Risk Factors for 1-5 Year Major Infection Events (MIE) after Kidney Transplant (KTx) Including First-Year Immunosuppression (IS) Data: An Analysis of the Choosing Immune Suppression in Renal Transplantation by Efficacy and Morbidity (CISTEM) Study
1Washington Univ, St. Louis, MO, 2Univ of Iowa, Iowa City, IA, 3Saint Louis Univ, St. Louis, MO, 4SRTR, Minneapolis, MN
Meeting: 2019 American Transplant Congress
Abstract number: 463
Keywords: Immunosuppression, Infection, Kidney transplantation, Risk factors
Session Information
Session Name: Concurrent Session: Novel Insights in Kidney Infections
Session Type: Concurrent Session
Date: Tuesday, June 4, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 3:18pm-3:30pm
Location: Room 311
*Purpose: From our CISTEM study of linked national registries, we reported that older recipient age, female sex, diabetic kidney failure, non-standard-criteria organs, and mTORi-based IS increase risk for within-1-year post-KTx MIE: pneumonia, sepsis, and urinary tract infection (UTI), based on initial IS (Naik et al, Transplant Intl 2016). Cyclosporine- and mTORi-based IS increased the 3-year risk for all three MIEs; steroid-free regimens reduced the risk for pneumonia and sepsis (Dharnidharka et al, Transplantation 2017). In this analysis, we studied risk factors for developing these MIE de novo, years 1-5, using through-first-year IS data.
*Methods: The CISTEM study linked SRTR transplant data, 2009-2013, to Medicare claims and Symphony Health System pharmacy fills data. MIE diagnosis was based on ICD-9 codes. Maintenance IS was classified into the most common regimens. MIE was defined by at least two outpatient or one inpatient claim. Rates are presented as per patient-years (py).
*Results: Among 28,894 eligible KTx recipients (60% male, 54% white, primary renal disease diabetes in 24%, hypertension in 24%) all three MIEs occurred more frequently within year 1 post KTx (33 per 100 py, UTI; 12.8, pneumonia; 15.5, sepsis). In years 2-5, cumulative rates for each MEI, subtracting the first year, were 18.1 py, UTI; 16.2, pneumonia; 15.7, sepsis. MIE occurrence in the first year was the strongest predictor of the same MIE recurring in years 1-5 (HRs >3, P<0.001 for all). Any of the MIEs in the first year raised the risk for the other two in years 2-5. Acute rejection within the first year raised only years 1-5 sepsis risk. Low BMI raised 1-5 year pneumonia risk. Recipient age, female sex, non-standard-criteria organs, degree of renal function, induction agents, and maintenance regimens did not alter the risk for MIEs in years 1-5.
*Conclusions: Many known MEI risk factors may apply only to shorter time posttransplant, affecting predictive modeling. Risk factors for later-onset MIEs differ from those for early onset MEIs, and include no maintenance IS regimens.
To cite this abstract in AMA style:
Dharnidharka V, Axelrod D, Zhang Z, Schnitzler M, Lentine K, Kasiske B. Risk Factors for 1-5 Year Major Infection Events (MIE) after Kidney Transplant (KTx) Including First-Year Immunosuppression (IS) Data: An Analysis of the Choosing Immune Suppression in Renal Transplantation by Efficacy and Morbidity (CISTEM) Study [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-factors-for-1-5-year-major-infection-events-mie-after-kidney-transplant-ktx-including-first-year-immunosuppression-is-data-an-analysis-of-the-choosing-immune-suppression-in-renal-transplan/. Accessed May 17, 2025.« Back to 2019 American Transplant Congress