Pulmonary Complications in Kidney Transplant Recipients: A 17-Year Retrospective Analysis of Infectious Etiologies, Risk Factors, and Outcomes.

Abstract

Objectives: Kidney transplant represents a major therapeutic advance for end -stage renal disease, but chronic immunosuppression compromises host defense mechanisms, rendering recipients vulnerable to serious infections. Pulmonary infections constitute a major cause of morbidity and mortality posttransplant, requiring vigilant surveillance and multidisciplinary management.

Materials and methods: This retrospective descriptive study included patients who underwent kidney transplant at the Nephrology Department of Sahloul University Hospital from November 1, 2007, to December 31, 2024, in whom pulmonary involvement was diagnosed during follow -up.

Results: Among 332 kidney transplant recipients, 12 patients (3.6 % ) developed pulmonary infections. The mean age was 34.5 ± 11.6 years (range, 18 -53 years ) with male predominance. Chronic interstitial nephropathy was the most common original kidney disease (66.6 % ). All patients received thymoglobulin induction with methylprednisolone; the main maintenance immunosuppression comprised tacrolimus (83.3 % ) and mycophenolate mofetil (91.7 % ). All patients received Pneumocystis jirovecii prophylaxis. Mean serum creatinine at diagnosis was 142.8 ± 70.1 μmol /L (range, 70 -262 μmol /L ), compared with baseline mean of 63.1 ± 9.9 μmol /L (range, 48 -78 μmol /L ). Acute kidney injury occurred in 7 patients (58.3 % ). Mean time to pulmonary involvement was 29.3 ± 23.8 months. The most frequently isolated pathogen was Pneumocystis jirovecii (41.6 % ), followed by Aspergillus species (25 % ), Mycobacterium tuberculosis (16.7 %), coinfection with Candida albicans (33.3 % ), and cytomegalovirus infection (16.7% ). Immunosuppression was reduced in all cases. Evolution was favorable with targeted therapy in 83 % of cases; 1 patient (8.3 % ) died after intensive care unit transfer.

Conclusions: Prevention of severe pulmonary infections requires optimization of prophylaxis strategies and individualized adaptation of immunosuppressive regimens. Close collaboration with infectious disease specialists and pulmonologists is essential for effective multidisciplinary management.