Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Spectrum of Pulmonary Infections in Renal Transplant Recipients in the Tropics: A Single Center Study

  • 145 Accesses

  • 7 Citations

Abstract

Background: Pulmonary infections have been implicated as the most common cause of infection related mortality in renal transplant recipients. An appropriate empirical treatment of post transplant pulmonary infections requires knowledge of the spectrum of the microorganisms involved in causing these infections. Besides this knowledge, an aggressive diagnostic approach including the use of invasive tests is often essential to make an early diagnosis for instituting timely and appropriate therapy. We carried out a prospective cohort study to analyze the spectrum of pulmonary infections in these patients and study the utility of bronchoalveolar lavage (BAL) in the diagnosis of the same. Methods: From September 2001 to December 2002, 428 patients were under follow up with the department. In all, 40 renal transplant recipients reported with 44 episodes of pulmonary infection during this study period. All patients underwent detailed and appropriate investigations including specific laboratory tests, sputum analysis, X-ray chest, CT and BAL. The spectrum of the causative organisms and the utility of BAL as compared to the other methods of diagnosis were studied and compared. Results: Out of the 44 episodes of pulmonary infection evaluated, single causative organism could be found in only 24 (54.5%) episodes and multiple etiologies were found in 15 (34.1%) episodes. No definitive cause could be found in 5 episodes. Out of 57 organisms isolated in the 44 episodes, 20 (45.4 %) were bacteria, 16 (36.3 %) each were M. tuberculosis and fungus, 3 were CMV infection and 2 were nocardia. BAL gave a diagnostic yield of 75.8% (25 out of 33 cases). Nine of forty patients died (mortality rate 22.5%) of which 6 deaths could be attributed directly to pulmonary infection. Out of these 9 patients who died, cause of pulmonary infection was bacterial in 5, fungal in 2 and CMV disease in 1. In one patient, organism could not be isolated. Conclusions: Our study has shown that more than 1/3rd of pulmonary infections in renal transplant recipients can be attributed to multiple organisms. Bacterial infections were the commonest cause of post transplant pulmonary infection. Tuberculosis is common cause of pulmonary infection in these patients in our set up. Because of its high diagnostic yield, BAL should be considered in all patients with suspected pulmonary infections in the post transplant period.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    R Jha G Narayan MA Jaleel (1999) ArticleTitlePulmonary infections after kidney transplantation J Assoc Physicians India 47 779–783 Occurrence Handle10778621 Occurrence Handle1:STN:280:DC%2BD3c3ktFSruw%3D%3D

  2. 2.

    PK Peterson HH Balfour SuffixJr DS Fryd (1981) ArticleTitleFever in renal transplant recipients: causes, prognostic significance and changing patterns at University of Minnesota Hospital Am J Med 71 345–351 Occurrence Handle10.1016/0002-9343(81)90149-2 Occurrence Handle6269425 Occurrence Handle1:STN:280:DyaL38%2FitFWntQ%3D%3D

  3. 3.

    RL Simmons VM Uranga ES Plante ParticleLa (1972) ArticleTitlePulmonary complications in transplant recipients Arch Surg 105 260–268 Occurrence Handle4557982 Occurrence Handle1:STN:280:CS2B3srps1A%3D

  4. 4.

    IG Sia CV Paya (1998) ArticleTitleInfectious complications following renal transplantation Surg Clin North Am 78 95–112 Occurrence Handle10.1016/S0039-6109(05)70637-X Occurrence Handle9531938 Occurrence Handle1:STN:280:DyaK1c7ptlSruw%3D%3D

  5. 5.

    RH Rubin (1993) ArticleTitleInfectious disease complications of renal transplantation Kidney Int 44 221–236 Occurrence Handle8394951 Occurrence Handle1:STN:280:ByyA28%2FkvFc%3D

  6. 6.

    MS Kumar P Cridge A Molavi (1995) ArticleTitleInfectious complications in the first 100 days after renal transplantation Transplant Proc 27 2705–2706 Occurrence Handle7482882 Occurrence Handle1:STN:280:BymD2cbjslw%3D

  7. 7.

    V Jha S Chugh KS Chugh (2000) ArticleTitleInfections in dialysis and transplant patients in tropical countries Kidney Int 57 IssueID74 S85–S93 Occurrence Handle10.1046/j.1523-1755.2000.07415.x

  8. 8.

    RN Soman (1991) ArticleTitlePulmonary infections in the immunocompromised host J Assoc Physicians India 39 633–636 Occurrence Handle1667654 Occurrence Handle1:STN:280:By2B28jps1A%3D

  9. 9.

    Massry SG, Glassock RJ. Textbook of Nephrology. 4th ed. 1653–1654

  10. 10.

    GT John A Date CM Mathew (1996) ArticleTitleA timetable for infections after renal transplantation in the tropics Transplantation 61 970–972 Occurrence Handle8623169 Occurrence Handle1:STN:280:BymC1crjt1c%3D

  11. 11.

    V Jha V Sakhuja D Gupta (1999) ArticleTitleSuccessful management of pulmonary tuberculosis in renal allograft recipients in a single center Kidney Int 56 1944–1950 Occurrence Handle10.1046/j.1523-1755.1999.00746.x Occurrence Handle10571806 Occurrence Handle1:STN:280:DC%2BD3c%2FktVyqtw%3D%3D

  12. 12.

    N Heurlin C Brattstrom G Tyden (1989) ArticleTitleCytomegalovirus the predominant cause of pneumonia in renal transplant patients. A two-year study of pneumonia in renal transplant recipients with evaluation of fiberoptic bronchoscopy Scand J Infect Dis 21 245–253 Occurrence Handle2547242 Occurrence Handle1:STN:280:BiaA3s3jtlE%3D

  13. 13.

    R Munda JW Alexander MR First (1978) ArticleTitlePulmonary infections in renal transplant recipients Ann Surg 187 126–133 Occurrence Handle343733 Occurrence Handle1:STN:280:DyaE1c7it12guw%3D%3D

  14. 14.

    R Sternberg R Baughman M Dohn M Roy (1993) ArticleTitleUtility of bronchoalveolar lavage in assessing pneumonia in immunosuppressed renal transplant recipients Am J Med 95 358–364 Occurrence Handle10.1016/0002-9343(93)90303-7 Occurrence Handle8213866 Occurrence Handle1:STN:280:ByuD38jhtFY%3D

  15. 15.

    GK Modi G Ahluwalia SK Agarwal (1998) ArticleTitlePulmonary infections in renal transplant recipients and bronchoalveolar lavage (BAL) as a diagnostic tool (Abstract) Indian J Nephrol 8 IssueID3 146–147

  16. 16.

    LR Menon S Divate VN Acharya (2002) ArticleTitleUtility of bronchoalveolar lavage in the diagnosis of pulmonary infections in immunosuppressed patients J Assoc Physicians India 50 1110–1114 Occurrence Handle12516691 Occurrence Handle1:STN:280:DC%2BD3s%2FhtVegtw%3D%3D

  17. 17.

    WR Webb G Gamsu BM Rohlfing (1978) ArticleTitlePulmonary complications of renal transplantation: a survey of patients treated by low dose immunosuppression Radiology 126 IssueID1 1–8 Occurrence Handle339267 Occurrence Handle1:STN:280:CSeD2szosVE%3D

  18. 18.

    PA Willcox ED Bateman P Potgieter SR Benatar (1990) ArticleTitleExperience with fiberoptic bronchoscopy in the diagnosis of pulmonary shadows in renal transplant recipients over a 12-year period Respir Med 84 297–302 Occurrence Handle2236757 Occurrence Handle1:STN:280:By6D2cjgtVw%3D

  19. 19.

    CL Edelstein JC Jacobs MR Moosa (1995) ArticleTitlePulmonary complications in 110 consecutive renal transplant recipients S Afr Med J 85 160–163 Occurrence Handle7777966 Occurrence Handle1:STN:280:ByqB1MnotVA%3D

  20. 20.

    SK Agarwal SC Dash SC Tiwari (1992) ArticleTitleSpectrum of tuberculosis in renal transplant recipients in northern India Indian J Nephrology 2 39–43

  21. 21.

    JF Murphy FD McDonald M Dawson (1976) ArticleTitleFactors affecting the frequency of infection in renal transplant recipients Arch Intern Med 136 670–677 Occurrence Handle776110 Occurrence Handle1:STN:280:CSmB3cvotVQ%3D

  22. 22.

    KK Malhotra SC Dash IK Dhawan (1986) ArticleTitleTuberculosis and renal transplantation- observations from an endemic area of tuberculosis Postgrad Med J 62 359–362 Occurrence Handle3532083 Occurrence Handle1:STN:280:DyaL2s%2Fhs1Ontw%3D%3D Occurrence Handle10.1136/pgmj.62.727.359

  23. 23.

    GT John V Shankar AM Abraham (2001) ArticleTitleRisk factors for post transplant tuberculosis Kidney Int 60 1148–1153 Occurrence Handle10.1046/j.1523-1755.2001.0600031148.x Occurrence Handle11532111 Occurrence Handle1:STN:280:DC%2BD3MvovFGmuw%3D%3D

  24. 24.

    AJ Branten PJ Beckers GW Tiggeler AJ Hiotsma (1995) ArticleTitle Pneumocystis carinii pneumonia in renal transplant recipients Nephrol Dial Transplant 10 1194–1197 Occurrence Handle7478123 Occurrence Handle1:STN:280:BymD3c%2FmvFM%3D

  25. 25.

    S Schmaldienst WH Horl (1997) ArticleTitleBacterial infections after renal transplantation Nephron 75 140–153 Occurrence Handle9041533 Occurrence Handle1:STN:280:ByiC1MzpsFE%3D Occurrence Handle10.1159/000189523

  26. 26.

    SK Sharma JN Pande (1990) ArticleTitleBronchoalveolar lavage: application in pulmonary diseases Ind J Chest Dis Allied Sci 32 157–176 Occurrence Handle1:STN:280:By6C1cvosFU%3D

  27. 27.

    A Mohan JN Pande SK Sharma (1995) ArticleTitleBronchoalveolar lavage in pulmonary tuberculosis: a decision analysis approach Q J M 88 269–276 Occurrence Handle1:STN:280:ByqA3Mnks1Q%3D

  28. 28.

    DE Stover MB Zaman SI Hajdu (1984) ArticleTitleBronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host Ann Intern Med 101 1–7 Occurrence Handle6375497 Occurrence Handle1:STN:280:BiuB38bmtVw%3D

  29. 29.

    BM Eriksson M Brytting B Zweygberg-Wirgart (1993) ArticleTitleDiagnosis of cytomegalovirus in bronchoalveolar lavage by polymerase chain reaction, in comparison with virus isolation and detection of viral antigen Scand J Infect Dis 25 IssueID4 421–7 Occurrence Handle8248740 Occurrence Handle1:STN:280:ByuD28bislA%3D Occurrence Handle10.3109/00365549309008522

  30. 30.

    AR Bahrmand VV Bakayev MH Babaei (1996) ArticleTitleUse of polymerase chain reaction for primary diagnosis of pulmonary tuberculosis in the clinical laboratory Scand J Infect Dis 28 469–472 Occurrence Handle8953676 Occurrence Handle1:STN:280:ByiC3M7pt1E%3D

Download references

Author information

Correspondence to Sanjay Kumar Agarwal.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kalra, V., Agarwal, S.K., Khilnani, G.C. et al. Spectrum of Pulmonary Infections in Renal Transplant Recipients in the Tropics: A Single Center Study. Int Urol Nephrol 37, 551–559 (2005). https://doi.org/10.1007/s11255-005-4012-9

Download citation

Keywords

  • Bronchoalveolar lavage
  • P. carinii pneumonia
  • Pulmonary infections
  • Renal allograft recipient
  • Tuberculosis