indian journal of transplantation 9 (2015) 47–60
Abstract #: ISOT2015-90 Post renal transplant opportunistic infections single tertiary care centre experience Binoy, Noble Gracious, Jacob George Medical College, Thiruvananthapuram, India Background: Life long immunosuppressant use following renal transplantation is at the risk of opportunistic infections, which have drastic consequences to the graft and recipient. Western literature enumerating various opportunistic infections and their timing and effects on graft and patient survival are numerous however there is paucity of Indian data. We in this study reviewed our post transplant opportunistic infections from August 2012 to July 2015. Aims: To analyze the post renal transplant infection in our center during the time period August 2012 to July 2015. Methodology: Retrospective analysis of infections in renal transplant recipients from August 2012 to July 2015. Inclusion criteria-recipients with post renal transplant infection and transplant surgery performed in our center were included. Recipients with post transplant infection and transplant surgery performed elsewhere were excluded. Results: 163 renal allograft recipients were done. Mean age was 36 12.23 years of which 118 of them were males. 112 were live recipients. Urinary tract infection was the commonest infection with 30% prevalence. Cytomegalovirus infection and tuberculosis had a prevalence rate of 10% and 9%, respectively. BK virus nephropathy in two recipients with evidence of virus demonstrated in the graft in one case. Systemic fungal infection was seen in one case. Post transplant hepatotropic viruses B and C seen in two recipients respectively. No Pneumocystis infection was documented. Post transplant infection had a proportional mortality rate of 7.3%. Systemic CMV infection related mortality was seen in 7 recipients. Urinary tract infection accounted for early post transplant infection. CMV infection was noted in three months to one year period and tuberculous infection at a later period. D+R+ sero-status, ATG use were signiﬁcant risk factor for CMV. Conclusions: Urinary tract infection was the commonest infection. Systemic CMV infection was a major factor contributing to infection related mortality. Tuberculous reactivation occurred mostly in time period after 1 year of renal transplantation. http://dx.doi.org/10.1016/j.ijt.2015.09.006 Abstract #: ISOT2015-91 A case–control study to identify risk factors for Pneumocystis jiroveci Pneumonia (PCP) in renal allograft transplant recipients Navdeep Singh, Sunil Kumar, Deepesh B. Kenwar, Sarbpreet Singh, Ashish Sharma, Mukut Minz Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India Background: Pneumocystis jiroveci is an opportunistic pathogen that can cause severe pulmonary infection in renal transplant recipients. The infection can progress from minor illness to severe inﬂammatory pneumonia, resulting in respiratory failure or death. However, the risk factors for Pneumocystis infection are still not completely understood. We present a case– control study comprising 30 renal allograft transplant recipients to identify the risk factors for Pneumocystis jiroveci Pneumonia (PCP). Aims: To identify the risk factors for Pneumocystis jiroveci Pneumonia (PCP) in renal allograft transplant recipients.
Methodology: We retrospectively analyzed 30 renal transplant recipients who were operated between January 2000 and June 2015 at our centre. The cases (n = 10) included were either diagnosed as PCP based on the identiﬁcation of Pneumocystis jiroveci in lung tissue or respiratory secretions (7/10) or were presumed as PCP (3/10) because of strong clinical and radiological suspicion and rapid response to therapy. The renal transplant recipients who were operated on the preceding and the subsequent days of the transplantation of the cases were taken as controls (n = 20). All patients received cotrimoxazole (400/80 mg) prophylaxis for six months after transplant. Various parameters studied in the cases and controls were age, sex, baseline serum creatinine, basic disease, maintenance immunosuppression, use of pulse steroids in acute rejection, use of ATG, therapy for humoral rejection and prior infections. Statistical analysis was done using Chi square test and p value <0.05 was considered signiﬁcant. Results: The mean age of the cases was 36.5 9.6 years and the mean age of the controls was 34.3 12.6 years; p = 0.64. All cases were males and in controls there were 17 males (85%) and 3 females (15%). The mean baseline serum creatinine in cases and controls was 1.35 0.38 and 1.19 0.61, respectively; p = 0.46. Glomerulonephritis was the basic disease in 7/10 cases (70%) and in 12/20 controls (60%); p > 0.05. Tacrolimus based maintenance immunosuppression was observed in 8/10 cases (80%) and 15/20 controls (75%); p > 0.05. Pulse steroids were used for treating acute rejection in 4/10 cases (40%) and in 1/20 controls (5%); p = 0.015 and was found to be the only statistically signiﬁcant parameter. Use of ATG, therapy for humoral rejection and prior infections were not found statistically signiﬁcant when compared between cases and controls; p = 1.0, p = 0.15, p = 0.11, respectively. Conclusions: Use of pulse steroid for acute rejection in renal allograft transplant recipients is a risk factor for PCP infection. All renal transplant recipients should receive cotrimoxazole prophylaxis for 6–12 months following use of pulse steroids while treating rejection. http://dx.doi.org/10.1016/j.ijt.2015.09.007 Abstract #: ISOT2015-57 Acute pulmonary infiltrates in a renal allograft recipient Urmila Anandh, Sapna Marda, Y. Gopikrishna Departments of Nephrology, Radiology, and Pulmonology, Yashoda Hospitals, Secunderabad, India Background: Pulmonary inﬁltrates presenting in a renal allograft recipient early in the course of transplant is often abacterial pneumonia. It is common in heart lung transplants (22%) and rare in renal transplants (1%). However, in certain cases cardiogenic pulmonary edema, pulmonary hemorrhage and interstitial lung disease needs to be considered. We present a case of noninfective involvement of the lung in a renal allograft recipient. Aims: To present a case report of a acute lung injury in a renal allograft recipient and postulate a probable cause of the acute lung injury. Methodology: Clinical investigations performed were duly analysed and a case report was prepared. Results: A renal allograft recipient developed cough with hemoptysis on ﬁrst post op day. A chest X ray was done which was suggestive of ﬂuid overload. His ﬂuid was restricted and diuretics were added. On post op day 3 his pulmonary inﬁltrates worsened and a repeat CT chest suggested the presence of right lower lobe consolidation. A bronchoscopy was done and ﬂuid was sent for cultures. Besides routine antibiotics, treatment for CMV, fungus and Pneumocystis jiroveci was