Infections and Kidney Transplant Patients: What to Know

Undergoing any surgery puts you at greater risk for infection. But with kidney transplants, you are often at even higher risk of infection from a range of viruses and bacteria, known as pathogens, because the medications you take afterward affect your immune system.

“Medications suppress your immune system so you will not reject the new kidney,” says Nikhil Agrawal, MD, a nephrologist at Beth Israel Deaconess Medical Center in Boston. “This makes it harder for your body to fight off a viral or bacterial infection.”

What Causes Kidney Transplant Infections?

There are a number of ways that you might contract infections after kidney transplant. Exposure to bacteria or viruses after a transplant can occur in the hospital setting, or in everyday life. For example, touching a contaminated surface or being in close contact with someone who is infected can put you at risk. You are at higher risk of infection in the months following transplant surgery because you are on more aggressive immune-suppressing medications to prevent kidney transplant rejection. These medications make it harder for your body to fight off infections when exposed.

Aggressive immune suppression usually only lasts for up to a year after surgery. But virtually all people will stay on immune-suppressing medications for the rest of their life. So they are still at higher risk than other people whose immune systems are not suppressed.

The second risk after transplant is a pathogen that entered your body before the transplant but didn’t become active until immunosuppressants started. This is called latent pathogen activation. Suppressing your immune system can allow these pathogens to multiply without anything to fight them off. To reduce your risk of reactivating latent infections, doctors will¹:

• Screen for pathogens before your transplant
• Recommend immunizations before your transplant surgery
• Prescribe antibacterial and antiviral medications that can fight these pathogens

A third way you might be exposed to infection is from the donor organ itself. This is called donor-derived disease (DDD). However, in a review by the Organ Procurement and Transplantation Network (OPTN) Disease Transmission Advisory Group, unexpected DDD occurred in less than 1% of organ transplants.²

The OPTN requires organ procurement organizations and living donor recovery centers to test for multiple infections before transplant, including³:

• CMV
• Epstein-Barr
• Hepatitis B and hepatitis C
• HIV
• Syphilis
• Toxoplasmosis (for deceased donors)

Additional Risk Factors for Infection After a Kidney Transplant

In addition to a suppressed immune system, other factors can further increase your risk for infection after a kidney transplant. In some cases, these risk factors are tied to particular types of infections.

Additional risk factors include⁴:

• Sex, since women are more likely to get an infection of the urinary tract, for example.
• Donor age or recipient age, since older patients are more likely to have comorbidities (other health conditions) that affect organ function and also tend to have less robust immune systems than younger patients.
• Simultaneous kidney and pancreas transplantation. Research is ongoing to identify the reasons for increased infection risk, although it may have to do with technical aspects and duration of the procedure.

Most Common Infections After Renal Transplant

As someone with a transplanted kidney, you’re at higher risk for a range of infections. But the most common types of infections after renal (kidney) transplant include:

UTIs After Kidney Transplant

Urinary tract infections (UTIs) are one of the most common infections for someone after a kidney transplant.⁵ They begin in the lower urinary tract, in the urethra (a small tube where urine comes out of your body) and bladder. Infection can eventually also move up the ureter (the tube that connects your bladder to your transplanted kidney), and into your kidney.

The best way to avoid UTIs after kidney transplant is with good hygiene and by taking all antibiotic medications as prescribed after your transplant surgery.

Skin Infections After Kidney Transplant

Skin conditions can affect you after a renal transplant, and are most common in the first year following your surgery. Some common skin conditions include:

• Cellulitis,
• Eczema,
• Fungal infections
• Viral warts

Fighting off skin infections can be a challenge when you are on immunosuppressing medications, so it’s important to monitor your skin carefully and talk to a dermatologist about any concerns.

Blood Infections After Kidney Transplant

Bloodstream infections (BSIs) are one of the highest risks for people receiving transplanted organs. They’re caused not only by bacteria and viruses, but also by parasites and fungi. These infections are the cause of 2.5% to 11% of kidney transplant recipient mortality (deaths).⁶

Viral Infections After Kidney Transplant

Common viruses that affect you after kidney transplant include⁷:

• Adenovirus
• BK polyomavirus
• Cytomegalovirus (CMV)
• Epstein-Barr virus
• Herpes simplex
• Varicella zoster

Some of these viruses may not cause immediate complications but can still increase the chance of developing certain cancers later, Dr. Agrawal says. For example, Epstein-Barr viruses can cause mononucleosis — a condition that can increase your risk of particular lymphomas over time. Talk to your doctor about your own risk factors for these viral infections.

Kidney Transplant Infection Symptoms

Doctors continually watch for infections in the days and weeks after a kidney transplant. They order blood tests to find pathogens and check for common symptoms such as⁴:

• Burning sensation during urination (for UTIs)
• Chills
• Fatigue
• Fever
• Sore throat and cough

How to Avoid Infection After Kidney Transplant

We are continually exposed to bacteria and viruses throughout our everyday lives. While it would be very difficult to avoid them entirely, there are some important steps you can take to minimize your risk of exposure. These precautions include:

• Avoiding close contact with people you know are sick or have been exposed to a virus
• Cooking all your foods (especially meat) thoroughly and avoiding raw foods — bacteria or viruses in the gastrointestinal tract can cause serious harm to people on immunosuppressants
• Ensuring that drinking water is clean
• Keeping appointments for monitoring so doctors can identify signs of infection early
• Practicing good hygiene by washing hands regularly with soap and warm water
• Taking antibiotic medications exactly as prescribed following your transplant surgery

Find more resources for people receiving kidney transplants at CareDx.

This information is not intended or implied to be a substitute for professional medical advice from your healthcare provider. You should always seek the advice of your physician or medical team with any questions you may have regarding your specific medical condition.

References:

1. Contemporary Kidney Transplantation, Infection in Kidney Transplantation – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7123753/
2. American Journal of Transplantation, Ten years of donor-derived disease: A report of the disease transmission advisory committee – https://onlinelibrary.wiley.com/doi/10.1111/ajt.16178
3. CDC, Donor Screening and Testing – https://www.cdc.gov/transplantsafety/protecting-patient/screening-testing.html
4. CJASN, Common Infections in Kidney Transplant – https://cjasn.asnjournals.org/content/7/12/2058
5. National Kidney Foundation – https://www.kidney.org/transplantation/transaction/TC/winter11/TCwinter11_UTI
6. Virulence, Bloodstream infections after solid-organ transplantation – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871682/#
7. Contemporary Kidney Transplantation, Infection in Kidney Transplantation – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7123753/