title: Incidence, risk factors, and outcomes of opportunistic infections in pediatric renal transplant recipients.
abstract: OIs present significant risks to patients following solid organ transplantation. The purpose of this study was to identify risk factors for the development of OIs after kidney transplantation in pediatric patients and to evaluate the impact of OIs on outcomes in this patient population. A single-center retrospective longitudinal cohort analysis including pediatric patients 21 yr of age or younger transplanted from July 1999 to June 2013 at an academic medical center was conducted. Patients were excluded if they received multi-organ transplant. A total of 175 patients were included in the study. Patients who developed OIs were more likely to be female and younger at the time of transplant. A six-factor risk model for OI development was developed. Death, disease recurrence, and PTLD development were similar between groups but trended toward increased incidence in the OI group. Incidence of rejection was significantly higher in the OI group (p = 0.04). Patients who developed OIs had several important risk factors, including younger age, EBV-negative serostatus, CMV donor (+)/recipient (-), biopsy-proven acute rejection, ANC <1000, MMF dose >500 mg/m(2), and any infection. Incidence of rejection was higher in the OI group, but rate of graft loss was not statistically different.
authors.affiliation: Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Cameron L
authors.initials: CL
authors.lastname: Jordan
authors.affiliation: Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Taber
authors.affiliation: Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Maggee O
authors.initials: MO
authors.lastname: Kyle
authors.affiliation: Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: James
authors.initials: J
authors.lastname: Connelly
authors.affiliation: Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Nicole W
authors.initials: NW
authors.lastname: Pilch
authors.affiliation: Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: James
authors.initials: J
authors.lastname: Fleming
authors.affiliation: Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Holly B
authors.initials: HB
authors.lastname: Meadows
authors.affiliation: Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Bratton
authors.affiliation: Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Satish N
authors.initials: SN
authors.lastname: Nadig
authors.affiliation: Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: McGillicuddy
authors.affiliation: Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Chavin
authors.affiliation: Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Prabhakar K
authors.initials: PK
authors.lastname: Baliga
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Ibrahim F
authors.initials: IF
authors.lastname: Shatat
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Twombley
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001706:Biopsy; D002648:Child; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D009894:Opportunistic Infections / Q000453:epidemiology*; D012372:ROC Curve; D012008:Recurrence; D051437:Renal Insufficiency / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: pediatric kidney transplant; pediatric kidney transplantation