Infection following KTP 신장내과 R3 김경엽

Infections Infections Leading cause of morbidity and mortality in the early posttransplant period Leading cause of morbidity and mortality in the early posttransplant period > 80% of recipients: ≥1 episode of infection in the 1 st year > 80% of recipients: ≥1 episode of infection in the 1 st year Level of overall immunosuppression: major risk factor for posttransplant infection Level of overall immunosuppression: major risk factor for posttransplant infection

Risk factors for posttransplant infection Risk factors for posttransplant infection Environmental exposure to an infecting agent, reactivation of a previously latent infection, or (rarely) active infection transmitted with the allograft Environmental exposure to an infecting agent, reactivation of a previously latent infection, or (rarely) active infection transmitted with the allograft Indwelling catheters Indwelling catheters Infection with immunomodulating viruses: CMV, EBV, HIV, Hepatitis B and C virus Infection with immunomodulating viruses: CMV, EBV, HIV, Hepatitis B and C virus Type of dialysis modality utilized prior to transplantation (PD >> HD) Transplantation 1999; 68:535 Type of dialysis modality utilized prior to transplantation (PD >> HD) Transplantation 1999; 68:535 Nutritional status and metabolic factors (hyperglycemia, etc.) Nutritional status and metabolic factors (hyperglycemia, etc.)

Early posttransplant infections Postoperative surgical infections Postoperative surgical infections Bacterial and fungal infections Bacterial and fungal infections Bacterial pneumonia Bacterial pneumonia Urinary or peritoneal catheter-related infections Urinary or peritoneal catheter-related infections Infections transmitted by a contaminated allograft Infections transmitted by a contaminated allograft Opportunistic infections – rare in this time period Opportunistic infections – rare in this time period Pneumocystits carninii Pneumocystits carninii Nocardia asteroides Nocardia asteroides Duration of exposure to immunosuppression: important determinant Duration of exposure to immunosuppression: important determinant

One to six months after transplantation CMV infection – most important CMV infection – most important Hepatitis, Herpes simplex, Mycobacterium tuberculosis, EBV Hepatitis, Herpes simplex, Mycobacterium tuberculosis, EBV Recurrence or relapse of UTI Recurrence or relapse of UTI

Late posttransplantation Infection in the majority of these patients is usually similar to that seen in the general population (influenza, pneumococcal pneumonia, benign UTI, etc) Infection in the majority of these patients is usually similar to that seen in the general population (influenza, pneumococcal pneumonia, benign UTI, etc) 10 to 15 percent of patients – chronic viral infections 10 to 15 percent of patients – chronic viral infections CMV chorioretinitis CMV chorioretinitis Lymphoproliferative disorders due to EBV, chronic hepatitis, and clinical AIDS Lymphoproliferative disorders due to EBV, chronic hepatitis, and clinical AIDS 5 to 15 percent of patients – history of multiple acute rejection episodes and high degree of immunosuppression 5 to 15 percent of patients – history of multiple acute rejection episodes and high degree of immunosuppression P. carinii, Listeria monicytogenes, and Norcardia asteroides P. carinii, Listeria monicytogenes, and Norcardia asteroides

Antimicrobial prophylaxis Perioperative surgical antibiotic prophylaxis with broad spectrum antibiotics for prevention of wound infections Perioperative surgical antibiotic prophylaxis with broad spectrum antibiotics for prevention of wound infections TMP-SMX: prevention of UTI, sepsis, and P. carinii pneumonia (allergy to TMP-SMX: oral quinolones) TMP-SMX: prevention of UTI, sepsis, and P. carinii pneumonia (allergy to TMP-SMX: oral quinolones) CMV prophylaxis CMV prophylaxis To prevent primary infection in CMV-negative recipients of CMV- positive donrs To prevent primary infection in CMV-negative recipients of CMV- positive donrs To prevent reactivation of infection in some CMV-positive recipients, particularly those receiving antirejection therapy with OKT3 To prevent reactivation of infection in some CMV-positive recipients, particularly those receiving antirejection therapy with OKT3