• Peter Boan, Ramyasuda Swaminathan, and Ashley Irish.
• Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia.
• Intern Med J. 2017 Jun 1; 47 (6): 648655648-655.

BackgroundInfectious complications remain a significant risk following renal transplantation.AimTo examine the burden and pattern of infection following renal transplantation in Aboriginal and Torres Strait Islander (ATSI) compared to non-ATSI.MethodsA retrospective cohort study of 141 consecutive adult renal transplant recipients in Western Australia between 2005 and 2011 was conducted. We determined baseline serological status for relevant organisms, the number of patients with specific infections, infectious admission in the first year post-transplantation and the rate of infectious death during follow up.ResultsThere were 57 ATSI and 84 non-ATSI renal transplant recipients. ATSI compared to non-ATSI had a high rate of cytomegalovirus (CMV) seropositivity (98.2% vs 73.2%, P < 0.001), HBcAb positivity (100% vs 13.3%, P < 0.001) and strongyloides seropositivity (ATSI 3/12 tested). In the first year post-transplant, ATSI compared to non-ASTI had a higher rate of pneumonia (17.9% vs 3.6% of patients, P = 0.006), and non-significant trend to higher rates of gastrointestinal parasitic infection (7.0% vs 1.2% of patients, P = 0.158), invasive fungal infection (10.5% vs 4.8% of patients, P = 0.316), and hospitalisation because of infection (10.0 vs 5.5 days, P = 0.071). Overall 5-year cumulative survival was lower for ATSI versus non-ATSI (0.64 vs 0.86, P = 0.022) with two-thirds of ATSI deaths attributed to infection.ConclusionsATSI are at high risk of infectious complications after renal transplantation associated with a burden of hospitalisation and death. Augmented screening and prophylaxis for infectious diseases should be considered. Further study needs to identify contributing environmental and immunity factors.© 2017 Royal Australasian College of Physicians.

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