Clinical Case Database / Category: Patient Management

Infections in renal transplantation

Publication details

Prof Sunil Bhandari, Dr Adam D Jakes, Poonam Jani
Foundation Years Journal, volume 8, issue 4, p.26 (123Doc Education, London, April 2014)


A 48 year old gentleman with adult polycystic kidney disease received a deceased donor renal transplant. His maintenance immunosuppressive therapy was tacrolimus and mycophenolate mofetil. He presented 8 months post-transplantation with fever and profuse diarrhoea for the previous 5 days (no blood), abdominal pain and lethargy. Initial investigations demonstrated an acute increase in serum creatinine from his baseline, together with a low white cell count and platelets. Here we discuss common infections in renal transplantation patients.

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Prof Sunil Bhandari

Consultant Nephrologist, Honorary Clinical Professor,
Deputy Head of School of Medicine, Yorkshire Deanery,
Hull & East Yorkshire Hospitals NHS Trust,
Anlaby Road, Kingston Upon Hull, HU32JZ

Dr Adam D Jakes

Academic Foundation Doctor, St James’s Univeristy Hospital,
Beckett Street, Leeds, West Yorkshire, LS9 7TF

Poonam Jani

Medical Student, Hull-York Medical School, Hertford Building,
University of Hull, Hull, HU6 7RX


1. UK Transplant Registry. Organ Donation and Transplantation Activity Data: United Kingdom. April 2013.
2. J, Douglas Briggs. Causes of death after renal transplantation. Nephrol Dial Transplant (2001) 16: 1545 – 1549.
3. Akbar SA, Jafri ZH, Amendola MA, et al. Complications in renal transplantation. Radiographics 2005; 25:1335-1356
4. Takai K, Tollemar J, Wilczek HE, Groth CG. Urinary tract infections following renal transplantation. Clin Transplant 1998;12(1): 19-23.
5. Dantas SRPE, Kuboyama RH, Mazzali M et al. Nonsocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections. J Hosp Infect 2006; 63:117-123.
6. Pillay D, Mutimer D , Singhal S, Turner A, Ward K, and Wood M. 2000. Management of herpes virus infections following transplantation. J. Antimicrob. Chemother. 45:729–748.
7. Diel R, Loddenkemper R and Nienhaus A. Evidence-Based Comparison of Commercial Interferongamma Release Assays for Detecting Active TB: A Metaanalysis. Chest; 137 (4):952-968, 2010.
8. Staras SAS, Dollard SC, Radford KW, Flanders WD, Pass RF, Cannon MJ: Seroprevalence of
cytomegalovirus infection in the United States, 1988-1994. Clin Infect Dis 2006, 43:1143-1151.
9. Rollag H, Sagedal S, Kristiansen KI et al. Cytomegalovirus DNA concentration in plasma predicts development of cytomegalovirus disease in kidney transplant recipients. Clin Microbiol Infect 2002; 8: 431–434.
10. Jakes AD, Roy A, Veerasamy M, Bhandari S. Crohn’s-like mycophenolate-induced colitis, a
fallout in steroid free regimens. Transplant Proceedings 2013, (45); 2, 842-844. Doi: 10.1016/j.
11. British Transplantation Society Guidelines for the Prevention and Management of CMV Disease after Solid Organ Transplantation. Third Edition, August 2011.
12. Stolt A, Sasnauskas K, Koskela P, et al. Seroepidemiology of the human polyomaviruses. J Gen Virol. 2003;84:1499-1504.
13. Bairy M, Sett A, Long E, Bhandari S. Obstruction or renal allograft rejection—potential clinical markers of BK virus nephropathy, Quarterly Journal of Medicine 2008: 101; (7) 594-598.
14. Beimler J, Sommerer C, Zeier M. The influence of immunosuppression on the development of BK virus nephropathy: does it matter? Nephrol Dial Transplant 2007; 22 Suppl. 8: viii66-71.
15. UK Renal Association: Post-operative Care of the Kidney Transplant Recipient. 5th Edition. 5th February 2011.
16. Fernàndez-Sabé N, Cervera C, Fariñas MC, et al. Risk factors, clinical features, and outcomes of toxoplasmosis in solid-organ transplant recipients: a matched case-control study. Clin Infect Dis 2012; 54:355.
17. First MR. Renal function as a predictor of long-term graft survival in renal transplant patients. Nephrol Dial Transplant 2003; 18 (Suppl 1): i3–i6.
18. Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. American Journal of Transplantation 2009; 9(Suppl 3):S1-S157


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