Epidemiology, risk factors, and clinical impact of early post-transplant infection in older kidney transplant recipients: the Korean organ transplantation registry study

Abstract

Background As in younger recipients, post-transplant infection is a frequent and devastating complication after kidney transplantation (KT) in older recipients. However, few studies have analyzed characteristics of post-transplant infection in older kidney recipients. In this study of a nation-wide cohort of older kidney recipients, we investigated the current epidemiology, risk factors, and clinical impacts of early post-transplant infection, which was defined as infectious complications requiring hospitalization within the first 6 months after KT. Methods Three thousand seven hundred thirty-eight kidney recipients registered in the Korean Organ Transplantation Registry between 2014 and 2017 were enrolled. Recipients were divided into two groups, younger (n = 3081) and older (n = 657), with a cutoff age of 60 years. We observed characteristics of early post-transplant infection, and investigated risk factors for the development of infection. We also analyzed the association of early post-transplant infection with clinical outcomes including cardiac events, rejection, graft loss, and all-cause mortality. Results The incidence of early post-transplant infection was more frequent in older recipients (16.9% in younger group and 22.7% in older group). Bacteria were the most common causative pathogens of early post-transplant infection, and the most frequent site of infection was the urinary tract in both older and younger recipients. Older recipients experienced more mycobacterial infections, co-infections, and multiple site infections compared with younger recipients. In older recipients, female sex (HR 1.398, 95% CI 1.199–1.631), older donor age (HR 1.010, 95% CI 1.004–1.016), longer hospitalization after KT (HR 1.010, 95% CI 1.006–1.014), and experience of acute rejection (HR 2.907, 95% CI 2.471–3.419) were independent risk factors for the development of early post-transplant infection. Experiencing infection significantly increases the incidence of rejection, graft loss, and all-cause mortality. Conclusion Our results illustrate current trends, risk factors, and clinical impacts of early post-transplant infection after KT in older recipients. Considering the poor outcomes associated with early post-transplant infection, careful screening of recipients at high risk for infection and monitoring of recipients who experience infection are advised. In addition, since older recipients exhibit different clinical characteristics than younger recipients, further studies are needed to establish effective strategies for treating older recipients.

Infections following rejection therapies in kidney and liver transplant recipients

“…Predisposing factors for infection are known to include organ of transplantation, older age at transplantation, underlying illness causing organ failure, and immunosuppression medication regimens used to prevent rejection. [1][2][3][4][5] Transplant recipients receive immunosuppressive medication for life, but infections are most likely to occur in the first 12 months after transplant, [6][7][8] when the patient is at the peak of immunosuppression. Treatment of rejection involves an increase in immunosuppression, creating a prime opportunity for infection.…”

“…Infections in solid‐organ transplant recipients are a major cause of morbidity and mortality. Predisposing factors for infection are known to include organ of transplantation, older age at transplantation, underlying illness causing organ failure, and immunosuppression medication regimens used to prevent rejection 1–5 . Transplant recipients receive immunosuppressive medication for life, but infections are most likely to occur in the first 12 months after transplant, 6–8 when the patient is at the peak of immunosuppression.…”

Retrospective Analysis of the Risk Factors of Perioperative Bacterial Infection and Correlation with Clinical Prognosis in Kidney Transplant Recipients

“…Post-transplant infection is clearly associated with poor clinical prognosis, such as increased mortality and higher risk of graft loss. 48 , 49 Our finding suggested that early infection increased the risks of acute rejection, PTDM, and secondary infection. Some studies have reported that infections trigger rejection in different transplant settings.…”

Bacterial Urinary Tract Infection and Early Asymptomatic Bacteriuria in Kidney Transplantation Still Negatively Affect Kidney Transplant Outcomes in the Era of Modern Immunosuppression and Cotrimoxazole Prophylaxis

“…For the direct associations, the early post-operative period is a vulnerable period for kidney transplant recipients because the degree of immunosuppression is usually at its peak and the effects of induction therapy are still present. UTI that occurs during this period is more likely to be severe and associated with prolonged hospitalization, which negatively affects kidney transplant outcomes [ 50 ]. In addition, kidney transplant recipients who develop early UTI would not be able to return to work or resume a normal life, leading to financial problems, poor mental health, and lower quality of life, which can indirectly impact transplant outcomes [ 49 ].…”