Trying To Understand Infections In Transplant Patients In A Private Hospital In Buenos Aires, Argentina

Background: Since the first renal transplantation performed in Boston in 1954, solid organ transplantation became a common strategy against end-stage diseases. The German Hospital in Buenos Aires performed its first renal transplantation in 2000 and since then practice grew including also liver and heart transplantations. After 15 years it is time to evaluate the current infectious complications, aiming to discover useful variables to work on. Methods & Materials: This analysis is a retrospective observational study, for which we have reviewed the medical records of all patients undergoing transplantation surgeries from 1-Jan-2014 to 31-Dec-2014. On an excel sheet we have analyzed information such as: age, gender, underlying disease, type of immune suppression, time of onset of the infectious event and type and source of microorganisms involved. Results: Forty-six patients were transplanted during 2014, 33 (71.7%) of them had at least one infectious event. Median age was 55 (8-78, 70% between 31-65 years), 74% males. There was no difference between infected and not-infected regarding these 2 points. Organs transplanted: 2 hearts, 21 kidneys and 23 livers. Percentage of infections was similar in the different groups. Twenty-seven (33%) of infectious events were due to urinary tract infections, 19 of them in renal transplants (70%, p=0.02). CMV-reactivation was seen in 12 cases, 9 (75%) of them in liver-transplantations. Primary bacteremia was in third place (9, 13%) and surgical site infection in fourth (7, 10%). Low numbers prevent from calculating rates. Most of the infections (88%) showed up during the first 3 months, only 1 (3%) after 6 months. There was a wide range of microorganisms involved, 68% bacteria (70% GNB), 19% virus, 95 fungus and 4% TB. Regarding the storage fluid, 24% presented bacterial growth. There wasn’t an increase incidence of infectious events in those in which the storage fluid was contaminated. Conclusion: Urinary tract infection was the main complication as literature mentions. Surgical site infections were not prevalent in a particular group, which rules out inappropriate surgical technique. The variety of microorganisms involved rules out a common source. CMV prophylaxis strategy in hepatic transplant patients has to be reviewed.