Epidemiology, risk factors and impact on long-term pancreatic function of infection following pancreas-kidney transplantation

Abstract

Limited information exists about epidemiology and risk factors of infection following pancreas-kidney transplantation and its impact on long-term pancreatic graft function. A retrospective chart review of episodes of severe infection in consecutive pancreas-kidney transplantations in a single institution was performed to assess the epidemiology, risk factors for infection and their impact on the development of pancreatic graft dysfunction. Ninety-four (81%) of 116 recipients (median follow-up of 1492 days; mean 1594) developed 248 episodes of severe infection. Bacterial infections were present in 208 episodes, with 12% of the isolates resistant to antibiotics used in prophylaxis. There were 40 episodes of fungal infection in 32 patients (28%) (mostly Candida spp), and CMV disease appeared in 20 patients (17%), of which 50% appeared after the third month following surgery. The multivariate analysis identified that surgical re-intervention and the use of steroid pulses were independently associated with the development of any infection. Additionally, pre-transplant evidence of peripheral artery disease, a longer cold ischaemia time and high transfusional requirements were associated with fungal infections. Cytomegalovirus (CMV) mismatch was independently related to CMV disease and female sex, and bladder drainage of the exocrine pancreas was associated with urinary tract infection. At the end of follow-up, 29 patients (25%) had developed severe pancreatic graft dysfunction, and fungal infection was independently associated with it. Our study identifies a subset of pancreas-kidney transplant recipients at a higher risk of developing severe infection. Fungal infection is an independent risk factor for the development of severe pancreatic graft dysfunction.

Epidemiology, risk factors, and impact of bacterial infections on outcomes for pancreatic grafts

“…We also found that urinary tract infection was the most frequent infection type, followed by abdominal and surgical site infection. These results are also consistent with those of other studies but not with the study by Herrero‐Martínez et al who reported that surgical site infection was the most frequent in the first month after transplantation.…”

“…In this large cohort of adult pancreas transplant recipients, we found that infections were common and clinically relevant to outcomes after transplantation, especially in the early postoperative period. Consistent with other studies reporting a proportion of patients affected by bacterial infections ranging from 51% to 95%, we found that the incidence was 61%. Importantly, our data are supported by our comprehensive analysis of the foci, risk factors, and impact of infection on graft loss.…”

Outcome of patients with hemodialysis or peritoneal dialysis undergoing simultaneous pancreas‐kidney transplantation. Comparative study

“…Our present series of SPKTs shows homogeneity with respect to the distribution of donor, recipient, and perioperative variables between the groups, and intra‐abdominal infections, thrombosis, pancreatitis, bleeding, and leak of the pancreas graft are the most frequent surgical complications after SPKT. Overall infection rate after SPKT has been reported in up to 80% of patients, whereas intra‐abdominal infections can represent up to 70% of all infections after pancreas transplant and are associated with higher risk of mortality and pancreas graft loss . Ninety percent of patients who suffer severe intra‐abdominal infections will need a relaparotomy, and 70% of these will require a pancreas explant .…”

Multidrug-resistant bacteria in solid organ transplant recipients

“…In pancreas transplant patients, secondary peritonitis is usually associated with anastomotic leaks or pancreas fistulae. Infection with bacteria in general and specifically surgical‐site bacterial infection occurs mainly within the first month of transplantation but bacterial peritonitis after pancreas transplantation may occur later, due to the development of late anastomotic leaks . Usually, secondary peritonitis after pancreas, liver or intestinal transplantation is cured after surgical repair of the anatomical site of the infection and with appropriate antimicrobial therapy.…”