Infektionen nach Nierentransplantation im Kindesalter

Michael van Husen; Markus J. Kemper

doi:10.1055/s-0038-1628912

Kinder- und Jugendmedizin, Table of Contents

Kinder- und Jugendmedizin 2008; 08(05): 271-278
DOI: 10.1055/s-0038-1628912

Transplantationsmedizin

Schattauer GmbH

Infektionen nach Nierentransplantation im Kindesalter

Infection in pediatric renal transplant recipients

Authors

Michael van Husen

¹Pädiatrische Nephrologie, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf (Direktor: Prof. Dr. med. K. Ullrich)
Markus J. Kemper

¹Pädiatrische Nephrologie, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf (Direktor: Prof. Dr. med. K. Ullrich)

Abstract

Zusammenfassung

Infektionen sind relevante Morbiditäts- und Mortalitätsfaktoren für Patienten nach einer erfolgreichen Organtrans-plantation. Aufgrund der immunsuppressiven Therapie ergibt sich eine höhere Empfänglichkeit für Infektionen gegenüber anderen pädiatrischen Patienten. Dazu steigt die Gefahr eines schweren Verlaufes inklusive Sepsis und Multiorganversagen bis zum Tod. Speziell nach Nierentrans-plantation sind febrile und afebrile Harnwegsinfektionen eine ernstzunehmende Komplikation, die Symptome einer Urosepsis aufweisen und zur akuten Transplantatdysfunktion führen können. Ansonsten spielen neben den im Kindesalter häufigen bakteriellen und viralen Infektionen des Respirationstraktes sowie Virusgastroenteritiden insbesondere Infektionen durch Viren wie CMV, EBV, Herpes-simplex-Virus und Polyomaviren eine relevante Rolle. Opportunistische Infektionen durch Pilze oder Pneumocystis carinii sind zwar selten, müssen aber wegen ihrer schlechten Prognose differenzialdiagnostisch immer berücksichtigt werden. Ziel dieses Artikels ist es, die Differenzialdiagnostik der häufigsten Infektionen in den verschiedenen Phasen nach Nierentransplantation im Kindesalter zu erläutern und relevante Therapiemaßnahmen (symptomatische, Antibiotika) zu vermitteln.

summary

Infectious complications are the leading cause of morbidity and mortality after successful solid organ transplantation. Immunosuppression contributes not only to a higher susceptibility to infection in contrast to the general pediatric population but also to an increased risk of sepsis, organ failure and death. Signs and symptoms of infection may be diminished in immunocompromised hosts. Especially febrile and afebrile urinary tract infections are an important complication, which can result in urosepsis and allograft dysfunction. Viral respiratory tract infections and gastroenteritis are the most frequent types of infection encountered after organ transplantation. Other important infectious complications are due to CMV, EBV and polyomavirus. Opportunistic and fungal pathogens have to be considered and may have a poor prognosis. General concepts in differential diagnosis and treatment after renal transplantation as well as prophylactic measures in pediatric patients after kidney transplantation will be discussed.

Schlüsselwörter

Nierentransplantation - Infektion - Harnwegsinfektion - Immunsuppression

Keywords

Renal transplantation - infection - urinary tract infection - immunsuppression

Full Text

References

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