Sepsis remains one of the most common causes of death among renal transplant recipients. Particular risk factors, however, are poorly described in this patient population, but crucial to improve sepsis outcomes.

A retrospective analysis was performed of all adult renal transplant recipients at our single transplant center transplanted between January 1, 2001, and December 31, 2010. 105 (10.4%) of 1013 patients studied were diagnosed with sepsis, among which 31 patients (29.5%) developed severe sepsis or septic shock, and 28 patients (26.7%) died from sepsis. Patients developing sepsis were generally older (mean age 55 vs. 50 years; p<0.01). An age- and gender-matched control group of 315 renal transplant recipients was used for comparison.

Upon multivariate analysis diabetes mellitus, CMV reactivation, zero HLA-B matches, and donor age increased the risk of developing sepsis after renal transplantation. The highest incidence of sepsis, 31.4%, was in renal transplant recipients with diabetes mellitus and zero HLA-B matches. Five-year patient survival was 70.3% with sepsis compared with 88.7% without (p=0.001). Five-year estimated GFR was significantly lower in renal transplant recipients developing sepsis (mean GFR 43 ml/min vs. 52 ml/min; p=0.017). Among patients developing sepsis after renal transplantation age, body mass index >30 or <17.5 kg/m², and zero HLA-B matches were predictive factors of mortality upon multivariate analysis. Patients who died from sepsis were generally older (mean age 65 vs. 55 years; p<0.01). The highest mortality in renal transplant recipients developing sepsis, 77.8%, was observed in patients with zero HLA-B matches and body mass index >30 or <17.5kg/m². Five-year patient survival with sepsis was 79.2% with one or two HLA-B matches versus 55.2% with zero HLA-B matches (p=0.03).

Severe sepsis remains a paramount issue in the renal transplant population. The high mortality of sepsis in renal transplant recipients demands that careful attention needs to be given to risk factors predicting the course of the septic event. Discouraging zero HLA-B matches in older renal transplant recipients with additional risk factors as diabetes mellitus or obesity may be worth consideration in organ allocation policies. Our results call for the development of new diagnostic and treatment strategies in order to improve patient survival and long-term allograft function.

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