A. Purpose: Infections are the most common non-cardiovascular causes of death after kidney transplantation. We analyzed in detail the current infection-related mortality among kidney transplant recipients in a nationwide cohort.

B. Methods: All adult recipients of a first kidney transplant during 1990-2012 in our country were included (N=3249). Infectious causes of death were analyzed in detail (ICD-10 codes were available for all deaths), and the mortality rates for infections were compared between two eras (1990-1999 and 2000-2012). Risk factors for infectious deaths were analyzed with Cox regression.

C. Results: Altogether 953 patients (29%) died during the follow-up, with 204 infection-related deaths (21.4% of deaths). The mortality rate (per 1000 patient-years) due to infections was lower in the recent cohort compared to the historic cohort (4.6, 95% CI 3.5-6.1; and 9.1, 95% CI 7.6-10.7). The incidence rate ratio for infectious mortality for the recent compared to the historic cohort was 0.51 (95% CI 0.30-0.68).

The main causes of infectious deaths were common bacterial infections: septicaemia in 38.2% and pulmonary infections in 45.1%. Invasive viral or fungal infections accounted for only 2.0% and 2.9% of all infectious deaths (such as single cases of CMV pneumonia, HSV meningoencephalitis, VZV encephalitis and Pneumocystis jirovecii infection). Similarly, opportunistic bacterial infections rarely caused death, as only one death was caused by Listeria monocytogenes and one by Mycobacterium tuberculosis. Two deaths were caused by Clostridium difficile. Recipient age, reduced renal function, diabetes, longer pretransplant dialysis duration, and low albumin-level were associated with increased risk of infectious death. Surprisingly, only 23 (11%) of the infection-related deaths occurred during the first posttransplant year, and 70 (34%) within five years after transplantation.

D. Conclusions: The risk of death due to infectious causes after kidney transplantation is lower in the most recent cohort. Most of the infection-related deaths occurred late after transplantation. Common bacterial infections remain the most frequent cause of infection-related mortality, whereas opportunistic viral, fungal or bacterial infections rarely cause deaths after kidney transplantation.

CITATION INFORMATION: Helanterä I, Kinnunen S, Karhapää P, Juutilainen A, Finne P. Infection-Related Mortality After Kidney Transplantation in the Current Era. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress