Session Time: 3:15pm-4:45pm
Presentation Time: 3:51pm-4:03pm
*Purpose: Infections remain a major threat to successful kidney transplantation (KT), although there is limited data on the spectrum and clinical consequences of a post-KT infection in the current immunosuppression era.
*Methods: To characterize the landscape and impact of post-KT infections in the modern immunosuppression era, we used national data from the United States Renal Data System to study 141,664 Medicare-primary KT recipients from 1/1/1999-12/31/2014, with linkage to SRTR for accurate outcome ascertainment. Infection diagnoses were ascertained by ICD-9 codes. We used adjusted Cox regression, treating the development of a post-KT infection as a time-varying exposure, to quantify the impact of a post-KT infection on mortality and death-censored graft failure (DCGF).
*Results: The cumulative incidence of a post-KT infection was 30.3% at 3 months, 46.5% at 1 year, and 73.9% at 5 years. The most common infections were UTI (37.6%) and pneumonia (21.9%), whereas the least common were meningitis (1.6%) and zoonotic (0.2%) (Figure 1). 5-year mortality for KT recipients who developed an infection was 25.7% vs. 8.9% for those who did not, and 5-year DCGF was 22.4% vs. 10.6% (p<0.001) (Figure 2). This translated to a 2.06-fold higher mortality risk (adjusted hazard ratio [aHR]: 2.002.062.13, p<0.001) and 1.82-fold higher DCGF risk (aHR: 1.761.821.89, p<0.001) for KT recipients who developed an infection, although the magnitude of this higher risk varied across infection types (for example, 2.65-fold higher mortality risk for Clostridium difficile versus 1.37-fold for a UTI) (Figure 3).
*Conclusions: Post-KT infections are common and substantially impact mortality and DCGF, even in the modern era. Immunosuppression choices should be carefully tailored accordingly, especially in those at higher risk of infection.
To cite this abstract in AMA style:Jackson KR, Motter J, Avery R, Werbel W, Massie A, Garonzik-Wang J, Segev D. Characterizing the Landscape and Impact of Infections Following Kidney Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/characterizing-the-landscape-and-impact-of-infections-following-kidney-transplantation/. Accessed March 4, 2021.
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