1. Spectrum of Infections in Renal Transplant
Dr. Salil Jain
Fortis Memorial Research Institute, Gurgaon

2. INTRODUCTION Transplantation Dialysis ESRD CKD CKD- an EPIDEMIC
Prevalence- 1 in 10
Progressive disease ESRD
150,000- in India on waitlist for renal tx
Renal tx- 1 out of 30
90%- on waiting list die without getting an organ
Transplantation
Dialysis
ESRD
CKD

3. COMPLICATIONS OF KIDNEY TRANSPLANT
Rejection
Infection
Side effects of immunosupressants

4. Infections
Rejection
Immunosuppression

5. Infections Late presentation Endemic infections eg TB
Expensive/nonavailability of lab tests
Lack of awareness in primary care physicians
Infections
Socioeconomic status
Poor hygiene
New potent immunosupressives
Tropical climate

6. Post Renal Tx -Infections
Developed vs developing nations- different spectrum of infections
Developing- 25% patients serious infection  allograft dysfunction
Infections accounts for 50% deaths in India
Common infections: UTI, TB, Candidiasis, Hepatitis B/C, CMV, Pneumocystis jirovecii

7. Aim & Objective
To study the incidence of infections in post renal allograft recipient and influence of factors leading to infections
To find out the most common cause of infections in post renal transplant patients
To correlate the incidence of various infections with the literature

8. Materials and methods
Single Centre observational retrospective hospital based study
Inclusion Criteria: all of the following
All patients who underwent renal transplant from September, 2013 to January, at FMRI
Patients having regular follow up for at least 3 months post transplant in Outpatient clinic
Exclusion criteria :
Patients lost to follow up after first 3 months
Definition of infection- culture/serology positive with suggestive symptoms

9. Results Baseline characteristics Variable n No of transplants 150
Males
124
Females 26
Mean age (years)
Dialysis vintage
7.38 months(15 days to 72 mnths)
Primary diagnosis
Hypertension
Diabetes
CGN
Obstructive
PKD
CIN
Unclassified 72 44 14 6 7 5 2

10. Results Baseline characteristics Variable n(%) Induction IL-2
50 (33.3%)
ATG
91 (60.7%)
No induction
9 (6%)

11. Patient distribution

12. Spectrum of positive cultures

13. Results- type of infection
Infections
Number of episodes
UTI 48
GI infection 27
Pneumonia 11
Soft tissue infection 8
Fungal 3 TB 2
Parvovirus
Herpes
CMV

14. Spectrum of infection

15. Spectrum of bacterial infections
E. coli
30(34%)
Klebsiella
13(14.7%)
Staphylococcus
10(11.3%)
Pseudomonas
7(7.9%)
Enterococcus
Acinetobacter
4(4.5%)

16. Bacterial infections-spectrum

17. Infection Incidence of infection ATG 46% P = 0.69 IL-2 42.8% Diabetic
43.2%
P= 0.98
Nondiabetic
43.3%

18. Kumar 2016
R Ram 2005
S Sujit 2016
FMRI
No. of patients 45
169 50
150
Mean age (years) -
41.1
Infection episodes
After 1 year 57
77.7%
410
128
105
Induction, ATG vs IL-2
9.2 vs 6.8% NS
UTI
33.3%
23.6%
72.7%
46.6% TB
17.8%
10.6%
1.9%
Fungal
15.6%
23% 8%
2.9%
CMV
13.3%
21.8%
7.8%
HBV
11.1%
9.4%
3.9%
HCV
7.6%
Deaths
8.9%
2.4%
1.3%
10%

19. Discussion
Overeall, infection incidence was lower compared to other studies in similar geographical region
Lower rate of CMV due to universal prophylaxis
Lower HBV/HCV due to stringent pretx workup and better medications for their tx.
Fungal/CMV infections have come down considerably in last 10 years due to better prophylaxis and lesser immunosuppression.

20. Conclusion
Infection still remains one of the most important complication and cause of mortality in transplant patients
UTI continues to be the commonest post transplant infection
We need investigations to monitor immune function to effectively manage immunosuppression
Multicentric prospective studies needed to assess various factors associated with infection
To increase the safety of organ transplantation further, we need improved diagnostic tests to detect infection earlier