Infections after kidney transplantation. Does age matter?

Abstract

Infections threaten successful outcomes after kidney transplantation. Our aim was to determine if the number, types of infections and the risk factors for common infections differed between older compared to younger kidney transplant (KT) recipients in the first year after surgery. We performed a single‐center retrospective cohort study. Between 2011 and 2015, 91 KTs were performed in patients ≥65 years of age; these were matched 1:1 (by year of transplantation, sex and race) to controls aged 40‐60 years. Over 90% of both groups had an infectious complication. Urinary tract infections (UTIs) and cytomegalovirus (CMV) viremia were significantly more frequent in older recipients. Older adults had more late onset UTIs, including after stent removal. CMV viremia was more frequent in older adults in the 1‐6 months post‐transplant period. Due to our center‐specific protocol utilizing pre‐emptive monitoring in the CMV recipient‐seropositive population, the higher CMV incidence in the aged recipient was driven by this subpopulation of older adults. No difference in pneumonias or bloodstream infections were found, nor in surgical complications, rejection or graft loss. Mortality was higher at 1‐year post‐transplant in the older recipients (9.9% vs 1.1%; P = 0.018). Prophylactic and immunosuppressive strategies may need to be altered for older KT recipients.

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

“…Another previous study that examined hospitalization for infection after KT showed a similar incidence of infection to the present study [ 17 ]. In the present study, older recipients experienced more frequent early post-transplant infections and these findings are in line with earlier studies [ 12 , 13 , 16 ]. Older recipients have high risk of post-transplant infection.…”

“…Despite extensive efforts, post-transplant infection continues to be a major cause of morbidity and mortality after KT and to have significant influence on maintaining allograft function [ 2 , 4 ]. Although several studies have analyzed the characteristics of post-transplant infection in kidney recipients to provide a basis for the prevention and treatment of infection, few studies have investigated infectious complications after KT in older recipients [ 12 , 13 , 16 ]. In one study been focused on elderly KT patients, 92.4% of the study sample experienced at least one infectious complication during the first year following KT.…”

“…Infection was a major reason for readmission and increased the risk of future infection in older kidney recipients [ 16 ]. The same study group also identified different characteristics of post-transplant infection after KT in older and younger recipients [ 12 ].…”

“…In recent years, the number of older patients with ESRD has increased, and the proportion of the elderly among kidney recipients has also increased [8,9]. Older kidney recipients are at high risk for post-transplant infection due to conditions including immunosuppressant use, multiple comorbidities, frailty, and immune senescence [9][10][11][12]. However, previous studies of KT in the elderly have focused on traditional outcomes such as rejection and survival, and few studies have evaluated infectious complications after KT in the elderly [12,13].…”

Assessment of infectious complications in elderly kidney transplant recipients receiving induction with anti‐thymocyte globulin vs basiliximab

“…These data are comparable to a recent article by Hemmersbach‐Miller et al evaluating infectious outcomes in a matched cohort of elderly KTRs (>65 years) and younger KTRs (aged 40‐60 years). Authors found an increased incidence of both UTIs and CMV infection in older recipients, which occurred most commonly between one and 6 months post‐transplant . Due to the limited number of patients without infections complications, formal analysis on the effect of induction immunosuppression was not conducted.…”