Prophylaxis in Kidney Transplantation

Catarina Cardoso; Pedro Bravo; Ana Messias; Joana Martins; Carlos Oliveira

Autores

Catarina Cardoso Hospital Garcia de Orta – Departamento de Nefrologia – Almada – Portugal. https://orcid.org/0000-0002-1609-1301
Pedro Bravo Hospital Garcia de Orta – Departamento de Nefrologia – Almada – Portugal. https://orcid.org/0000-0003-2398-4236
Ana Messias Hospital Garcia de Orta – Departamento de Nefrologia – Almada – Portugal. https://orcid.org/0000-0003-4734-6589
Joana Martins Hospital Garcia de Orta – Departamento de Nefrologia – Almada – Portugal. https://orcid.org/0009-0000-9459-2710
Carlos Oliveira Hospital Garcia de Orta – Departamento de Nefrologia – Almada – Portugal. https://orcid.org/0000-0001-6637-3617

Palavras-chave:

Transplante de Rim, Infeção, Profilaxia, Imunossupressão

Resumo

O transplante renal é o tratamento de excelência para a doença renal em estágio terminal, melhorando a sobrevivência e a qualidade de vida dos doentes em comparação com a diálise. No entanto, o uso de terapêutica imunossupressora para prevenção da rejeição do enxerto torna os recetores vulneráveis a infeções, uma complicação importante no período pós-transplante. As estratégias de profilaxia são indispensáveis para minimizar os riscos infeciosos e otimizar os resultados obtidos. Esta revisão pretende sistematizar as estratégias de profilaxia nas fases de pré-, peri- e pós-transplante, oferecendo uma visão abrangente das indicações, timing, doses e efeitos adversos. A profilaxia pré-transplante envolve a pesquisa meticulosa de infeções ativas, atualização do estado vacinal e tratamento de infeções latentes. A profilaxia peri-transplante concentra-se em abordagens antimicrobianas personalizadas, de forma a reduzir os riscos de infeção cirúrgica e relacionados com o dador durante o período do peri-operatório. A profilaxia pós-transplante é crucial para prevenir infeções oportunistas, com foco na pneumonia por Pneumocystis jirovecii e na infeção por citomegalovírus. Esta discussão pretende abranger as diferenças dos diversos regimes profiláticos, destacando a eficácia e os desafios associados aos agentes disponíveis e utilizados na prática clínica. Pretende ainda enfatizar o papel fundamental da instituição de profilaxias na minimização dos riscos infeciosos e na melhoria dos resultados dos recetores de transplante renal, defendendo uma abordagem proativa e multifacetada na gestão de doenças infeciosas nesse contexto.

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