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Infectious Complication in Extremely Elderly Kidney Transplant (KT) Recipients: A Leading Cause of Death.

J. Cabrera,1,3 M. Fernández-Ruiz,2 M. Molina,1 E. González,1 N. Polanco,1 F. López-Medrano,2 J. Aguado,2 M. Praga,1 A. Andrés.1

1Department of Nephrology, Hospital Universitario “12 de Octubre”, Madrid, Spain
2Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Madrid, Spain
3Department of Nephrology, Hospital Evangelico, Montevideo, Uruguay.

Meeting: 2016 American Transplant Congress

Abstract number: 166

Keywords: Bacterial infection, Cytomeglovirus, Elderly patients, Kidney transplantation

Session Information

Date: Sunday, June 12, 2016

Session Name: Concurrent Session: Organ Transplantation in the Era of Highly Resistant Pathogens

Session Time: 4:30pm-6:00pm

 Presentation Time: 5:42pm-5:54pm

Location: Room 311

Related Abstracts
  • Risk Factors for Graft Failure and Death in Elderly (>65 Years Old) Kidney Transplant Recipients
  • Elderly Kidney Transplant Recipients Need Optimized Immunosuppression According to Comorbidity and Infection.

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)
  Pneumonia   23 (13.9)
  Gastrointestinal tract infection   19 (11.5)
  Surgical site infection   17 (10.3)
  Skin and soft tissue infection   16 (9.7)
 Causative agent  
  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
  Staphylococci   8 (4.8)
  Clostridium difficile   8 (4.8)
  CMV   22 (13.3)
  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).

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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). https://atcmeetingabstracts.com/abstract/infectious-complication-in-extremely-elderly-kidney-transplant-kt-recipients-a-leading-cause-of-death/. Accessed March 6, 2021.

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