Modern immunosuppression regimens have substantially reduced acute rejection and improved patient and graft survival over the last decades. However, such potent regimens may also have increased the risks of infections after kidney transplant (KT).

Methods: Using USRDS, we reviewed hospitalization claims of 102,146 KT recipients between 1/1/1999-12/31/2013 who had Medicare as primary payer. We estimated 1-year cumulative incidence of infections by transplant year using Kaplan-Meier methods. We also compared the hazard of infections by transplant year using multivariable Cox models, censoring for death, graft loss, loss of Medicare primary coverage, and end of study (12/31/2013).

Results: Incidences of clostridium difficile, other intestinal infections, UTI and sepsis have increased over the last 15 years, while those of pneumonia, CMV infection, and candidiasis have decreased (Figure). Adjusting for immunosuppression regimen augmented the increasing trend in UTI and sepsis and attenuated the decreasing trend in pneumonia and CMV, suggesting the increasing trend might have been steeper should immunosuppression remained the same (Table).

Conclusion: We observed mixed trends in post-KT infections over the last 15 years: some infections have increased, while others have decreased. Modern immunosuppression does not seem to have introduced a global increase in infection risk.

CITATION INFORMATION: Bae S, Durand C, Kucirka L, DiBrito S, Avery R, Garonzik Wang J, Segev D. Trends in Infection Among Kidney Transplant Recipients, 1999-2013. Am J Transplant. 2017;17 (suppl 3).

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