Infections after renal allograft transplantation

This thesis outlines the epidemiology of bacteriuria and cytomegalovirus (CMV) infection and their impact on renal allograft function after renal transplantation. Among renal allograft recipients, bacteriuria can be classified in asymptomatic bacteriuria (ASB), cystitis and allograft pyelonephritis (AGPN).
The incidence of AGPN within the first year after transplantation was 13%, with the presence of an indwelling urological catheter and preceding ASB episodes as its risk factors. Having experienced only AGPN does not impair renal allograft function. However, experiencing first AGPN followed by acute
rejection resulted in lower eGFR (MDRD) compared to having experienced only AGPN or only acute rejection.
Renal allograft recipients receive trimethoprim-sulfamethoxazole (TMP-SMX) as Pneumocystis jiroveci pneumonia prophylaxis. This prophylaxis does not prevent asymptomatic bacteriuria nor cystitis or AGPN. This can be explained by the increase in TMP-SMX resistance observed among the isolated bacteria in urine cultures of renal allograft recipients receiving TMP-SMX.
The association between primary CMV infection on renal allograft survival, function and histological outcomes is controversial. In absence of acute rejection, primary CMV infection was not an independent risk factor for allograft loss. Nor did it influence the renal allograft function or contribute to development of interstitial fibrosis and tubular atrophy.
Finally, we evaluated faecal microbiota transplantation (FMT) against intestinal colonisation by ESBL producing Enterobacteriaceae. Here, we observed that the overall efficacy of multiple FMT is around 40%, while on the first attempt it was only 20%.