second most common cause of death in RAR.The necessity for continuous research in the field of infectious disease is immense now a days .

I have no potential conflict of interest to disclose.

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