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Infections in Kidney Transplant: An Overview.

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The incidence of infections in people who have had a kidney transplant is the major cause of morbidity and mortality. Read further to learn more.

Written by

Dr. Kinjal Shah

Published At November 2, 2023
Reviewed AtNovember 2, 2023

What Is a Kidney Transplant?

A kidney transplant is a surgical operation in which an individual with kidney failure or end-stage renal disease receives a healthy kidney from a donor. The transplanted kidney performs the duties of the failing kidneys, purifying the blood of wastes and extra fluid and generating urine. The non-functioning kidneys are kept in place after a kidney transplant, and the replacement kidney is implanted in the lower abdomen. The recipient's blood vessels are joined to the new kidney's blood vessels, and the new kidney's ureter is joined to the recipient's bladder.

Immunosuppressive drugs are frequently administered to kidney transplant recipients in order to avoid organ rejection. While these treatments are essential to the transplant's success, they also impair immune function, rendering patients more prone to infections.

What Are the Causes of Infections in Kidney Transplant?

Following is a summary of the illnesses that kidney transplant patients are susceptible to:

  • Immunosuppression: Immunosuppressive drugs lower immune function, rendering patients more prone susceptible to infections.

  • Surgery: Infections can be introduced during the transplantation procedure, including at the incision site.

  • Pre-existing Infections: After transplantation, pre-existing infections in the recipient may get worse or be harder to cure.

  • Hospital Setting: Extended hospital stays raise the risk of infections related to medical care.

  • Rarely, a transplanted kidney may harbor an infection that was contracted by the donor.

  • Opportunistic Infections: Weakened immune systems allow opportunistic infections, which are brought on by organisms normally benign in healthy people, to cause illness.

What Are the Different Infections in Kidney Transplant?

Many different bacteria and organ systems can cause infections in people who have had kidney transplants. Here is a more thorough breakdown of the infections that kidney transplant patients frequently experience:

  • Urinary Tract Infections (UTIs): The most frequent infections following kidney donation are urinary tract infections (UTIs). Escherichia coli and other germs frequently cause them when they enter the urinary system through the catheter used during the transplant or from other sources. UTIs can manifest as symptoms including fever, frequent urine, and discomfort or burning when urinating.

  • Viral Infections:

  1. Cytomegalovirus (CMV): These infections are widespread viral infections that can have serious consequences for transplant patients. It may have an impact on the neurological system, lungs, liver, gastrointestinal tract, and more. Fever, exhaustion, and flu-like symptoms are possible symptoms.

  2. Epstein-Barr Virus (EBV) Infection: The post-transplant lymphoproliferative disorder (PTLD), which is characterized by aberrant lymphoid tissue proliferation, can be brought on by EBV infection. PTLD can take the form of aggressive lymphomas or benign tumors. Malaise, swollen lymph nodes, and fever are possible symptoms.

  3. Herpes Simplex Virus (HSV) Infection: In kidney transplant recipients, HSV can result in oral or vaginal sores. These infections can cause severe pain and consequences and may be recurring.

  • Fungal Infections: Patients who have had kidney transplants may develop fungal infections like candidiasis (caused by species of the fungus Candida) or aspergillosis (caused by species of the fungus Aspergillus). They may appear as infections in the lungs, blood, or surgical wounds, among other organs. The nature and location of the infection will determine the symptoms.

  • Bacterial Infections: Various bacterial infections, such as the following, can affect kidney transplant recipients:

  1. Pneumonia: In transplant patients, bacterial pneumonia can result in respiratory symptoms such as coughing, breathing problems, and fever.

  2. Urinary Tract Infections: In addition to UTIs, which were already described, bacterial infections can also damage the kidneys or the bladder, resulting in symptoms including discomfort, fever, and urgency in the urine.

  3. Surgical Site Infections: Following a kidney transplant, infections at the incision site might develop and cause redness, swelling, warmth, and discharge.

  4. Bloodstream Infections: Sepsis, a serious systemic illness, can be brought on by bacteria entering the bloodstream. High temperatures, chills, low blood pressure, and organ malfunction may be symptoms.

  5. Skin and Soft Tissue Infections: Bacterial infections of the skin and soft tissues can cause symptoms, including, pain, swelling, and redness in the skin and underlying tissues.

  • Parasitic Infections: Although they are uncommon, parasite infections can harm kidney transplant patients, especially those who have certain risk factors or travel histories. Examples comprise:

  1. A transplant recipient may get toxoplasmosis (caused by Toxoplasma gondii) by coming into touch with infected cats, undercooked meat, or contaminated soil.

  2. Strongyloidiasis, which is brought on by Strongyloides stercoralis, can be contracted through polluted soil. Systemic and gastrointestinal problems may result from it.

How to Prevent Infections in Kidney Transplants?

The health of kidney transplant patients depends on eliminating infections. The following are some essential precautions that are frequently advised:

  • Immunizations: Prior to transplantation, confirm that the patient has had all recommended immunizations, including those for hepatitis B, pneumonia, influenza, and other diseases.

  • Hand Hygiene: It is crucial to regularly wash one’s hands thoroughly for at least 20 seconds with soap and water. Alcohol-based hand sanitizers can be used in place of soap and water if none are available.

  • Environmental Hygiene: Keep one’s home clean and hygienic to reduce exposure to infectious pathogens. This covers routine surface cleaning, handling food properly, and getting rid of garbage the right way.

  • Avoiding Sick Persons: Transplant patients should strive to stay away from persons who are contagious, such as those who have the flu, the cold, or other contagious illnesses.

  • Safe Food Handling: Use correct fruit and vegetable washing procedures, thoroughly cook meat, and steer clear of unpasteurized foods while preparing and storing food.

  • Personal Hygiene: Maintain proper personal hygiene by regularly showering or bathing, keeping cuts and scrapes clean and protected, and dressing in clean clothing.

  • Reduce Exposure to Groups: It may be wise for recipients to stay away from big groups or gatherings in the early post-transplant period since there is a higher chance of infectious infections spreading there.

  • Prophylactic Drugs: Transplant patients may be given prophylactic drugs to avoid certain infections, such as antivirals for CMV or antifungals for fungal infections, depending on the specific protocols and personal risk factors.

Conclusion

Even while infections continue to be an important cause of morbidity and death following transplantation, their negative impacts on transplant outcomes have diminished because of improved preventative, diagnostic, and therapeutic techniques. All patients being considered for transplantation should continue to receive ongoing attention to infection, prevention before transplantation and enhanced surveillance for infections.

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Dr. Tuljapure Samit Prabhakarrao
Dr. Tuljapure Samit Prabhakarrao

Urology

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kidney transplant surgery
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