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Non-viral infections in children after renal transplantation

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Abstract

Renal transplantation has long been recognised as the gold standard treatment for children with end-stage renal failure. There has been an improvement over the years in patient and renal allograft survival because of improved immunosuppression, surgical techniques and living kidney donation. Despite reduced acute allograft rejection rates, non-viral infections continue to be a serious complication for paediatric renal transplant recipients (RTR). The risk of infections in RTR is determined by the pre-transplantation immunisation status, post-transplant exposure to potential pathogens and the amount of immunosuppression. The greatest risk of life-threatening and Cytomegalovirus infections is during the first 6 months post-transplant owing to a high immunosuppressive burden. The potential sources of bacterial infections are donor derived, transplant medium fluid, peritoneal and haemodialysis catheter and transplant ureteric stent. Urinary tract infections are frequent in patients with lower urinary tract dysfunction and can result in renal allograft damage. This review outlines the incidence, timing, risk factors, prevention and treatment of non-viral infections in paediatric RTR by critically reviewing current immunosuppressive regimens, their risk–benefit ratio in order to optimise renal allograft survival with reduced rates of rejection and infectious complications.

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Author information

Authors and Affiliations

  1. Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, England, UK

    Francesca Mencarelli & Stephen D. Marks

Authors
  1. Francesca Mencarelli
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  2. Stephen D. Marks
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Corresponding author

Correspondence to Stephen D. Marks.

Additional information

Answers

1. c

2. d

3. e

4. a

5. a

Questions (answers are provided following the reference list)

Questions (answers are provided following the reference list)

  1. 1.

    What proportion of the mortality rate is due to infections after renal transplantation ?

    1. a.

      5–15%

    2. b.

      15–25%

    3. c.

      25–55%

    4. d.

      55–75%

    5. e.

      75–80%

  2. 2.

    What is the most frequent infection in the first month after renal transplantation ?

    1. a.

      Fungal infections

    2. b.

      Parasitic infections

    3. c.

      TB

    4. d.

      UTI

    5. e.

      Viral infections

  3. 3.

    Which is the current statement regarding prophylaxis with co-trimoxazole after renal transplantation:

    1. a.

      Must be given for 1 year post-transplant

    2. b.

      Not currently advocated

    3. c.

      Significant side-effects

    4. d.

      Useful in preventing PJP

    5. e.

      Useful in preventing PJP and UTI

  4. 4.

    What is the optimal time for the removal of PD catheters in children who receive a successful living, related renal transplant?

    1. a.

      At the time of the transplant

    2. b.

      In the first month post-transplantation

    3. c.

      Within 2 months post-transplantation

    4. d.

      Within 3 months post-transplantation

    5. e.

      Within 6 months post-transplantation

  5. 5.

    Which immunosuppressive treatment is most associated with a higher risk of non-viral infections?

    1. a.

      ATG

    2. b.

      Everolimus

    3. c.

      MMF

    4. d.

      Sirolimus

    5. e.

      Tacrolimus

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Mencarelli, F., Marks, S.D. Non-viral infections in children after renal transplantation. Pediatr Nephrol 27, 1465–1476 (2012). https://doi.org/10.1007/s00467-011-2099-z

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  • DOI: https://doi.org/10.1007/s00467-011-2099-z

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