Infectious complications in kidney transplantation: a 25-year retrospective study

Abstract Introduction Infectious complications remain a significant challenge in kidney transplant recipients, exacerbated by immunosuppressive therapy. This study aimed to analyze the patterns, prevalence, and predictors of infections in kidney transplant patients over 25 years at our center. Methods A retrospective analysis was conducted on 123 kidney transplant recipients between 1998 and 2023. Data included demographic, clinical, and microbiological characteristics, with infections categorized into three post-transplant periods: early (≤ 1 month), intermediate (1–6 months), and late (> 6 months). Statistical analyses identified risk factors and outcomes associated with infections. Results A total of 390 infectious episodes were recorded. Early infections were predominantly bacterial (71.4%), primarily urinary tract infections. Viral infections, particularly cytomegalovirus, were more prevalent during the intermediate period (39%). Late infections included respiratory and opportunistic pathogens, with viral infections accounting for 36%. UTIs were the most common infection across all periods (127 episodes), with Escherichia coli as the leading pathogen. Prolonged catheterization and female sex were significant predictors of recurrent UTIs ( p < 0.001). Infection-induced acute kidney injury occurred in 34% of cases, leading to sustained renal dysfunction in 49% of these episodes. Mortality due to infections was 5.7%, with COVID-19 as the leading cause. Conclusion Infectious complications, particularly UTIs and viral infections, significantly impact kidney transplant outcomes. Targeted prevention strategies, including optimized catheter management and tailored immunosuppression, are essential to reduce infection-related morbidity and mortality. Further research is needed to refine protocols and improve long-term transplant success.