Response to the H1n1 Vaccine in a Large Cohort of Renal Transplant Recipients

Abstract

Infectious complications-one of major causes of mortality after renal transplantation. The aim of the study was to compare frequency and structure of fatal infections in renal graft recipients who received different post-transplant therapy. Materials and methods. We analyzed the data of 2010 recipients who were trasplanted between 1989 and 2006. The patients were divided into 3 groups accoding to recieved therapy. Patients of the 1 st group (n=383, transplanted in 1989-1992) and of the 2 nd group (n= 479, transplanted in 1995-1997) recieved similar immunosuppression therapy that included prednisolon, azathiorine and cyclosporine. Patients of the 2 nd group were also given antiviral therapy (gancyclovir) for cytomegalovirus (CMV) profilaxis. In the 3 rd group (n=1148, transplanted in 2002-2006) prednisolon, mycofenolates, calcineirin inhibitors (cyclosporine or tacrolimus) and antiviral therapy were used. Total five-year mortality, frequency and structure of fatal infectious were determined and compared in all groups. Correlation between risk of infectious death at 5 years after transplantation and renal function was also studied. Results. Five-year mortality reduced in last 20 years: 28%,15% and 10% in groups 1,2 and 3, respectively. The share of fatal infections among the total mortality was of 66,7%, 28,7% and 49,7% in groups 1, 2 and 3, respectively. In group1 CMV disease was predominate cause of death (46%), while bacteril infecions caused 13% of deaths. In patients of groups 2 and 3 who recieved antiviral therapy fatal CMV was rare (4% and 18% respectively), but the share of bacteriafungal and other opportunistic infecions among the total mortality increased (16% и 27%, respectively) compared to in the 1st group. Tuberculosis was responsible for 5%, 1% и 4% of death cases in groups 1, 2 and 3, respectively. Chronic hepatitis B and C caused patients' death more rarely. The rate of infectious death was higher in patients with renal graft dysfunction. Risk of infectious death at 5 year after transplantation was only 5% in patients with serum Cr level ≤0,13 mmol/l versus 12% in patients with serum Cr level>0,14 mmol/l (p<0,05). Conclusion. Strucrture severe post-transplant infections depends not only on immunosupression therapy, but also on renal function. Systemic fungal and other opportunistic infections are the serious problem after renal transplantation.Disclosure: All authors have declared no conflicts of interest.