Introduction: Viral infections are common after kidney transplant (KT), with rising prevalence in the era of more potent immunosuppression. We describe the clinical course of patients undergoing renal transplant from an emerging centre.
Aims: To describe our experience of the clinical course over of children undergoing renal transplant in a centre with an emerging transplant program
Methodology: Retrospective chart review of children under follow up post renal transplant
Results: Nine patients underwent live related renal transplant between November 2017 and September 2022. The mean age was 7.22 years (range 6-15year). There were 6 males and 3 females; of the donors 6 were mothers, 2 were fathers and 1 was maternal grandmother. The induction agent used in 8/9 was ATG, while the most recent transplant child received Basiliximab. Post-operative period was uneventful in all 9 children who reached nadir creatinines within 48 hours. None had rejection or infection in the immediate post-transplant period.  Primary renal disease was hypo dysplastic kidney 3; PU valves 2; NPH2 mutations 2; Alport syndrome 1 and one had pauci immune chronic glomerulonephritis. Mean duration of follow up 254 months. Creatinine at last visit ranged between 0.7 and 1.6mg/dl (Mean 0.8mg/dl). Amongst the complications noted EBV occurred in 2/9, BKV in 2/9, CMV in 1/9, UTI in 4/9, probable sepsis with leukopenia requiring infection in first 2 months in 5/9. NODAT occurred in 1/9 requiring short-term insulin therapy, which recovered.
One patient had post-transplant complications of BK viremia within 6 months, which settled spontaneously, varicella infection which was treated with acyclovir, one urinary  infection and most recently was detected to have EB viremia. Another child developed initially CMV infection 2 years post-transplant and later both BK virus and EBV infection 3 years post-transplant, treated with Leflunamide and reduction of immunosuppression. He was also treated with IvIg and pulse steroids. Another child was noted to have EBV viremia 4 years post-transplant. None had evidence of PTLD. Four patients had UTI within the first 3 months post-transplant. One patient required growth hormone therapy in view of poor growth post-transplant; he also developed tachyarrhythmia’s, which required treatment with ivabradine  Of the 5 renal biopsies done, one showed acute cellular rejection after BKV and EBV infection which was successfully treated.
Conclusion: Post-transplant course can be challenging and requires great vigilance against infections, manipulation of immunosuppression and critical decision making at the appropriate time to ensure successful graft survival.