*Purpose: We aim to describe the spectrum of pulmonary infections after kidney transplant, to identify risk factors and to evaluate the impact of pre transplant infectious consultation for vaccination updates and infection prevention.

*Methods: We included patients with kidney transplant performed between 2015 and 2019 in a retrospective monocentric cohort study. Multivariate analyses were performed to assess the risk factors of pulmonary infections and mortality after kidney transplant.

*Results: 516 renal transplant patients were included, of which 145 had received pre-kidney transplant infectious disease consultation. We identified 123 pulmonary infections including 75 pneumonias in 95 patients at a median of 5 months post-kidney transplant. Bacterial infection was responsible for the majority of pulmonary infections (n=31), with a predominance of gram-negative bacteria (n=23). Immunosuppressive therapy had no impact on the occurrence of pulmonary infections. In contrast, independent risk factors were chronic infection with the human immunodeficiency virus (HIV) or hepatitis C virus (HCV), the presence of DSA prior to transplantation, the recipient’s age, and combined transplants. Inversely, an infectious disease consultation prior to kidney transplant was found to be a pulmonary infections-independent protective factor (p = 0.033). Importantly, pulmonary infections had an adverse impact on patient survival (p < 0.0001).

*Conclusions: By conducting a retrospective monocentric study, we describe the spectrum of pulmonary infections after renal transplantation. Pulmonary infections after renal transplant impact patient survival. Systematic infectious disease consultation was an independent protective factor.

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