Clinical presentation and outcome of dengue viral infection in live‐related renal transplant recipients in Karachi, Pakistan

Abstract

Abstract Introduction In Pakistan, dengue viral infection has become hyper‐endemic. Renal transplantation is also expanding. We aimed to study dengue in renal transplant recipients ( RTR ). Methods We conducted a study of RTR reported to be anti‐dengue immunoglobulin‐M antibody positive from J anuary 2009 to D ecember 2010 at our institution in K arachi and follow their clinical course and outcome. Results Median age was 28 years; 75 (73.7%) were males. Clinical presentation included fever in 82 (80.4%), gastrointestinal symptoms in 35 (34.3%), hemorrhagic complications in 9 (8.8%), and thrombocytopenia in 97 (95%), which was of >15 days duration in 24%. Fever was seen less frequently in patients on high‐dose (>7.5 mg) steroids as compared with low‐dose (≤7.5 mg) steroids. Forty‐four patients (43%) had primary and 58 (56.8%) had secondary dengue infection. Dengue fever ( DF ) occurred in 90 (88%), and dengue hemorrhagic fever/dengue shock syndrome ( DHF / DSS ) occurred in 12 (11.7%). DHF / DSS was seen in 3 (6.8%) of those with primary and in 9 (15.5%) of those with secondary infection ( P < 0.22). In secondary infection, patients on cyclosporine‐containing regimen had less severe disease, with DHF / DSS in 22% as opposed to DF in 59% ( P < 0.04). Of 102 RTR , 68 (66.7%) had graft dysfunction, 5 of whom died. Of the remaining 63, in 54 patients (85.7%) creatinine returned to baseline by an average of 12.6 days. Of 102 patients, 95 (93%) recovered and 7 (6.9%) died, 6 of whom had bacteremia with sepsis and 1 had respiratory failure. None died due to dengue infection alone. Conclusion In conclusion, in RTR without life‐threatening co‐morbidities, the clinical course of dengue infection is mild, with good recovery and preserved renal function.