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肾移植受者的感染模式与生存率

Infection Patterns and Survival Among Renal Transplant Recipients.

作者信息

Vishnu Dalvi Sayali, Tilve Parag, Bodke Sachin Yadav, Deb Satarupa, Andankar Mukund, Oza Umesh, Usulumarty Deepa, Billa Viswanath, Bichu Shrirang

机构信息

Department of Nephrology, Bombay Hospital Institute of Medical Sciences, India.

Industrial Engineering and Operations Research, IIT Bombay, India.

出版信息

Indian J Nephrol. 2025 Jul-Aug;35(4):490-496. doi: 10.25259/ijn_453_23. Epub 2024 Aug 9.

DOI:10.25259/ijn_453_23
PMID:40896608
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12392238/
Abstract

BACKGROUND

The outcome of kidney transplantation is determined by multiple factors and infections represent one of the major factors affecting graft and patient survival. Recent COVID-19 pandemic have adversely affected the transplant population. Very little data is available on post-transplant infections and patient survival from India.

MATERIALS AND METHODS

In this retrospective observational study, data related to post-transplant infections from patients who had undergone renal transplantation between October 2014 and October 2021 were collected.

RESULTS

A total of 255 infections episodes were observed in 118 patients. Bacterial infections were the most common (55%) followed by viral (35%), fungal (5%), mycobacterial (4%), and parasitic (1%). The most common bacterial and viral infections were urinary tract infections (70.5%) and COVID-19 (56%), respectively. BK virus and COVID-19 were associated with increased graft loss (p < 0.05). The majority of deaths due to infections were related to COVID-19 infection (71.42%). Kaplan-Meier survival analysis showed 1-, 3-, and 5-year patient survival of 98.23%, 96.36%, and 92.90% and graft survival of 98.14%, 95.97%, and 91.78, respectively.

CONCLUSION

Infections with their adverse impact remain a concern in kidney transplant patients. Comparable patient and graft survival to the Western data despite the high infection burden and the COVID-19 pandemic suggests that effective management can reduce the impact of infections on survival.

摘要

背景

肾移植的结果由多种因素决定，感染是影响移植物和患者存活的主要因素之一。近期的新冠疫情对移植人群产生了不利影响。来自印度的关于移植后感染和患者存活的数据非常少。

材料与方法

在这项回顾性观察研究中，收集了2014年10月至2021年10月期间接受肾移植患者的移植后感染相关数据。

结果

在118名患者中总共观察到255次感染发作。细菌感染最为常见（55%），其次是病毒感染（35%）、真菌感染（5%）、分枝杆菌感染（4%）和寄生虫感染（1%）。最常见的细菌和病毒感染分别是尿路感染（70.5%）和新冠病毒感染（56%）。BK病毒和新冠病毒感染与移植物丢失增加相关（p<0.05）。因感染导致的死亡大多与新冠病毒感染有关（71.42%）。Kaplan-Meier生存分析显示患者1年、3年和5年生存率分别为98.23%、96.36%和92.90%，移植物生存率分别为98.14%、95.97%和91.78%。

结论

感染及其不良影响仍是肾移植患者的一个问题。尽管感染负担高且有新冠疫情，但患者和移植物生存率与西方数据相当，这表明有效的管理可以降低感染对生存的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/078f/12392238/506d9532c9d2/IJN-35-4-490-g6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/078f/12392238/0cd663bfa3b8/IJN-35-4-490-g1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/078f/12392238/524e377ea420/IJN-35-4-490-g2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/078f/12392238/58d19b54783f/IJN-35-4-490-g3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/078f/12392238/31f4a70df019/IJN-35-4-490-g4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/078f/12392238/1b0049e1ba89/IJN-35-4-490-g5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/078f/12392238/506d9532c9d2/IJN-35-4-490-g6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/078f/12392238/0cd663bfa3b8/IJN-35-4-490-g1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/078f/12392238/524e377ea420/IJN-35-4-490-g2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/078f/12392238/58d19b54783f/IJN-35-4-490-g3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/078f/12392238/31f4a70df019/IJN-35-4-490-g4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/078f/12392238/1b0049e1ba89/IJN-35-4-490-g5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/078f/12392238/506d9532c9d2/IJN-35-4-490-g6.jpg

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本文引用的文献

1
Disseminated Nocardiosis in Kidney Transplant Recipients: A Report of 2 Cases.肾移植受者播散性诺卡菌病：2例报告
Kidney Med. 2022 Sep 30;4(12):100551. doi: 10.1016/j.xkme.2022.100551. eCollection 2022 Dec.
2
Long-Term Survival after Kidney Transplantation.肾移植后的长期存活
N Engl J Med. 2021 Aug 19;385(8):729-743. doi: 10.1056/NEJMra2014530.
3
A retrospective multi-center experience of renal transplants from India during COVID-19 pandemic.回顾性研究：COVID-19 大流行期间印度的肾脏移植多中心经验。
Clin Transplant. 2021 Oct;35(10):e14423. doi: 10.1111/ctr.14423. Epub 2021 Jul 19.
4
Pulmonary infections after renal transplantation: a prospective study from a tropical country.肾移植后肺部感染：来自热带国家的前瞻性研究。
Transpl Int. 2021 Mar;34(3):525-534. doi: 10.1111/tri.13817. Epub 2021 Feb 26.
5
Clinical Profile and Outcome of COVID-19 in 250 Kidney Transplant Recipients: A Multicenter Cohort Study From India.250 例肾移植受者 COVID-19 的临床特征和结局：来自印度的一项多中心队列研究。
Transplantation. 2021 Apr 1;105(4):851-860. doi: 10.1097/TP.0000000000003593.
6
Long-term kidney transplant graft survival-Making progress when most needed.长期肾移植移植物存活率——最需要时取得进展。
Am J Transplant. 2021 Aug;21(8):2824-2832. doi: 10.1111/ajt.16463. Epub 2021 Feb 8.
7
Tuberculosis in renal transplant recipients: Our decade long experience with an opportunistic invader.肾移植受者中的结核病：我们长达十年的机会性入侵经验。
Indian J Tuberc. 2020 Jan;67(1):73-78. doi: 10.1016/j.ijtb.2019.05.001. Epub 2019 May 15.
8
Profile of infections in renal transplant recipients from India.印度肾移植受者的感染情况
J Family Med Prim Care. 2016 Jul-Sep;5(3):611-614. doi: 10.4103/2249-4863.197320.
9
Impact of type of calcineurin inhibitor on post-transplant tuberculosis: Single-center study from India.钙调神经磷酸酶抑制剂类型对移植后结核病的影响：来自印度的单中心研究。
Transpl Infect Dis. 2017 Feb;19(1). doi: 10.1111/tid.12626. Epub 2016 Dec 16.
10
Aspergillosis in solid organ transplantation.实体器官移植中的曲霉病
Am J Transplant. 2013 Mar;13 Suppl 4:228-41. doi: 10.1111/ajt.12115.