title: Infection related renal impairment: a major cause of acute allograft dysfunction.
abstract: We prospectively analyzed the impact of post-transplant infections on the renal function in 532 stable renal transplant recipients (M=340; F=192) over a period of 5 years. Their age ranged from 3-75 years (40+14 years). During the follow-up period, 52 patients expired and 64 lost on followup. We defined renal impairment (RI) as a persistent rise in serum creatinine above 20% from baseline value. 495 episodes of RI occurred in 269 recipients. This included 180-36% episodes of acute rejection, 53-10.7% Cyclosporine toxicity, 236-47.7% infection related renal impairment [IRRI] and 26-5.3% others. The severity of renal failure is less in IRRI (100+90.2) than that of acute rejection (166+127.1), but was more than that in cyclosporine toxicity (50+42.2). Sites of infection in IRRI were urinary (33%), respiratory (26.3%), septicemia (15.7%) and others (25.4%). Episode of IRRI occurred more frequently in LURD (159-67.4%) compared to LRD-RTR (50-21.2%). Occurrence of IRRI is more significantly higher in patients on triple drug immunosuppression (IS) (34.3%) than those on two drug IS (13.2%) (P=or<0.01). Ecoli (23.1%), Pseudomonas (11.1%), Salmonella (8.8%), Klebsiella (8.8%) and Staphylococai (8.3%) were the major organisms producing IRRI. IRRI is frequent (27.8%) during the first six months. Present study denotes that IRRI is a major cause of acute failure in RTR.
authors.affiliation: Hamad El-Essa Organ Transplant Centre, Faculty of Medicine, Kuwait University, Kuwait.
authors.forename: Mangalathillam R N
authors.initials: MR
authors.lastname: Nampoory
authors.forename: Kaivilayil V
authors.initials: KV
authors.lastname: Johny
authors.forename: Jamal N
authors.initials: JN
authors.lastname: Costandy
authors.forename: Madhavan P
authors.initials: MP
authors.lastname: Nair
authors.forename: Tarek
authors.initials: T
authors.lastname: Said
authors.forename: Hani
authors.initials: H
authors.lastname: Homoud
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Al-Muzairai
authors.forename: Mohmoud
authors.initials: M
authors.lastname: Samhan
authors.forename: Mustafa
authors.initials: M
authors.lastname: Al-Moussawi
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000382:microbiology / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications / Q000209:etiology* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D006084:Graft Rejection / Q000150:complications / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine