Characterizing the landscape and impact of infections following kidney transplantation

被引:34
作者
Jackson, Kyle R. [1 ]
Motter, Jennifer D. [1 ]
Bae, Sunjae [1 ]
Kernodle, Amber [1 ]
Long, Jane J. [1 ]
Werbel, William [2 ]
Avery, Robin [2 ]
Durand, Christine [2 ]
Massie, Allan B. [1 ]
Desai, Niraj [1 ]
Garonzik-Wang, Jacqueline [1 ]
Segev, Dorry L. [1 ,3 ,4 ]
机构
[1] Johns Hopkins Univ, Sch Med, Dept Surg, Baltimore, MD 21205 USA
[2] Johns Hopkins Univ, Sch Med, Div Infect Dis, Baltimore, MD 21205 USA
[3] Johns Hopkins Sch Publ Hlth, Dept Epidemiol, Baltimore, MD 21205 USA
[4] Sci Registry Transplant Recipients, Minneapolis, MN 55404 USA
关键词
RENAL-ALLOGRAFT RECIPIENTS; SURGICAL SITE INFECTION; RISK-FACTORS; PNEUMONIA; MORTALITY; HOSPITALIZATION; REJECTION; BACTERIAL; SURVIVAL; OUTCOMES;
D O I
10.1111/ajt.16106
中图分类号
R61 [外科手术学];
学科分类号
摘要
Infections remain a major threat to successful kidney transplantation (KT). To characterize the landscape and impact of post-KT infections in the modern era, we used United States Renal Data System (USRDS) data linked to the Scientific Registry of Transplant Recipients (SRTR) to study 141 661 Medicare-primary kidney transplant recipients from January 1, 1999 to December 31, 2014. Infection diagnoses were ascertained by International Classification of Diseases, Ninth Revision (ICD-9) codes. The cumulative incidence of a post-KT infection was 36.9% at 3 months, 53.7% at 1 year, and 78.0% at 5 years. The most common infections were urinary tract infection (UTI; 46.8%) and pneumonia (28.2%). Five-year mortality for kidney transplant recipients who developed an infection was 24.9% vs 7.9% for those who did not, and 5-year death-censored graft failure (DCGF) was 20.6% vs 10.1% (P < .001). This translated to a 2.22-fold higher mortality risk (adjusted hazard ratio [aHR]:(2.15)2.22(2.29),P < .001) and 1.92-fold higher DCGF risk (aHR:(1.84)1.91(1.98),P < .001) for kidney transplant recipients who developed an infection, although the magnitude of this higher risk varied across infection types (for example, 3.11-fold higher mortality risk for sepsis vs 1.62-fold for a UTI). Post-KT infections are common and substantially impact mortality and DCGF, even in the modern era. Kidney transplant recipients at high risk for infections might benefit from enhanced surveillance or follow-up to mitigate these risks.
引用
收藏
页码:198 / 207
页数:10
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