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J Pediatr Infect Dis 2016; 11(03): 106-112
DOI: 10.1055/s-0036-1597300
DOI: 10.1055/s-0036-1597300
Review Article
Infections in Pediatric Kidney Transplant Recipients
Further Information
Publication History
02 August 2016
11 September 2016
Publication Date:
12 December 2016 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00029028/201603/lookinside/thumbnails/10-1055-s-0036-1597300_16si005-1.jpg)
Abstract
Infections after kidney transplant in children remain a significant problem. Infections can be viral (Epstein–Barr virus, cytomegalovirus, and BK virus), bacterial (urinary tract infections, wound infections, and pneumonia), or fungal (candidiasis and Pneumocystis jirovecii, formerly Pneumocystis carinii); all can have a significant negative impact on graft survival. Infections are typically defined as early (0–30 days posttransplant), intermediate (1–6 months posttransplant), or late (> 6 months posttransplant) depending on how far after transplant they occur. Here, we will review some of the common infections in children postkidney transplant.
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References
- 1 Smith JM, Martz K, Blydt-Hansen TD. Pediatric kidney transplant practice patterns and outcome benchmarks, 1987-2010: a report of the North American Pediatric Renal Trials and Collaborative Studies. Pediatr Transplant 2013; 17 (02) 149-157
- 2 Matas AJ, Smith JM, Skeans MA. , et al. OPTN/SRTR 2013 annual data report: kidney. Am J Transplant 2015; 15 (Suppl. 02) 1-34
- 3 Scott LJ, McKeage K, Keam SJ, Plosker GL. Tacrolimus: a further update of its use in the management of organ transplantation. Drugs 2003; 63 (12) 1247-1297
- 4 Saad AH, DePestel DD, Carver PL. Factors influencing the magnitude and clinical significance of drug interactions between azole antifungals and select immunosuppressants. Pharmacotherapy 2006; 26 (12) 1730-1744
- 5 Silva A, Rodig N, Passerotti CP. , et al. Risk factors for urinary tract infection after renal transplantation and its impact on graft function in children and young adults. J Urol 2010; 184 (04) 1462-1467
- 6 Feber J, Spatenka J, Seeman T. , et al. Urinary tract infections in pediatric renal transplant recipients--a two center risk factors study. Pediatr Transplant 2009; 13 (07) 881-886
- 7 Esezobor CI, Nourse P, Gajjar P. Urinary tract infection following kidney transplantation: frequency, risk factors and graft function. Pediatr Nephrol 2012; 27 (04) 651-657
- 8 John U, Kemper MJ. Urinary tract infections in children after renal transplantation. Pediatr Nephrol 2009; 24 (06) 1129-1136
- 9 Weigel F, Lemke A, Tönshoff B. , et al. Febrile urinary tract infection after pediatric kidney transplantation: a multicenter, prospective observational study. Pediatr Nephrol 2016; 31 (06) 1021-1028
- 10 Robinson LG, Hilinski J, Graham F. , et al. Predictors of cytomegalovirus disease among pediatric transplant recipients within one year of renal transplantation. Pediatr Transplant 2002; 6 (02) 111-118
- 11 Lapidus-Krol E, Shapiro R, Amir J. , et al. The efficacy and safety of valganciclovir vs. oral ganciclovir in the prevention of symptomatic CMV infection in children after solid organ transplantation. Pediatr Transplant 2010; 14 (06) 753-760
- 12 Camacho-Gonzalez AF, Gutman J, Hymes LC, Leong T, Hilinski JA. 24 weeks of valganciclovir prophylaxis in children after renal transplantation: a 4-year experience. Transplantation 2011; 91 (02) 245-250
- 13 Höcker B, Fickenscher H, Delecluse HJ. , et al. Epidemiology and morbidity of Epstein-Barr virus infection in pediatric renal transplant recipients: a multicenter, prospective study. Clin Infect Dis 2013; 56 (01) 84-92
- 14 Suzuki T, Ikezumi Y, Okubo S. , et al. Epstein-Barr virus DNA load and seroconversion in pediatric renal transplantation with tacrolimus immunosuppression. Pediatr Transplant 2007; 11 (07) 749-754
- 15 Köpf S, Tönshoff B. Surveillance of Epstein-Barr virus infection as a risk factor for post-transplant lymphoproliferative disorder in pediatric renal transplant recipients. Pediatr Nephrol 2004; 19 (04) 365-368
- 16 Smith JM, Corey L, Healey PJ, Davis CL, McDonald RA. Adolescents are more likely to develop posttransplant lymphoproliferative disorder after primary Epstein-Barr virus infection than younger renal transplant recipients. Transplantation 2007; 83 (11) 1423-1428
- 17 Smith JM, McDonald RA, Finn LS, Healey PJ, Davis CL, Limaye AP. Polyomavirus nephropathy in pediatric kidney transplant recipients. Am J Transplant 2004; 4 (12) 2109-2117
- 18 Jordan CL, Taber DJ, Kyle MO. , et al. Incidence, risk factors, and outcomes of opportunistic infections in pediatric renal transplant recipients. Pediatr Transplant 2016; 20 (01) 44-48
- 19 Li L, Chaudhuri A, Weintraub LA. , et al. Subclinical cytomegalovirus and Epstein-Barr virus viremia are associated with adverse outcomes in pediatric renal transplantation. Pediatr Transplant 2007; 11 (02) 187-195
- 20 Smith JM, Corey L, Bittner R. , et al. Subclinical viremia increases risk for chronic allograft injury in pediatric renal transplantation. J Am Soc Nephrol 2010; 21 (09) 1579-1586
- 21 Höcker B, Zencke S, Krupka K. , et al. Cytomegalovirus infection in pediatric renal transplantation and the impact of chemoprophylaxis with (Val-)Ganciclovir. Transplantation 2016; 100 (04) 862-870
- 22 Kotton CN, Kumar D, Caliendo AM. , et al; Transplantation Society International CMV Consensus Group. Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation 2013; 96 (04) 333-360
- 23 Chapman JR. The KDIGO clinical practice guidelines for the care of kidney transplant recipients. Transplantation 2010; 89 (06) 644-645
- 24 Humar A, Michaels M. AST ID Working Group on Infectious Disease Monitoring. American Society of Transplantation recommendations for screening, monitoring and reporting of infectious complications in immunosuppression trials in recipients of organ transplantation. Am J Transplant 2006; 6 (02) 262-274
- 25 Smith JM, Dharnidharka VR. Viral surveillance and subclinical viral infection in pediatric kidney transplantation. Pediatr Nephrol 2015; 30 (05) 741-748
- 26 Cockfield SM, Preiksaitis JK, Jewell LD, Parfrey NA. Post-transplant lymphoproliferative disorder in renal allograft recipients. Clinical experience and risk factor analysis in a single center. Transplantation 1993; 56 (01) 88-96
- 27 Walker RC, Paya CV, Marshall WF. , et al. Pretransplantation seronegative Epstein-Barr virus status is the primary risk factor for posttransplantation lymphoproliferative disorder in adult heart, lung, and other solid organ transplantations. J Heart Lung Transplant 1995; 14 (02) 214-221
- 28 Ho M, Miller G, Atchison RW. , et al. Epstein-Barr virus infections and DNA hybridization studies in posttransplantation lymphoma and lymphoproliferative lesions: the role of primary infection. J Infect Dis 1985; 152 (05) 876-886
- 29 Bingler MA, Feingold B, Miller SA. , et al. Chronic high Epstein-Barr viral load state and risk for late-onset posttransplant lymphoproliferative disease/lymphoma in children. Am J Transplant 2008; 8 (02) 442-445
- 30 Green M, Soltys K, Rowe DT, Webber SA, Mazareigos G. Chronic high Epstein-Barr viral load carriage in pediatric liver transplant recipients. Pediatr Transplant 2009; 13 (03) 319-323
- 31 Lau AH, Soltys K, Sindhi RK, Bond G, Mazariegos GV, Green M. Chronic high Epstein-Barr viral load carriage in pediatric small bowel transplant recipients. Pediatr Transplant 2010; 14 (04) 549-553
- 32 Dharnidharka VR, Sullivan EK, Stablein DM, Tejani AH, Harmon WE. North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Risk factors for posttransplant lymphoproliferative disorder (PTLD) in pediatric kidney transplantation: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Transplantation 2001; 71 (08) 1065-1068
- 33 Rowe DT, Qu L, Reyes J. , et al. Use of quantitative competitive PCR to measure Epstein-Barr virus genome load in the peripheral blood of pediatric transplant patients with lymphoproliferative disorders. J Clin Microbiol 1997; 35 (06) 1612-1615
- 34 Wadowsky RM, Laus S, Green M, Webber SA, Rowe D. Measurement of Epstein-Barr virus DNA loads in whole blood and plasma by TaqMan PCR and in peripheral blood lymphocytes by competitive PCR. J Clin Microbiol 2003; 41 (11) 5245-5249
- 35 Hill CE, Harris SB, Culler EE, Zimring JC, Nolte FS, Caliendo AM. Performance characteristics of two real-time PCR assays for the quantification of Epstein-Barr virus DNA. Am J Clin Pathol 2006; 125 (05) 665-671
- 36 Twombley K, Pokala H, Ardura MI. , et al. Intraventricular rituximab and systemic chemotherapy for treatment of central nervous system post-transplant lymphoproliferative disorder after kidney transplantation. Pediatr Transplant 2012; 16 (06) E201-E209
- 37 Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 2009; 9 (Suppl. 03) S1-S155
- 38 Allen U, Preiksaitis J. AST Infectious Diseases Community of Practice. Epstein-Barr virus and posttransplant lymphoproliferative disorder in solid organ transplant recipients. Am J Transplant 2009; 9 (Suppl. 04) S87-S96
- 39 Green M. Management of Epstein-Barr virus-induced post-transplant lymphoproliferative disease in recipients of solid organ transplantation. Am J Transplant 2001; 1 (02) 103-108
- 40 Green M, Webber S. Posttransplantation lymphoproliferative disorders. Pediatr Clin North Am 2003; 50 (06) 1471-1491
- 41 Rowe DT, Webber S, Schauer EM, Reyes J, Green M. Epstein-Barr virus load monitoring: its role in the prevention and management of post-transplant lymphoproliferative disease. Transpl Infect Dis 2001; 3 (02) 79-87
- 42 Jongsma H, Bouts AH, Cornelissen EA, Beersma MF, Cransberg K. Cytomegalovirus prophylaxis in pediatric kidney transplantation: the Dutch experience. Pediatr Transplant 2013; 17 (06) 510-517
- 43 Hashim F, Gregg JA, Dharnidharka VR. Efficacy of extended valganciclovir prophylaxis in preventing cytomegalovirus infection in pediatric kidney transplantation. Open Urol Nephrol J 2014; 7 , (2 suppl 2 M7) 152-157
- 44 Villeneuve D, Brothers A, Harvey E. , et al. Valganciclovir dosing using area under the curve calculations in pediatric solid organ transplant recipients. Pediatr Transplant 2013; 17 (01) 80-85
- 45 Gardner SD, Field AM, Coleman DV, Hulme B. New human papovavirus (B.K.) isolated from urine after renal transplantation. Lancet 1971; 1 7712 1253-1257
- 46 Knowles WA. Discovery and epidemiology of the human polyomaviruses BK virus (BKV) and JC virus (JCV). Adv Exp Med Biol 2006; 577: 19-45
- 47 Ahsan N, Shah KV. Polyomaviruses and human diseases. Adv Exp Med Biol 2006; 577: 1-18
- 48 Vanchiere JA, Abudayyeh S, Copeland CM, Lu LB, Graham DY, Butel JS. Polyomavirus shedding in the stool of healthy adults. J Clin Microbiol 2009; 47 (08) 2388-2391
- 49 Vanchiere JA, Carillo B, Morrow AL, Jiang X, Ruiz-Palacios GM, Butel JS. Fecal polyomavirus excretion in infancy. J Pediatric Infect Dis Soc 2016; 5 (02) 210-213
- 50 Dharnidharka VR, Abdulnour HA, Araya CE. The BK virus in renal transplant recipients-review of pathogenesis, diagnosis, and treatment. Pediatr Nephrol 2011; 26 (10) 1763-1774
- 51 Zarauza Santoveña A, García Meseguer C, Martínez Mejía S. , et al. BK virus infection in pediatric renal transplantation. Transplant Proc 2015; 47 (01) 62-66
- 52 Smith JM, Dharnidharka VR, Talley L, Martz K, McDonald RA. BK virus nephropathy in pediatric renal transplant recipients: an analysis of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry. Clin J Am Soc Nephrol 2007; 2 (05) 1037-1042
- 53 Ginevri F, Azzi A, Hirsch HH. , et al. Prospective monitoring of polyomavirus BK replication and impact of pre-emptive intervention in pediatric kidney recipients. Am J Transplant 2007; 7 (12) 2727-2735
- 54 Hirsch HH, Drachenberg CB, Steiger J, Ramos E. Polyomavirus-associated nephropathy in renal transplantation: critical issues of screening and management. Adv Exp Med Biol 2006; 577: 160-173
- 55 Liptak P, Kemeny E, Ivanyi B. Primer: histopathology of polyomavirus-associated nephropathy in renal allografts. Nat Clin Pract Nephrol 2006; 2 (11) 631-636
- 56 Drake KA, Najera L, Reed RC, Verghese PS. Unusual presentations of BK virus infections in pediatric renal transplant recipients. Pediatr Transplant 2013; 17 (01) E9-E15
- 57 Verghese PS, Schmeling DO, Knight JA, Matas AJ, Balfour Jr HH. The impact of donor viral replication at transplant on recipient infections posttransplant: a prospective study. Transplantation 2015; 99 (03) 602-608
- 58 Hirsch HH, Brennan DC, Drachenberg CB. , et al. Polyomavirus-associated nephropathy in renal transplantation: interdisciplinary analyses and recommendations. Transplantation 2005; 79 (10) 1277-1286
- 59 Hirsch HH, Randhawa P. AST Infectious Diseases Community of Practice. BK virus in solid organ transplant recipients. Am J Transplant 2009; 9 (Suppl. 04) S136-S146
- 60 Pham PT, Schaenman J, Pham PC. BK virus infection following kidney transplantation: an overview of risk factors, screening strategies, and therapeutic interventions. Curr Opin Organ Transplant 2014; 19 (04) 401-412
- 61 Jung YH, Moon KC, Ha JW. , et al. Leflunomide therapy for BK virus allograft nephropathy after pediatric kidney transplantation. Pediatr Transplant 2013; 17 (02) E50-E54
- 62 Vu D, Shah T, Ansari J, Naraghi R, Min D. Efficacy of intravenous immunoglobulin in the treatment of persistent BK viremia and BK virus nephropathy in renal transplant recipients. Transplant Proc 2015; 47 (02) 394-398
- 63 Araya CE, Lew JF, Fennell RS, Neiberger RE, Dharnidharka VR. Intermediate dose cidofovir does not cause additive nephrotoxicity in BK virus allograft nephropathy. Pediatr Transplant 2008; 12 (07) 790-795
- 64 Araya CE, Lew JF, Fennell III RS, Neiberger RE, Dharnidharka VR. Intermediate-dose cidofovir without probenecid in the treatment of BK virus allograft nephropathy. Pediatr Transplant 2006; 10 (01) 32-37
- 65 Araya CE, Garin EH, Neiberger RE, Dharnidharka VR. Leflunomide therapy for BK virus allograft nephropathy in pediatric and young adult kidney transplant recipients. Pediatr Transplant 2010; 14 (01) 145-150
- 66 Pifer LL, Hughes WT, Stagno S, Woods D. Pneumocystis carinii infection: evidence for high prevalence in normal and immunosuppressed children. Pediatrics 1978; 61 (01) 35-41
- 67 de Boer MG, de Fijter JW, Kroon FP. Outbreaks and clustering of Pneumocystis pneumonia in kidney transplant recipients: a systematic review. Med Mycol 2011; 49 (07) 673-680
- 68 Sassi M, Ripamonti C, Mueller NJ. , et al. Outbreaks of Pneumocystis pneumonia in 2 renal transplant centers linked to a single strain of Pneumocystis: implications for transmission and virulence. Clin Infect Dis 2012; 54 (10) 1437-1444
- 69 Höcker B, Wendt C, Nahimana A, Tönshoff B, Hauser PM. Molecular evidence of Pneumocystis transmission in pediatric transplant unit. Emerg Infect Dis 2005; 11 (02) 330-332
- 70 Kasiske BL, Zeier MG, Chapman JR. , et al; Kidney Disease: Improving Global Outcomes. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney Int 2010; 77 (04) 299-311
- 71 Evans RA, Clifford TM, Tang S, Au T, Fugit AM. Efficacy of once-weekly dapsone dosing for Pneumocystis jirovecii pneumonia prophylaxis post transplantation. Transpl Infect Dis 2015; 17 (06) 816-821