Infection in the Renal Transplant Patient

Serious infectious complications of corticosteroid therapy for COPD

We report seven elderly patients with COPD who developed serious infectious complications during prolonged treatment with high doses of corticosteroids. Infections included invasive pulmonary aspergillosis, Herpes simplex stomatitis and esophagitis, cytomegalovirus pneumonia, bacterial sepsis, fungemia and meningitis due to Cryptococcus neoformans. Each of the three patients who developed invasive aspergillus pneumonia died. The efficacy of prolonged therapy with high doses of corticosteroids in patients with COPD is not proven. These cases illustrate the potential for serious infections in patients with COPD treated with corticosteroids.

Tuberculosis in patients undergoing maintenance haemodialysis and renal transplantation

The difficulty in diagnosis of tuberculosis in patients with chronic renal failure or on immunosuppressive therapy is discussed. Anti-tuberculous therapy was required in 19 out of 315 patients who received a renal transplant in the Urology Unit, Hammersmith Hospital, between February 1961 and December 1979. Twelve patients were from overseas. Their management and the effect of anti-tuberculous therapy on the immunosuppressed patient were also studied. The disease was treated successfully in 18 patients, even though there were problems with diagnosis. The patient who died had active tuberculosis on post-morten examination. Prophylaxis should be considered in patients who have had tuberculosis in the past and may have received inadequate treatment.

Infection in the renal transplant recipient

The incidence of infection in the renal transplant patient is directly related to the net immunosuppressive effect achieved and the duration of time over which this therapy is administered. A second major factor in the causation of infections in this population is the nosocomial hazards to which these patients are exposed, ranging from invasive instrumentation to environmental contamination with Aspergillus species, Legionella pneumophila, Pseudomonas aeruginosa and other microbial pathogens. Careful surveillance is necessary to identify and eliminate such nosocomial sources of infection. The major types of infection observed can be categorized according to the time period post-transplant in which they occur: postsurgical bacterial infection in the first month after transplantation; opportunistic infection, with cytomegalovirus playing a major role, and transplant pyelonephritis in the period one to four months post-transplant; and a mixture of conventional and opportunistic infections in the last post-transplant period. Conventional infection in this late period occurs primarily in patients with good renal function who are receiving minimal immunosuppressive therapy; opportunistic infection occurs primarily in patients with poor renal function who are receiving higher levels of immunosuppression.