Nephrology Dialysis Transplantation, Vol 12, Issue 4 764-771, Copyright © 1997 by Oxford University Press
YF Smets, JW van der Pijl, JT van Dissel, J Ringers, JW de Fijter and HH Lemkes
BACKGROUND: Although technical success rate of simultaneous pancreas kidney
(SPK) transplantation in insulin-dependent diabetes mellitus (IDDM)
patients with diabetic nephropathy has improved, morbidity remains high due
to infection and rejection. The purpose of this study was to analyse
infections encountered in our series of SPK transplants, using a
restrictive antibiotic prophylaxis policy. METHODS: We reviewed all
infectious diseases after 66 consecutive bladder-drained SPK
transplantations in 64 IDDM patients with end-stage renal disease due to
diabetic nephropathy. During follow-up, the perioperative antibiotic
regimen was altered (from 5 days preemptive therapy with multiple drugs to
1 day prophylaxis with cefamandole), and long-term viral prophylaxis
(high-dose aciclovir) was introduced. For post-operative urinary tract or
opportunistic infection, no prophylaxis was given. RESULTS: Overall mean
infection rate was 2.9 infections/ patient/year after a mean follow-up of
2.3 years. Surgical site infections (SSI) were seen in 30% of the patients,
with Enterococci present in 47%. Logistic regression showed one day
cefamandole prophylaxis to be associated with SSI, but there was no
significant influence of SSI on either graft or patient survival.
Forty-eight percent of all infections were lower urinary tract infections
(UTI). There were 59 first UTIs (89%), probably related to long-term Foley
catheter use, and 47 second UTIs (71%). Subsequent UTIs were not
microbiologically related to first UTIs. Cytomegalovirus (10 patients) and
other opportunistic agents did not cause mortality or graft loss. Five
grafts were lost due to infection (SSI three times, post-transplant
lymphoproliferative disease twice). Only one patient died because of
infection (2%). CONCLUSIONS: Infectious diseases after SPK transplantation
caused significant morbidity but did not influence either patient or graft
survival. A change in prophylactic policy for both SSI as well as recurrent
UTI, combined with earlier Foley removal, may lower incidences of these
infections.
ORIGINAL ARTICLES
Infectious disease complications of simultaneous pancreas kidney transplantation
Department of Endocrinology, Leiden University Hospital, The Netherlands.
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