Date: Sunday, June 12, 2016
Session Time: 4:30pm-6:00pm
Presentation Time: 5:42pm-5:54pm
Location: Room 311
Introduction: The incidence of infection after KT have been reported to directly increase with recipient's age, likely due to the combined effect of co-morbidities and immunosenescence.
Method: Retrospective analysis of 106 patients aged ≥75 years that underwent KT at our center between January 2002 and July 2012. We analyzed the incidence and risk factors for post-transplant-infection, graft and patient survival, and determinants of all-cause mortality.
Results: Recipients age was 77.6 ± 2.4. Immunosuppression consisted of basiliximab (89.6%) or anti-thymocyte globulin (3.8%), followed by tacrolimus (94.3%) or cyclosporin A (2.8%), MMF and steroids. Seventy patients (66.0%) had 165 episodes of infection
|Clinical syndrome||N (%)|
|Urinary tract infection||43 (32.6)|
|Bloodstream infection||35 (21.2)|
|Gastrointestinal tract infection||19 (11.5)|
|Surgical site infection||17 (10.3)|
|Skin and soft tissue infection||16 (9.7)|
|Escherichia coli||35 (21.2)|
|Klebsiella pneumoniae||11 (6.6)|
|Other Enterobacteriaceae||4 (2.4)|
|Non-fermenting Gram negative bacilli||14 (8.4)|
|Enterococcus spp.||10 (6.1)S|
|Clostridium difficile||8 (4.8)|
|VZV / HSV||16 (9.7)|
|Aspergillus spp.||4 (2.4)|
. Pre-transplant diabetes increased the risk of bacterial infection (adjusted hazard ratio [aHR]: 1.07; 95% CI: 1.08-3.59; P-value = 0.026). Biopsy-proven acute rejection (BPAR) was a risk factor for cytomegalovirus (CMV) disease (aHR: 6.18; 95% CI: 1.38-27.77; P-value = 0.017). Five-year death-censored graft survival was 85.7%. One- and five-year patient survival was 85.4% and 76.1%. Infection was the most common cause of death (51.5% [19/37]). The occurrence of BPAR within the first 90 days was the main determinant of patient survival (aHR: 4.48; 95% CI: 1.33-15.11; P-value = 0.016).
Conclusions: Post-transplant infection is a common life-threatening complication among extremely elderly KT recipients. Pre-transplant diabetes and BPAR act as risk factors for bacterial infection and CMV disease. The early occurrence of BPAR decreased patient survival.
CITATION INFORMATION: Cabrera J, Fernández-Ruiz M, Molina M, González E, Polanco N, López-Medrano F, Aguado J, Praga M, Andrés A. Infectious Complication in Extremely Elderly Kidney Transplant (KT) Recipients: A Leading Cause of Death. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Cabrera J, Fernández-Ruiz M, Molina M, González E, Polanco N, López-Medrano F, Aguado J, Praga M, Andrés A. Infectious Complication in Extremely Elderly Kidney Transplant (KT) Recipients: A Leading Cause of Death. [abstract]. Am J Transplant. 2016; 16 (suppl 3). http://atcmeetingabstracts.com/abstract/infectious-complication-in-extremely-elderly-kidney-transplant-kt-recipients-a-leading-cause-of-death/. Accessed September 21, 2017.
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