Böbrek Transplantı Alıcılarında Görülen İnfeksiyonların Sıklığı ve Özellikleri

Amaç: Böbrek transplantasyonu sonrası infeksiyöz komplikasyonlar önemli morbidite nedenidir. Çalışmada böbrek transplantasyonu yapılan hastalarda transplantasyon sonrası gelişen infeksiyonları ve özelliklerini incelemek amaçlanmıştır. Materyal ve Metod: İstanbul Tıp Fakültesi Hastanesinde, Ocak 2005-Aralık 2006 tarihleri arasında transplantasyon yapılan 91 hasta (71’ i canlı, 20’ si kadavradan) Aralık 2007 tarihine dek (ortalama 23.4±7.4 ay süreyle), retrospektif olarak değerlendirilmiştir. Bulgular: Böbrek transplantı alıcılarında saptanan infeksiyon oranı % 48.4’dir. Kadavradan organ alan hastalarda yoğun immünosüpresif tedavi, geniş spektrumlu ve uzun süreli uygulanan perioperatif profilaksi ve idrar sondasının uzun süre kalması gibi infeksiyon riski taşıyan uygulamalar dikkat çekmiş ve bu hastalarda infeksiyon sıklığı (% 70), canlıdan organ alanlara (% 42.25) göre daha yüksek bulunmuştur. İnfeksiyon zaman takvimine göre değerlendirildiğinde, posttransplantasyon dönemde en fazla infeksiyon 1-6 ay arası dönemde (% 43) görülmüştür. Üriner sistem infeksiyonları tüm dönemlerde en sık (% 68.6) saptanan infeksiyon olup bunu pnömoni (% 14) ve cerrahi alan infeksiyonları (% 9.3) izlemiştir. Sitomegalovirus infeksiyonu (n=2), herpes zoster (n=2), kandidemi (n=1) ve tüberkülöz epididimoorşit (n=1) diğer nadir infeksiyonlardır. Bakteriyel infeksiyonlar en sık saptanırken, Pseudomonas aeruginosa ve Escherichia coli en sık etkenlerdir. Sonuç: Böbrek transplantasyonunda immünosüpresyon tedavisi ve cerrahi tekniklerde elde edilen tüm gelişmelere rağmen, infeksiyonlar hâlâ önemli bir problemdir ve transplantasyon öncesi değerlendirme ve transplantasyon sonrası koruma ve kontrol önlemlerine uymak en iyi yaklaşım olacaktır.

Anahtar Kelimeler:

böbrek, transplantasyon, infeksiyon

Frequency and Characteristics of Infections in Kidney Transplant Recipients

Objective: Infectious complications after kidney transplantation are important causes of morbidity. In this study, it was aimed to examine the post-transplantation infections and their characteristics in kidney transplant patients. Materials and Methods: 91 patients (71 living, 20 cadaveric) transplanted between January 2005 and December 2006 in Istanbul Medical Faculty Hospital were evaluated retrospectively until December 2007 (mean duration of 23.4±7.4 months). Results: The infection rate detected in kidney transplant recipients was 48.4%. Intensive immunosuppressive therapy, broad-spectrum and long-term perioperative prophylaxis, and prolonged urinary catheterization in patients who received organs from cadavers attracted attention, and the incidence of infection in these patients (70%) was found to be higher than those who received organs from living organs (42.25%). . When evaluated according to the infection time calendar, the highest number of infections was observed in the posttransplantation period between 1-6 months (43%). Urinary system infections were the most common infection (68.6%) in all periods, followed by pneumonia (14%) and surgical site infections (9.3%). Other rare infections are cytomegalovirus infection (n=2), herpes zoster (n=2), candidemia (n=1), and tuberculous epididymoorchitis (n=1). While bacterial infections are the most common, Pseudomonas aeruginosa and Escherichia coli are the most common agents. Conclusion: Despite all the advances in immunosuppression therapy and surgical techniques in kidney transplantation, infections are still an important problem and it would be best to follow pre-transplant evaluation and post-transplant prevention and control measures.

Keywords:

kidney, transplantation, infection,

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