Mo976gender and Age Disparity in Infectious Complications After Kidney Transplantation

Abstract

Background and Aims Number of older patients with end stage kidney disease has been increasing, therefore there are increased number of older kidney transplant recipients. Potent immunosuppression (IS) used in patients after kidney transplantation (KTx) lowered the incidence of acute kidney rejection but increased the risk of post-transplant infection and sepsis as the most common non-cardiac cause of death. Older adults are at high risk of infections due to functional impairment and multiple comorbidities leading to poor outcome after KTx. Nowadays, no change in IS or prophylactic therapy is recommended based on the age of an adult KTx recipient. Female gender may be risk factor for infection after KTx due immunomodulatory effect of sex hormones such as estradiol. Methods The aim of our analysis was to find whether there are sex differences in the incidence of single and repeat infection and whether there is increased incidence of single and recurrent infectious complications in older kidney transplant recipients. Results Our analysis consisted of 100 patients after KTx (66 males, 34 females), average age 47,5 ± 12,6 years, treated with anti-thymocyte globulin as an induction IS. Male gender was a protective factor for the incidence of following infections in the 1st month after KTx: infection in general (P = 0.0054), recurrent infection (P = 0.0239), bacterial (P = 0.0125) and mycotic infection (P = 0.0103), recurrent bacterial infection (P = 0.0258). From the 1st to 6th month after KTx, female gender was identified as a risk factor for the incidence of infection in general (P = 0.0218), bacterial (P = 0.0186) and mycotic infection (P = 0.0318), repeat infection (P = 0.0216), recurrent bacterial infection (P = 0.0368). From 6th to 12th month after KTx, female gender was found as a risk factor for the incidence of bacterial infection (P = 0.0144), single infection (P = 0.0355), recurrent infection (P = 0.0007), single bacterial infection (P = 0.0309). Age > 60 years was not found as a risk factor for the incidence of single, repeat infection regarding its etiology. In our analysis we did not found correlation between gender and the incidence of single or recurrent infection of any etiology, we did not find significant differences in the severity of infections reflected by need for hospitalization, intensive care unit or use of vasopressors neither in gender, nor in older patients. In our study we did not confirm gender or age as a risk factor for the acute kidney rejection. Conclusion In our analysis, we found significant sex differences in the incidence of bacterial, viral, mycotic, single and repeat infection in different time intervals after kidney transplantation, while we did not confirmed age > 60 years is a risk factor for the infectious complications after KTx.

(Bio)printing in Personalized Medicine—Opportunities and Potential Benefits

“…Vnucak et al discovered major sex differences in the frequency of single and repeat infections in different time intervals after kidney transplantation. The female sex is a risk factor for the incidence of infection generally [ 47 ]. Post-transplant mortality also depends on sex and gender.…”

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

“…34,36,42,43 UTI after KT are the most common infectious complication, albeit with decreasing prevalence since the 1990s. 34,42,44,45 In a meta-analysis of 13 studies (n = 3 364), the pooled prevalence of UTIs in KT recipients was 38.0% (95% CI, 29%-47%; p < .01). 35 In a multivariable analysis, higher plasma creatinine concentration at the end of the first year after KT, end stage kidney disease due to diabetes, longer duration of pretransplant dialysis and low plasma albumin remained risk factors for infection-related death.…”

“…41 Bacterial infections are most frequent after KT, followed by viral infections, with fungal and parasitic infections being much rarer. 34,36,42,43 UTI after KT are the most common infectious complication, albeit with decreasing prevalence since the 1990s. 34,42,44,45 In a meta-analysis of 13 studies (n = 3 364), the pooled prevalence of UTIs in KT recipients was 38.0% (95% CI, 29%-47%; p < .01).…”