Infectious risk factors in the immunosuppressed host

A survey of 194 renal transplant recipients was undertaken to clarify factors of importance in the genesis of infections in the immunosuppressed host. The need for high dose prednisone therapy and the occurrence of hyperglycemia were significantly greater in patients with fatal and nonfatal post-transplant infections than in patients without such infection. Being over 40 years of age at the time of transplantation and the presence of leukopenia were occasionally significantly associated with infectious death after transplantation. Renal failure was associated with infectious death in some transplant recipients; this association likely reflected the use of high dose immunosuppressive agents to treat refractory rejection. Hypogammaglobulinemia, azathioprine therapy (at the dosage level studied) and the sex and race of the recipient, the type of underlying renal disease, nephrectomy, splenectomy and thymectomy were not associated with post-transplant infectious death.There was a marked diminution in infection and infectious death after 1965. We postulate that this decline was due to two factors: (1) the accumulation of extensive experience with post-transplant infections leading to a more aggressive diagnostic and therapeutic approach in recent transplant recipients with infection, and (2) a decrease in the use of high dose prednisone therapy and of the occurrence of hyperglycemia in recent transplant recipients. The more frequent use of related donor kidneys and the introduction of antilymphocyte globulin permitted less use of high dose prednisone therapy in transplant recipients after 1965.