A Comprehensive Review of Infections in Older Kidney Transplant Recipients

Purpose of Review While a great deal of literature has been published in recent years on infections in kidney transplant (KT) recipients, there is a relative paucity of literature on infections and their impact on the graft and overall health of older KT recipients. We reviewed the most recent literature and guidelines in the field of kidney transplantation and summarized the current recommendations for physicians caring for older KT recipients at risk for infections. Recent Findings Older KT recipients are at an increased risk of infections during the first year post-KT resulting in readmission or other poor outcomes, compared to younger KT recipients. Immune senescence and frailty likely increase the risk for infections in older KT recipients during the first year post-KT when KT recipients are receiving a higher degree of immune suppressive therapy. Most common infections include urinary tract infections, bloodstream infections, cytomegalovirus reactivation or primary infection, and BK virus. A majority of older KT recipients survive and have a functioning graft at 1 year. KT can be a successful treatment for older adults on dialysis if post-transplant complications, including rejection and infection, can be appropriately managed. Despite this increased risk for infections, older KT recipients have a lower risk for all-cause mortality and death secondary to infections compared with patients on dialysis. Further studies on modification of immune suppression and prophylactic strategies are much needed in this high-risk KT population.