Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Analysis of Infectious Complications Occurring After Solid-Organ Transplantation

Analysis of Infectious Complications Occurring After Solid-Organ Transplantation Abstract • To improve our understanding of posttransplant infections, we analyzed bacterial, viral, fungal, parasitic, and other infections in 604 consecutive recipients of kidney (n = 518), kidney-pancreas (n = 82), kidney-liver (n = 3), or kidney-islet (n = 1) allografts (355 cadaveric, 14 living-unrelated, 235 living-related donors) who also received cyclosporine, azathioprine, and prednisone immunosuppression. Recipients of cadaveric grafts received additional induction immunosuppression (antilymphocyte globulin or murine monoclonal antibody OKT3). Rejection episodes were treated with high-dose steroids, and either antilymphocyte globulin or OKT3 was administered when clinically indicated. Perioperative antibiotics and posttransplant prophylactic acyclovir sodium or ganciclovir sodium, trimethoprim-sulfamethoxazole, and clotrimazole or nystatin (Mycostatin) were administered to all recipients. Two hundred thirteen patients (35.3%) were found to have had no identifiable infections, while 391 (64.7%) had either isolated bacterial (97 [16.1 %]), viral (53 [8.8%]), or fungal (34 [5.6%]) infections or combination (concurrent or sequential) infections with bacterial plus viral (46 [7.6%]), bacterial plus fungal (66 [10.9%]), viral plus fungal (20 [3.3%]), bacterial plus viral plus fungal (64 [10.6%]), or bacterial plus viral plus fungal plus parasitic (11 [1.8%]) pathogens in the posttransplantation period. Renal allograft survival (percentage, actuarial method) was diminished in patients with infections at both 1 year (91% vs 83%) and 3 years (81% vs 76%) after transplantation, as was actuarial patient survival (1 year, 97% vs 92%; 3 years, 93% vs 88%). We conclude that infection remains a major cause of both patient demise and allograft loss following successful solid-organ transplantation. (Arch Surg. 1992;127:38-48) References 1. Najarian JS, Fryd DS, Strand M, et al. A single institution, randomized, prospective trial of cyclosporine versus azathioprine-antilymphocyte globulin for immunosuppression in renal allograft recipients . Ann Surg . 1985;201:142-157.Crossref 2. Canadian Multicentre Transplant Study Group. A randomized clinical trial of cyclosporine in cadaveric renal transplantation . N Engl J Med . 1983;309:809-815.Crossref 3. Dunn DL. Problems related to immunosuppression: posttransplant infection and malignancy . Crit Care Clin . 1990;6:955-977. 4. Tilney NL, Strom TB, Vineyard GC, Merrill JP. Factors contributing to the declining mortality rate in renal transplantation . N Engl J Med . 1978;299:1321-1325.Crossref 5. Schweitzer EJ, Matas AJ, Gillingham KJ, et al. Causes of renal allograft loss: progress in the 80's, challenges for the 90's. Ann Surg. In press. 6. Brayman KL, Dafoe DC, Smythe WR, et al. Prophylaxis of serious cytomegalovirus infection in renal transplant candidates using liver human cytomegalovirus vaccine: interim results of a randomized controlled trial . Arch Surg . 1988;123:1502-1508.Crossref 7. Balfour HH Jr, Chace BA, Stapleton JT, Simmons RI, Fryd DS. A randomized, placebo-controlled trial of oral acyclovir for the prevention of cytomegalovirus disease in recipient of renal allografts . N Engl J Med . 1989;320:1381-1387.Crossref 8. Dunn DL, Mayoral JM, Gillingham KJ, et al. Treatment of invasive cytomegalovirus disease in solid organ transplant patients with ganciclovir . Transplantation . 1991;51:98-106.Crossref 9. Simmons RL, Migliori RJ. Infection prophylaxis after successful organ transplantation . Transplant Proc . 1988;20:7-11. 10. Collaborative DHPG Treatment Study Group. Treatment of serious cytomegalovirus infections with 9-(1,3-dihydro-2-propoxymethyl)guanine in patients with AIDS and other immunodeficiencies . N Engl J Med . 1986;314:801-805.Crossref 11. Peters C, Peterson P, Marabella P, Simmons RL, Najarian JS. Continue sulfa prophylaxis for urinary tract infection in renal transplant recipients . Am J Surg . 1983;146:589-593.Crossref 12. Fox BC, Sollinger HW, Belzer FO, Maki DG. A prospective, randomized, double-blind study of trimethoprim-sulfamethoxazole for prophylaxis of infection in renal transplantation: clinical efficacy, absorption of trimethoprim-sulfamethoxazole, effects on the microflora and the cost-benefit of prophylaxis . Am J Med . 1990;89:255-274.Crossref 13. Peterson PK, Ferguson R, Fryd DS, Balfour HH, Rynasiewicz J, Simmons RL. Infectious diseases in hospitalized renal transplant recipients: a prospective study of a complex and evolving problem . Medicine . 1982;61:360-372.Crossref 14. Masur H, Cheigh JS, Stubenbord WT. Infection following renal transplantation: a changing pattern . Rev Infect Dis . 1982;4:1208-1219.Crossref 15. Shaffer D, Hammer SM, Monaco AP. Infectious complications with the use of cyclosporine versus azathioprine after cadaveric kidney transplantation . Am J Surg . 1987;153:381-386.Crossref 16. Rubin RH, Wolfson JS, Cosimi AB, Tolkoff-Rubin NE. Infection in the renal transplant recipient . Am J Med . 1981; 70:405-411.Crossref 17. Brooks RG, Hofflin JM, Jamieson SW, Stinson EB, Remington JS. Infectious complication in heart-lung transplant recipients . Am J Med . 1985;79:412-422.Crossref 18. Colonna JO, Winston DJ, Brill JE, et al. Infectious complications in liver transplantation . Arch Surg . 1988;123:360-364.Crossref 19. Rubin RH, Rubin NET. Opportunistic infections in renal allograft recipients . Transplant Proc . 1988;20:12-18. 20. Gottesdiener KM. Transplanted infections: donor to host transmission with the allograft . Ann Intern Med . 1989;110:1001-1016.Crossref 21. Dunn DL, Najarian JS. Infectious complications in transplant surgery . In: Shires GT, Davis J, eds. Principles and Management of Surgical Infection . Philadelphia, Pa: JB Lippincott; 1990:425-464. 22. Murphy JF, McDonald FD, Dawson M, Reite A, Turcotte J, Fekety FR. Factors affecting the frequency of infection in renal transplant recipients . Arch Intern Med . 1976;136:670-677.Crossref 23. Simmons RL, Balfour HH, Lopez C, et al. Infection in immunosuppressed transplant recipients . Surg Clin North Am . 1975;55:1419-1430. 24. Burgos-Calderon R, Pankey GA, Figueroa JE. Infection in kidney transplantation . Surgery . 1971;70:334-340. 25. Dummer JS, Hardy A, Poorsattar A, Ho M. Early infections in kidney, heart, and liver transplant recipients on cyclosporine . Transplantation . 1983;36:259-267.Crossref 26. Eickhoff TC. Infectious complications in renal transplant recipients . Transplant Proc . 1973;5:1233-1238. 27. Ramos E, Karmi S, Alongi SV, Dagher FJ. Infectious complications in renal transplant recipients . South Med J . 1980;73:751-754.Crossref 28. Peterson PK, Balfour HH, Fryd DS, Ferguson RM, Simmons RL. Fever in renal transplant recipients: causes, prognostic significance and changing patterns at the University of Minnesota Hospital . Am J Med . 1981;71:345-351.Crossref 29. Kirkman RL, Strom TB, Weir MR, Tilney NL. Late mortality and morbidity in recipients of long-term renal allografts . Transplantation . 1982;34:347-351.Crossref 30. Stock PG, Snover DC, Payne WD, et al. Biopsy guided immunosuppressive therapy in treatment of liver transplant rejection: an individualized approach . Clin Transplant . 1987;1:179-186. 31. Gehan E. A generalized Wilcoxon test for comparing arbitrarily singly-sensored samples . Biometrika . 1965;52:203-223.Crossref 32. Washer GF, Schroter GP, Starzl TE, Weil R. Causes of death after kidney transplantation . JAMA . 1983;250:49-54.Crossref 33. Marker SC, Howard RJ, Simmons RL, et al. Cytomegalovirus infection: a quantitative prospective study of three hundred twenty consecutive renal transplants . Surgery . 1981;89:660-671. 34. Kyriakides GK, Simmons RL, Najarian JS. Wound infections in renal transplant wounds: pathogenetic and prognostic factors . Ann Surg . 1975;186:770-775.Crossref 35. EORTC International Microbial Therapy Project Group. Trimethoprim-sulfamethoxazole in the prevention of infection in neutropenic patients . J Infect Dis . 1984;150:372-397.Crossref 36. Tolkoff-Rubin ME, Cosimi AB, Russell PS, Rubin RH. A controlled study of trimethoprim-sulfamethoxazole prophylaxis of urinary tract infection in renal transplant recipients . Rev Infect Dis . 1982;4:614-618.Crossref 37. Hoy WE, May AG, Freeman RB. Primary renal transplant wound infections . N Y State J Med . 1981;81:1469-1473. 38. Henry ML, Sommer BG, Ferguson RM. Beneficial effects of cyclosporine compared with azathioprine in cadaveric renal transplantation . Am J Surg . 1985;150:533-536.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Loading next page...
 
/lp/american-medical-association/analysis-of-infectious-complications-occurring-after-solid-organ-OCmUmxMe8L

References (39)

Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1992.01420010044007
Publisher site
See Article on Publisher Site

Abstract

Abstract • To improve our understanding of posttransplant infections, we analyzed bacterial, viral, fungal, parasitic, and other infections in 604 consecutive recipients of kidney (n = 518), kidney-pancreas (n = 82), kidney-liver (n = 3), or kidney-islet (n = 1) allografts (355 cadaveric, 14 living-unrelated, 235 living-related donors) who also received cyclosporine, azathioprine, and prednisone immunosuppression. Recipients of cadaveric grafts received additional induction immunosuppression (antilymphocyte globulin or murine monoclonal antibody OKT3). Rejection episodes were treated with high-dose steroids, and either antilymphocyte globulin or OKT3 was administered when clinically indicated. Perioperative antibiotics and posttransplant prophylactic acyclovir sodium or ganciclovir sodium, trimethoprim-sulfamethoxazole, and clotrimazole or nystatin (Mycostatin) were administered to all recipients. Two hundred thirteen patients (35.3%) were found to have had no identifiable infections, while 391 (64.7%) had either isolated bacterial (97 [16.1 %]), viral (53 [8.8%]), or fungal (34 [5.6%]) infections or combination (concurrent or sequential) infections with bacterial plus viral (46 [7.6%]), bacterial plus fungal (66 [10.9%]), viral plus fungal (20 [3.3%]), bacterial plus viral plus fungal (64 [10.6%]), or bacterial plus viral plus fungal plus parasitic (11 [1.8%]) pathogens in the posttransplantation period. Renal allograft survival (percentage, actuarial method) was diminished in patients with infections at both 1 year (91% vs 83%) and 3 years (81% vs 76%) after transplantation, as was actuarial patient survival (1 year, 97% vs 92%; 3 years, 93% vs 88%). We conclude that infection remains a major cause of both patient demise and allograft loss following successful solid-organ transplantation. (Arch Surg. 1992;127:38-48) References 1. Najarian JS, Fryd DS, Strand M, et al. A single institution, randomized, prospective trial of cyclosporine versus azathioprine-antilymphocyte globulin for immunosuppression in renal allograft recipients . Ann Surg . 1985;201:142-157.Crossref 2. Canadian Multicentre Transplant Study Group. A randomized clinical trial of cyclosporine in cadaveric renal transplantation . N Engl J Med . 1983;309:809-815.Crossref 3. Dunn DL. Problems related to immunosuppression: posttransplant infection and malignancy . Crit Care Clin . 1990;6:955-977. 4. Tilney NL, Strom TB, Vineyard GC, Merrill JP. Factors contributing to the declining mortality rate in renal transplantation . N Engl J Med . 1978;299:1321-1325.Crossref 5. Schweitzer EJ, Matas AJ, Gillingham KJ, et al. Causes of renal allograft loss: progress in the 80's, challenges for the 90's. Ann Surg. In press. 6. Brayman KL, Dafoe DC, Smythe WR, et al. Prophylaxis of serious cytomegalovirus infection in renal transplant candidates using liver human cytomegalovirus vaccine: interim results of a randomized controlled trial . Arch Surg . 1988;123:1502-1508.Crossref 7. Balfour HH Jr, Chace BA, Stapleton JT, Simmons RI, Fryd DS. A randomized, placebo-controlled trial of oral acyclovir for the prevention of cytomegalovirus disease in recipient of renal allografts . N Engl J Med . 1989;320:1381-1387.Crossref 8. Dunn DL, Mayoral JM, Gillingham KJ, et al. Treatment of invasive cytomegalovirus disease in solid organ transplant patients with ganciclovir . Transplantation . 1991;51:98-106.Crossref 9. Simmons RL, Migliori RJ. Infection prophylaxis after successful organ transplantation . Transplant Proc . 1988;20:7-11. 10. Collaborative DHPG Treatment Study Group. Treatment of serious cytomegalovirus infections with 9-(1,3-dihydro-2-propoxymethyl)guanine in patients with AIDS and other immunodeficiencies . N Engl J Med . 1986;314:801-805.Crossref 11. Peters C, Peterson P, Marabella P, Simmons RL, Najarian JS. Continue sulfa prophylaxis for urinary tract infection in renal transplant recipients . Am J Surg . 1983;146:589-593.Crossref 12. Fox BC, Sollinger HW, Belzer FO, Maki DG. A prospective, randomized, double-blind study of trimethoprim-sulfamethoxazole for prophylaxis of infection in renal transplantation: clinical efficacy, absorption of trimethoprim-sulfamethoxazole, effects on the microflora and the cost-benefit of prophylaxis . Am J Med . 1990;89:255-274.Crossref 13. Peterson PK, Ferguson R, Fryd DS, Balfour HH, Rynasiewicz J, Simmons RL. Infectious diseases in hospitalized renal transplant recipients: a prospective study of a complex and evolving problem . Medicine . 1982;61:360-372.Crossref 14. Masur H, Cheigh JS, Stubenbord WT. Infection following renal transplantation: a changing pattern . Rev Infect Dis . 1982;4:1208-1219.Crossref 15. Shaffer D, Hammer SM, Monaco AP. Infectious complications with the use of cyclosporine versus azathioprine after cadaveric kidney transplantation . Am J Surg . 1987;153:381-386.Crossref 16. Rubin RH, Wolfson JS, Cosimi AB, Tolkoff-Rubin NE. Infection in the renal transplant recipient . Am J Med . 1981; 70:405-411.Crossref 17. Brooks RG, Hofflin JM, Jamieson SW, Stinson EB, Remington JS. Infectious complication in heart-lung transplant recipients . Am J Med . 1985;79:412-422.Crossref 18. Colonna JO, Winston DJ, Brill JE, et al. Infectious complications in liver transplantation . Arch Surg . 1988;123:360-364.Crossref 19. Rubin RH, Rubin NET. Opportunistic infections in renal allograft recipients . Transplant Proc . 1988;20:12-18. 20. Gottesdiener KM. Transplanted infections: donor to host transmission with the allograft . Ann Intern Med . 1989;110:1001-1016.Crossref 21. Dunn DL, Najarian JS. Infectious complications in transplant surgery . In: Shires GT, Davis J, eds. Principles and Management of Surgical Infection . Philadelphia, Pa: JB Lippincott; 1990:425-464. 22. Murphy JF, McDonald FD, Dawson M, Reite A, Turcotte J, Fekety FR. Factors affecting the frequency of infection in renal transplant recipients . Arch Intern Med . 1976;136:670-677.Crossref 23. Simmons RL, Balfour HH, Lopez C, et al. Infection in immunosuppressed transplant recipients . Surg Clin North Am . 1975;55:1419-1430. 24. Burgos-Calderon R, Pankey GA, Figueroa JE. Infection in kidney transplantation . Surgery . 1971;70:334-340. 25. Dummer JS, Hardy A, Poorsattar A, Ho M. Early infections in kidney, heart, and liver transplant recipients on cyclosporine . Transplantation . 1983;36:259-267.Crossref 26. Eickhoff TC. Infectious complications in renal transplant recipients . Transplant Proc . 1973;5:1233-1238. 27. Ramos E, Karmi S, Alongi SV, Dagher FJ. Infectious complications in renal transplant recipients . South Med J . 1980;73:751-754.Crossref 28. Peterson PK, Balfour HH, Fryd DS, Ferguson RM, Simmons RL. Fever in renal transplant recipients: causes, prognostic significance and changing patterns at the University of Minnesota Hospital . Am J Med . 1981;71:345-351.Crossref 29. Kirkman RL, Strom TB, Weir MR, Tilney NL. Late mortality and morbidity in recipients of long-term renal allografts . Transplantation . 1982;34:347-351.Crossref 30. Stock PG, Snover DC, Payne WD, et al. Biopsy guided immunosuppressive therapy in treatment of liver transplant rejection: an individualized approach . Clin Transplant . 1987;1:179-186. 31. Gehan E. A generalized Wilcoxon test for comparing arbitrarily singly-sensored samples . Biometrika . 1965;52:203-223.Crossref 32. Washer GF, Schroter GP, Starzl TE, Weil R. Causes of death after kidney transplantation . JAMA . 1983;250:49-54.Crossref 33. Marker SC, Howard RJ, Simmons RL, et al. Cytomegalovirus infection: a quantitative prospective study of three hundred twenty consecutive renal transplants . Surgery . 1981;89:660-671. 34. Kyriakides GK, Simmons RL, Najarian JS. Wound infections in renal transplant wounds: pathogenetic and prognostic factors . Ann Surg . 1975;186:770-775.Crossref 35. EORTC International Microbial Therapy Project Group. Trimethoprim-sulfamethoxazole in the prevention of infection in neutropenic patients . J Infect Dis . 1984;150:372-397.Crossref 36. Tolkoff-Rubin ME, Cosimi AB, Russell PS, Rubin RH. A controlled study of trimethoprim-sulfamethoxazole prophylaxis of urinary tract infection in renal transplant recipients . Rev Infect Dis . 1982;4:614-618.Crossref 37. Hoy WE, May AG, Freeman RB. Primary renal transplant wound infections . N Y State J Med . 1981;81:1469-1473. 38. Henry ML, Sommer BG, Ferguson RM. Beneficial effects of cyclosporine compared with azathioprine in cadaveric renal transplantation . Am J Surg . 1985;150:533-536.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jan 1, 1992

There are no references for this article.