Infections following rejection therapies in kidney and liver transplant recipients

Abstract

Introduction Infections are known complications of solid‐organ transplant. Treatment for rejection may increase risk of infection. We aimed to study frequency of infection and identify the risk factors for infections in solid organ transplant (SOT) (liver and kidney) recipients treated for rejection. Methods This is a retrospective chart review of all liver and kidney transplant recipients treated for rejection at our institution from 2014 to 2020. We collected information on episodes of acute rejection in the first year of transplant and infections within 6 months following rejection treatment. Results We identified 257 transplant patients treated for rejection. One hundred twelve (43.6%) developed infections, with a total of 226 infections. Urinary tracts infections were the most common, 72 (31.9%), followed by cytomegalovirus viremia in 37 (16.4%), bacteremia in 24 (10.6%), and BK virus in 14 (6.2%). Female sex (p = .047), elevated neutrophil count at rejection (p = .002), and increased number of rejection episodes (p = .022) were predictors of infection in kidney and simultaneous liver‐kidney recipients. No specific type of induction or rejection therapy was identified as a risk factor for infection, likely due to the prophylaxis protocols at our institution. Infection post rejection treatment was associated with higher graft loss (p = .021) and mortality (p = .031) in kidney transplant recipients. Conclusions Infections are common complications after treatment of SOT rejection. Female gender, higher neutrophil at time of rejection, and increased numbers of rejection episodes were predictors of infections after rejection in simultaneous liver‐kidney and kidney transplant patients. Infections were predictors of graft loss at 6 months and mortality at any point in follow‐up in kidney transplant patients.

Recipient donor sex combinations in solid organ transplantation and impact on clinical outcome: A scoping review

“…Moreover, female recipient was an independent risk factor for post‐transplant infection within the first 6 months following KT for the elderly (≥60 year‐old: multivariate HR 1.398; 95% CI, 1.199–1.631, p < .001) and the younger recipient (<60 year‐old: multivariate HR 1.323; 95% CI, 1.103–1.587, p = .003) group alike 36 . Similarly, female recipient (multivariate OR 1.89; 95% CI, 1.01–3.55; p = .047) was one of the identified predictors of infectious complications in a cohort of simultaneous KT‐LiT recipients undergoing rejection therapy 38 . No relationship was observed between infection and recipient and donor sex in a study population, in which pulmonary infections (45.9%) were most frequent, followed by intra‐abdominal infections (21.2%) and a relatively low rate of UTI (17.6%) 40 .…”

“…Female recipients have been reported to be at increased risk for developing a urinary tract infection (UTI) following KT (pooled OR 3.11; 95% CI, 2.10–4.13; p < .01) 33,35–39 . Independent risk factors for bacterial UTI in recipients of kidney and kidney‐pancreas transplants were age (multivariate OR per decade 1.10; 95% CI, 1.02–1.17; p = .001), female sex (multivariate OR 1.74; 95% CI, 1.42–2.13; p = .001) and the need for immediate post‐transplant dialysis (multivariate OR 1.63; 95% CI, 1.29–2.05; p = .001) 37 .…”

“…36 Similarly, female recipient (multivariate OR 1.89; 95% CI, 1.01-3.55; p = .047) was one of the identified predictors of infectious complications in a cohort of simultaneous KT-LiT recipients undergoing rejection therapy. 38 No relationship was observed between infection and recipient and donor sex in a study population, in which pulmonary infections (45.9%) were most frequent, followed by intra-abdominal infections (21.2%) and a relatively low rate of UTI (17.6%). 40 However, there was no separate analysis of the four RDSC.…”

“…This further highlights the importance of incorporating RDSC-stratified outcome analyses after SOT. RDSC is likely to have a relevant impact on outcome after SOT, not only influencing organ acceptance but also affecting post-transplant management alike, as certain risks such as allograft rejection 21,24,28,31,32,51,52 and occurrence of infections 28,33,[35][36][37][38][39] may vary fundamentally.…”

Impact of Early Rejection Treatment on Infection Development in Kidney Transplant Recipients: A Propensity Analysis

“…Acute allograft rejection has previously been noted by multiple studies to be associated with subsequent graft loss [7,9,10], with factors including timing of rejection, number of acute rejection episodes, and degree of kidney function recovery after rejection treatment all afecting long-term outcomes [11]. Infections in kidney transplant recipients are also known causes of morbidity and mortality, with prior research showing that infection is the second leading cause of death in recipients with allograft function [12][13][14]. However, the relationship between rejection and its treatment on subsequent infection development in transplant recipients is not defned, though has been hypothesized.…”