Analysis of infectious complications occurring after solid-organ transplantation
K. L. Brayman, E. Stephanian, A. J. Matas, W. Schmidt, W. D. Payne, D. E. Sutherland, P. F. Gores, J. S. Najarian and D. L. Dunn
Department of Surgery, University of Minnesota, Minneapolis.
To improve our understanding of posttransplant infections, we analyzed
bacterial, viral, fungal, parasitic, and other infections in 604
consecutive recipients of kidney (n = 518), kidney-pancreas (n = 82),
kidney-liver (n = 3), or kidney-islet (n = 1) allografts (355 cadaveric, 14
living-unrelated, 235 living-related donors) who also received
cyclosporine, azathioprine, and prednisone immunosuppression. Recipients of
cadaveric grafts received additional induction immunosuppression
(antilymphocyte globulin or murine monoclonal antibody OKT3). Rejection
episodes were treated with high-dose steroids, and either antilymphocyte
globulin or OKT3 was administered when clinically indicated. Perioperative
antibiotics and posttransplant prophylactic acyclovir sodium or ganciclovir
sodium, trimethoprim-sulfamethoxazole, and clotrimazole or nystatin
(Mycostatin) were administered to all recipients. Two hundred thirteen
patients (35.3%) were found to have had no identifiable infections, while
391 (64.7%) had either isolated bacterial (97 [16.1%]), viral (53 [8.8%]),
or fungal (34 [5.6%]) infections or combination (concurrent or sequential)
infections with bacterial plus viral (46 [7.6%]), bacterial plus fungal (66
[10.9%]), viral plus fungal (20 [3.3%]), bacterial plus viral plus fungal
(64 [10.6%]), or bacterial plus viral plus fungal plus parasitic (11
[1.8%]) pathogens in the posttransplantation period. Renal allograft
survival (percentage, actuarial method) was diminished in patients with
infections at both 1 year (91% vs 83%) and 3 years (81% vs 76%) after
transplantation, as was actuarial patient survival (1 year, 97% vs 92%; 3
years, 93% vs 88%). We conclude that infection remains a major cause of
both patient demise and allograft loss following successful solid-organ
transplantation.
