Infections are a major cause of morbidity and mortality in recipients of kidney grafts, as was made clear by Prof. T. Fuller (DE) during the joint meeting of the EAU Section of Transplantation Urology (ESTU), the EAU Section of Infections in Urology (ESIU) and the EAU Section of Urolithiasis (EULIS).
Pre-transplant screening secures successful transplantation, but vigilance is indicated post-transplant as well. Infection such as cytomegalovirus (CMV) and Epstein-Barr-Virus (EBV) have a relatively high prevalence in this population, the risk being highest in case of a positive donor and a negative recipient.
“A remarkable exception is hepatitis C virus (HCV) which is now a relative issue due to recent revolutionary developments in treatment. New agents can achieve sustained virological response (SVR) which can be as high as 100%. However, for end-stage renal disease (ESRD) patients, HCV is still a relevant problem where the number of years on dialysis are an independent risk factor for HCV infection,” Fuller emphasized.
Taking all of the above into account, Fuller concluded that improved prophylactic, diagnostic and treatment strategies have led to an improvement in long-term renal graft outcomes. “Screening and prophylaxis as well as meticulous post-transplant surveillance for infections should be the standard of care in renal transplant patients,” he said.
Of a rather different nature – but nevertheless impacting on renal transplantation in total – are the significant country-to-country differences in kidney transplants rates. Different legal and social standards across Europe might be responsible for this phenomenon as was shown by a new Europe-wide survey.
Within the EU, the number of kidney donors per country per head of population ranges from 3.3 deceased donors (per million) in the Russian Federation up to 35.7 for Spain. Dr. Díez-Nicolás (ES) explained this variation: “Basically, it depends on two factors: social sensitivity and legislation. Most organs for transplantation are derived from brain dead donors, but each country manages organ availability differently. In Spain, each citizen is a potential donor unless they opt-out of the transplant scheme, whereas in Germany there is an ‘opt-in’ scheme. Furthermore, some countries also allow donation from living donors, or from donors whose hearts have stopped.”
ESTU Chairman Prof. A.J. Figueiredo (PT) added: “Transplantation remains the most effective way of replacing kidney function. End-stage renal failure incidence is increasing steadily in all European countries and, notwithstanding the fact that efforts should primarily be put on prevention, transplantation activity also needs be promoted, as the demand clearly exceeds supply.”
Figueiredo also said there are significant discrepancies in transplant activity among European countries, and the ones with lower rates of transplant per capita should look at the examples of the leaders.
“At the same time, there are important differences where the transplanted organs come from, such as brain dead, non-heart beating and living donors, meaning there is scope for improvement in each program,” he added.