Opportunistic infections in children following renal transplantation

Abstract

Opportunistic infections following renal transplantation in children are a major cause of severe morbidity and mortality. These infections account for the majority of early post renal-transplant deaths in children. General risk factors which affect the incidence and severity of these infections include: transmission of the infectious agent by the donor organ; history of immunity in the recipient prior to transplantation; type and amount of immunosuppression including treatment for rejection episodes; availability of specific treatment for the infection. Children are at particular risk because of the lack of exposure to certain pathogens prior to transplantation. There have been recent advances in the prevention and treatment of important infections which occur in children following transplantation, including varicella, Pneumocystis carinii pneumonia (PCP) and cytomegalovirus (CMV) disease. Varicella is treatable with acyclovir, often without decreasing immunosuppression and placing the graft at risk. Prophylaxis against PCP may be achieved by provision of alternate-day trimethoprim sulpha, but clear guidelines for determining who should be treated are lacking. Treatment of this disease with high-dose trimethoprim sulfa or pentamidine is usually successful. CMV disease is frequently severe, especially when the donor is seropositive and the recipient seronegative. In these situations, prophylactic CMV immunoglobulin reduces the morbidity and the mortality of the disease and prophylactic oral acyclovir may decrease its incidence. Treatment of severe CMV disease with gancyclovir is promising.

Immunization in children with chronic renal failure

“…Standard vaccination schedules generally induce an antibody response in children with CRF [12,13,14,15,16,17], although specific revaccination is recommended [17]. The completion of the vaccination program before RTPL is particularly important, as immunosuppressed infants and young children without specific protection -either after immunization or wild-type infection -are at high risk that benign childhood infections are severe and life threatening [12,18]. Data on the implementation of the comprehensive vaccination schedule in children with CRF and RTPL are rare.…”

Early Diagnosis in Post Renal Transplant Opportunistic Infections: A Fresh Look

“…CMV disease is frequently severe. specially when the donor is seropositive and recipient seronegative [7]. In a recent study [10] the incidences of CMV infection and disease were 56% and 23% respectively during the first 6 months following renal transplantation.…”

“…However in developing countries like India, the incidence is expected to be high [6]. All these infections account for major cause of morbidity and mortality in transplant patients [7]. So awareness, early detection and quick management of these infections is very essential.…”

Vaccination Status of Children Considered for Renal Transplant: Missed Opportunities for Vaccine Preventable Diseases

“…[1][2][3] Infections such as influenza, chickenpox, and measles are more likely to be complicated and even life-threatening in solidorgan transplant recipients. [1][2][3][4][5][6][7] During childhood, the possibility of incomplete immunizations at the time of transplant is more frequently observed than during adulthood. Several previous studies have shown inadequate immunization for some vaccines (measles, mumps, rubella [MMR], diphtheriatetanus-pertussis, and hepatitis B) in liver and kidney transplant candidates.…”