Session Name: Concurrent Session: Novel Insights in Kidney Infections
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 9, 2021.
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