Abstract Objectives: Pneumonia is an important cause of morbidity and mortality in recipients of solid-organ transplant. We aimed to determine risk factors for development of pneumonia and associated deaths in kidney transplant recipients. Materials and Methods: A retrospective review of medical records was performed for all kidney transplant recipients from December 1988, to April 2011. The diagnosis of community-acquired pneumonia was made from symptoms, clinical findings, and chest radiography. The diagnosis of nosocomial pneumonia was made according to published criteria. Laboratory and serologic tests, radiographic findings, cultures of respiratory specimens, and tissue biopsies were reviewed. Results: In 406 kidney transplant recipients, there were 82 patients (20%) who had 111 episodes of pneumonia, including 49 nosocomial episodes of pneumonia (44%). Bacterial infections were the most common cause (34 episodes [31%]). In multivariate analysis, significant risk factors associated with pneumonia episodes were older age, hypertension, cardiac disease, history of acute graft rejection, and not using everolimus/mycophenolate mofetil/prednisolone protocol. There were 28 episodes that resulted in death (25%), including 20 nosocomial episodes (71%). In multivariate analysis, significant risk factors associated with death from pneumonia episodes were antibiotic use in the previous 3 months, high C-reactive protein, and low albumin. Cutoff values for increased risk of death from pneumonia included C-reactive protein > 10 mg/dL and procalcitonin > 8.8 ng/mL. Conclusions: Recipients of kidney transplant may be at risk for pneumonia and associated death. Nosocomial pulmonary infections may be associated with marked morbidity and mortality in kidney transplant recipients. Key words: Renal failure, Nephrology, Lung, Infection Introduction Infectious complications markedly increase morbidity and mortality after kidney transplant. Sepsis and pulmonary infections are associated with high mortality. 1,2 Although effective prophylactic and immunosuppressive regimens reduce the incidence of pulmonary infections after transplant, bacterial pneumonia is the most common cause of acute respiratory failure. 3 However, little information is available about risk factors for developing infection and death in kidney transplant recipients with lower respiratory tract infection such as pneumonia. 4 The purpose of the present study was to identify the characteristics of episodes of pneumonia and risk factors for developing pneumonia and its related mortality in kidney transplant recipients. Materials and Methods Subjects The study retrospectively evaluated medical records of all adult kidney transplant recipients who had kidney transplant from December 1988 to April 2011 at ARTICLe Pneumonia After Kidney Transplant: Incidence, Risk Factors, and Mortality Oguzhan Sitki Dizdar, 1 Alparslan Ersoy, 2 Halis Akalin 3 Copyright © Başkent University 2014 Printed in Turkey. All Rights Reserved. DOI: 10.6002/ect.2013.0093 From the 1 Department of Internal Medicine, Afşin State Hospital, Kahramanmaraş, Turkey; the 2 Department of Internal Medicine, Division of Nephrology, Uludag University Medical School, Bursa, Turkey; and the 3 Departments of Microbiology and Infectious Diseases, Uludag University Medical School, Bursa, Turkey Acknowledgements: The authors declare that they have no financial or other conflicts of interest. Oguzhan Sitki Dizdar participated in research design, collected and analyzed the data, and wrote the manuscript. Alparslan Ersoy and Halis Akalin designed the study, contributed to research discussion, and edited the manuscript. The authors thank the hospital staff from the Departments of General Medicine, Nephrology, Microbiology and Infectious Diseases, Intensive Care, Chest Diseases, and Diagnostic Laboratories for contributions to diagnosis and treatment. Corresponding author: Alparslan Ersoy, Department of Internal Medicine, Division of Nephrology, Uludag University Medical School, 16059 Gorukle/Nilufer/Bursa, Turkey Phone: +90 224 2951413 Fax: +90 224 2951444 E-mail: alpersoy@uludag.edu.tr Experimental and Clinical Transplantation (2014) 3: 205-211