Evaluation of clinical characteristics of pediatric kidney transplant recipients hospitalized for infection in Akdeniz University Medical Faculty Hospital

Kidney transplantation is a renal replacement therapy that is considered the gold standard in patients with end-stage renal disease. Infections are the most common cause of hospitalization in kidney transplant patients and also one of the most common causes of mortality. The aim of this study was to examine the clinical features of hospitalizations due to infections of pediatric kidney transplant recipients. The files of the patients who were followed up between 01.01.2014 and 01.11.2022 were reviewed retrospectively through the hospital electronic data system. A total of 226 patients, 124 (%54,9) male and 102 (%45,1) female, were included in the study. The mean age at kidney transplantation was 10.54±5.40 years, and the median follow-up period after transplantation was calculated as 5.47 years. During the follow-up period, it was determined that 226 patients were hospitalized 627 times, and 432 (68,9%) of these hospitalizations were due to infection. Of 139 patients hospitalized due to infection, 57 (%41,0) were hospitalized once, 33 (%23,7) were hospitalized twice, while 49 (%35,2) had three or more hospitalizations. It was observed that the mean age of the patients hospitalized due to infection was younger than those who were not hospitalized with infection (9,67±5,50 years vs 12,00±4,92 years, p=0,002). The most common causes of hospitalization were urinary system infections (UTI) with 205 (%47,5) hospitalizations, respiratory system infections with 118 (%27,3) admissions, and gastrointestinal system infections with 48 (%11,1) admissions. Risk factors for hospitalizations due to UTI were female gender (OR=2,0), post-transplant first 6 months (OR:4,2), neurogenic bladder (OR:6,4), presence of post-transplant VUR (OR:15,3), and the presence of a JJ stent (OR:5,0). The most common agents detected in patients with UTI were E.coli (%43,7) and Klebsiella (%32,3); bacterial resistance rate was %45,2. The presence of a central venous catheter was found to be a significant risk factor for bacteremia (OR=8,3). At follow-up, 7 patients died, 6 of whom were died due to infections. The risk factors for mortality were the presence of a central venous catheter (OR=16,0), bacteremia (OR=20,8), pneumonia (OR=9,9), and the need for intensive care (OR: 350). In our study, infections, especially bacterial infections, were both the most frequent cause of hospitalizations and the most important cause of mortality in pediatric kidney transplant recipients.