Renal Transplantasyon Hastalarında Tüberküloz, Pnömosistis Jirovecii, Sitomegalovirus Profilaksi Etkinliğinin Belirlenmesi

Abstract

Infections are important causes of morbidity in kidney transplant patients and prophylactic treatments and vaccinations play an important role in the strategy to fight infections. In this study, 630 patients who were followed up by the Department of Adult Nephrology at Hacettepe University Hospital between 01.10.2001 and 01.02.2021 were evaluated in terms of tuberculosis, cytomegalovirus and Pneumocystis jirovecii prophylaxis. Although routine tuberculosis prophylaxis was not used, only 2 of the 630 patients had tuberculosis infection and these two patients were successfully treated during follow-up with no graft loss or mortality. While 3 patients received prophylactic isoniazid treatment, these patients had a moderate deterioration in liver function tests and no serious complications. Of the patients, 59.1% received CMV prophylaxis, 80.1% of this group were able to complete prophylactic treatment, and valganciclovir prophylaxis was discontinued in the remaining group, mainly due to cytopenia and increased creatinine. CMV viremia (p=0.003), rejection (p=0.07) and death (p<0.001) were significantly lower in the prophylaxis group compared to the non-prophylaxis group. Completion of CMV prophylaxis for 3 months had no effect on mortality, but reduced the risk of viremia (p=0.030). 54.1% of the patients received prophylactic trimethoprimsulfamethoxazole (TMP-SMX) prophylaxis for PJP, 66% of them were able to complete prophylaxis, and TMP-SMX prophylaxis was discontinued in the remaining group, mainly due to increased creatinine and cytopenia. PJP infection (p=0.008), rejection (p=0.025) and death (p<0.001) were significantly lower in the group of patients who received PJP prophylaxis compared to those who did not. There was no significant difference in mortality and rejection between patients receiving 3 months and 6 months prophylaxis (p=0.328) The association of CMV and PJP prophylaxis was significantly higher in patients (p<0.001). In conclusion, the effect of CMV prophylaxis and PJP prophylaxis on morbidity and mortality was supported by our study. Although tuberculosis prophylaxis was not administered in our clinic, the fact that only 2 patients showed signs of tuberculosis suggests that tuberculosis prophylaxis should be questioned.