As immunosuppressive therapy and allograft survival have improved in simultaneous pancreas/kidney transplant recipients (SPKTRs), the increased incidence of infection has become a major hurdle of disease-free survival. Against the background of a rising incidence of sepsis, an analysis of SPKTRs with respect to risk factors for sepsis, microbiological characteristics, and its impact on patient and allograft outcomes is lacking.

Here, we studied all primary SPKTRs and primary deceased-donor kidney transplant recipients (KTRs; <65 years) at our transplant center between 2005 and 2015 for the development of septic complications. 36 of 134 SPKTRs (26.9%) and 61 of 538 KTRs (11.3%) were diagnosed with sepsis. A control group of 98 SPKTRs without septic complications was used for comparison.

SPKTRs were more likely to develop septic complications compared to KTRs (p<0.001). While urosepsis was less common among SPKTRs (45%) compared to KTRs (65%), pneumonia (33%) and peritonitis (15%) as site of infection were more frequent (p<0.05). Here, gram-positive and fungal sepsis were more common among SPKTRs (p<0.05). Onset of sepsis was earlier in SPKTRs with a median of 6 months posttransplantation compared to KTRs with a median of 19 months posttransplantation (p<0.05). Mortality from severe sepsis/septic shock was 29% among SPKTRs compared to 58% among KTRs. Among SPKTRs, female sex, low body mass index, CMV seronegativity, CMV disease, and acute cellular rejection increased the risk of sepsis (p<0.05). SPKTRs with sepsis showed comparable patient, kidney, and pancreas allograft survival compared with SPKTRs without sepsis (p>0.05), but superior patient and kidney allograft survival compared to KTRs with sepsis (p<0.05).

Differences of incidence, site of infection, causative pathogens, and onset of sepsis between SPKTRs and KTRs may be attributed to more intense immunosuppression, major surgery, and complications of diabetes among SPKTRs. Despite the higher incidence of sepsis among SPKTRs, however, mortality related to sepsis presents lower among SPKTRs compared to KTRs. Identified risk factors among SPKTRs may prove useful to identify patients at greatest risk.

CITATION INFORMATION: Schachtner T, Zaks M, Kahl A, Reinke P. Factors in Association with Sepsis Differ Between Simultaneous Pancreas/Kidney and Single Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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