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009 Changing Spectrum of Infections in Renal Transplant Recipients
34
Indian Journal of Transplantation
009 Changing Spectrum of Infections in Renal Transplant Recipients V Saxena, S Pokhariyal, S B Bansal, M Singhal, S Gulati, A Kumar, R Ahlalwat, V Kher Fortis Hospitals, NCR, Delhi
Introduction: Infections have been the commonest cause of mortality and morbidity in kidney transplant patients. The spectrum of infections depends on a number of factors, the most important being the immunosuppressive protocol. Methods: This study was conducted to evaluate the spectrum of infections in live related kidney transplant recipients with the current immunosuppressive protocols. The study group comprised of 266 patients who received a live related allograft between May 2006 – April 2009 and had a minimum 3 months follow up. Of the 266 patients, 147 received IL2 induction. 99 received Tac, MMF and prednisolone; 114 received Tac, Aza and prednisolone; 28 received CsA, MMF and prednisolone and 25 were on steroid free protocol. They were followed twice weekly for first month, once weekly in second month, fortnightly in third month and then monthly thereafter. At each visit they were assessed clinically for height, weight, BP and biochemical investigations (BUN, S. Creatinine, Na, K, Blood sugar).They were screened for infections using standard hematology, microbiological and radiological tests : CBC, urine RM, blood c/s, urine c/s, chest skiagram, CSF, CT scan (whenever required). We compared the frequency of infections in patients who received IL2 R antibodies vs those who did not, as well as those with MMF vs Aza as maintenance immunosuppressive protocol. Results: There were 209 males and 57 females. The mean age was 40.7 years + 12.9. The mean duration of follow up was 16.5 + 9.76 months. Of the 266 patients, 55 had one or more episodes of infections. Bacterial infections were the commonest (37/55,67.3%) followed by viral (16/ 55,29.1%) and fungal (2/55, 3.6%). UTI was the commonest infection (18/55, 32.7%) followed by pneumonia (12/55, 21.8%) and TB (4/55). Amongst the viral infections, Herpes zoster (8/55) was the commonest, followed by CMV and BKV in 3 each and Herpes simplex in 2 patients. Fungal infections were seen in 2 patients. The frequency of infections in patients who received IL2 induction (33/147 vs 22/119, p=0.52) was similar to those who did not receive any induction. The frequency of infections was also similar in patients who received MMF as compared to those who were on Aza based maintenance protocol (25/114 vs 30/152, p=0.77). Of the 266 patients, there were 10 deaths and 4 of them were attributable to infections.
Copyright © 2010 by The Indian Society of Organ Transplantation
Indian J Transplant 2010; 1: 26-42
Conclusion: Infections remain an important problem in renal transplant patients. However with optimal utilization of immunosuppression, the proportion of patient mortality due to infections has decreased. Also the number of patients developing opportunistic infections has also decreased considerably. Keywords: Infections, renal transplant, CMV, BKV, UTI, immunosuppression
010 Steroid free immunosuppression in children – a pilot study P N Gupta, S Gulati, V Saxena, S Pokhariyal, R Ahlalwat, V Kher Fortis Hospitals, NCR, Delhi
Introduction: Corticosteroids have always been an integral part of immunosuppressive regimens in renal transplantation. The primary goal of this study was to assess the safety of steroid free protocol in our pediatric renal transplant recipients receiving Tacrolimus based immunosuppression. We report results of our preliminary experience in 3 children who received live related kidney transplant and were on steroid free protocol. Methods: We evaluated three children who received live related kidney transplant in past two years and were on steroid free protocol. All of them received two doses of IL2RA as induction. They were given IV Methylprednisolone in an initial dose 500 mg followed by oral prednisolone which was stopped on day 5. All of them received Tacrolimus (0.1 mg/kg) and MMF (1100 mg/m 2) as maintenance immunosuppression. We compared these 3 children with three other children who received steroid based protocol (without IL2R induction) during the same time period. They were followed twice weekly for first month, once weekly in second month, fortnightly in third month and then monthly. At each visit they were assessed clinically for height, weight, BP and biochemical investigations (BUN, S. Creatinine, Na, K, Blood sugar). The outcome measures that were evaluated were number of acute rejections, graft loss, PTDM, antihypertensive medications, S. Cholestrol, eGFR, height velocity and height SDS. Results: The study group comprised of two boys and one girl. The mean age was 11.7 years and mean follow up was 14 months (5-24 months). We compared these 3 children (Group 1) with 3 other age matched controls who were on steroid protocol (Group 2). The mean follow up in group 1 was similar to that in group 2 (14 months vs 12.3 months). None of these six children has any episode of acute rejection. On comparing the two groups we observed that the growth velocity in group 1 (6.8 cm/yr) was greater than group 2 (4.7 cm/yr). Similarly the improvement in Z-score was greater in group 1 as
Indian Journal of Transplantation
009 Changing Spectrum of Infections in Renal Transplant Recipients V Saxena, S Pokhariyal, S B Bansal, M Singhal, S Gulati, A Kumar, R Ahlalwat, V Kher Fortis Hospitals, NCR, Delhi
Introduction: Infections have been the commonest cause of mortality and morbidity in kidney transplant patients. The spectrum of infections depends on a number of factors, the most important being the immunosuppressive protocol. Methods: This study was conducted to evaluate the spectrum of infections in live related kidney transplant recipients with the current immunosuppressive protocols. The study group comprised of 266 patients who received a live related allograft between May 2006 – April 2009 and had a minimum 3 months follow up. Of the 266 patients, 147 received IL2 induction. 99 received Tac, MMF and prednisolone; 114 received Tac, Aza and prednisolone; 28 received CsA, MMF and prednisolone and 25 were on steroid free protocol. They were followed twice weekly for first month, once weekly in second month, fortnightly in third month and then monthly thereafter. At each visit they were assessed clinically for height, weight, BP and biochemical investigations (BUN, S. Creatinine, Na, K, Blood sugar).They were screened for infections using standard hematology, microbiological and radiological tests : CBC, urine RM, blood c/s, urine c/s, chest skiagram, CSF, CT scan (whenever required). We compared the frequency of infections in patients who received IL2 R antibodies vs those who did not, as well as those with MMF vs Aza as maintenance immunosuppressive protocol. Results: There were 209 males and 57 females. The mean age was 40.7 years + 12.9. The mean duration of follow up was 16.5 + 9.76 months. Of the 266 patients, 55 had one or more episodes of infections. Bacterial infections were the commonest (37/55,67.3%) followed by viral (16/ 55,29.1%) and fungal (2/55, 3.6%). UTI was the commonest infection (18/55, 32.7%) followed by pneumonia (12/55, 21.8%) and TB (4/55). Amongst the viral infections, Herpes zoster (8/55) was the commonest, followed by CMV and BKV in 3 each and Herpes simplex in 2 patients. Fungal infections were seen in 2 patients. The frequency of infections in patients who received IL2 induction (33/147 vs 22/119, p=0.52) was similar to those who did not receive any induction. The frequency of infections was also similar in patients who received MMF as compared to those who were on Aza based maintenance protocol (25/114 vs 30/152, p=0.77). Of the 266 patients, there were 10 deaths and 4 of them were attributable to infections.
Copyright © 2010 by The Indian Society of Organ Transplantation
Indian J Transplant 2010; 1: 26-42
Conclusion: Infections remain an important problem in renal transplant patients. However with optimal utilization of immunosuppression, the proportion of patient mortality due to infections has decreased. Also the number of patients developing opportunistic infections has also decreased considerably. Keywords: Infections, renal transplant, CMV, BKV, UTI, immunosuppression
010 Steroid free immunosuppression in children – a pilot study P N Gupta, S Gulati, V Saxena, S Pokhariyal, R Ahlalwat, V Kher Fortis Hospitals, NCR, Delhi
Introduction: Corticosteroids have always been an integral part of immunosuppressive regimens in renal transplantation. The primary goal of this study was to assess the safety of steroid free protocol in our pediatric renal transplant recipients receiving Tacrolimus based immunosuppression. We report results of our preliminary experience in 3 children who received live related kidney transplant and were on steroid free protocol. Methods: We evaluated three children who received live related kidney transplant in past two years and were on steroid free protocol. All of them received two doses of IL2RA as induction. They were given IV Methylprednisolone in an initial dose 500 mg followed by oral prednisolone which was stopped on day 5. All of them received Tacrolimus (0.1 mg/kg) and MMF (1100 mg/m 2) as maintenance immunosuppression. We compared these 3 children with three other children who received steroid based protocol (without IL2R induction) during the same time period. They were followed twice weekly for first month, once weekly in second month, fortnightly in third month and then monthly. At each visit they were assessed clinically for height, weight, BP and biochemical investigations (BUN, S. Creatinine, Na, K, Blood sugar). The outcome measures that were evaluated were number of acute rejections, graft loss, PTDM, antihypertensive medications, S. Cholestrol, eGFR, height velocity and height SDS. Results: The study group comprised of two boys and one girl. The mean age was 11.7 years and mean follow up was 14 months (5-24 months). We compared these 3 children (Group 1) with 3 other age matched controls who were on steroid protocol (Group 2). The mean follow up in group 1 was similar to that in group 2 (14 months vs 12.3 months). None of these six children has any episode of acute rejection. On comparing the two groups we observed that the growth velocity in group 1 (6.8 cm/yr) was greater than group 2 (4.7 cm/yr). Similarly the improvement in Z-score was greater in group 1 as