TY - JOUR
T1 - Characterizing the landscape and impact of infections following kidney transplantation
AU - Jackson, Kyle R.
AU - Motter, Jennifer D.
AU - Bae, Sunjae
AU - Kernodle, Amber
AU - Long, Jane J.
AU - Werbel, William
AU - Avery, Robin
AU - Durand, Christine
AU - Massie, Allan B.
AU - Desai, Niraj
AU - Garonzik-Wang, Jacqueline
AU - Segev, Dorry L.
N1 - Funding Information:
This work was supported by grant numbers F32DK113719 (Jackson), F32DK117563 (Kernodle), K01DK101677 (Massie), K24DK101828 (Segev), and K23DK115908 (Garonzik-Wang) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the ASN Foundation for Kidney Research (Bae), and the Doris Duke Charitable Foundation (Garonzik-Wang). The analyses described herein are the responsibility of the authors alone and do not necessarily reflect the views or policies of the US Department of Health and Human Services; nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The data reported herein have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government.
Funding Information:
This work was supported by grant numbers F32DK113719 (Jackson), F32DK117563 (Kernodle), K01DK101677 (Massie), K24DK101828 (Segev), and K23DK115908 (Garonzik‐Wang) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the ASN Foundation for Kidney Research (Bae), and the Doris Duke Charitable Foundation (Garonzik‐Wang). The analyses described herein are the responsibility of the authors alone and do not necessarily reflect the views or policies of the US Department of Health and Human Services; nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The data reported herein have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government.
Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2021/1
Y1 - 2021/1
N2 - Infections remain a major threat to successful kidney transplantation (KT). To characterize the landscape and impact of post-KT infections in the modern era, we used United States Renal Data System (USRDS) data linked to the Scientific Registry of Transplant Recipients (SRTR) to study 141 661 Medicare-primary kidney transplant recipients from January 1, 1999 to December 31, 2014. Infection diagnoses were ascertained by International Classification of Diseases, Ninth Revision (ICD-9) codes. The cumulative incidence of a post-KT infection was 36.9% at 3 months, 53.7% at 1 year, and 78.0% at 5 years. The most common infections were urinary tract infection (UTI; 46.8%) and pneumonia (28.2%). Five-year mortality for kidney transplant recipients who developed an infection was 24.9% vs 7.9% for those who did not, and 5-year death-censored graft failure (DCGF) was 20.6% vs 10.1% (P <.001). This translated to a 2.22-fold higher mortality risk (adjusted hazard ratio [aHR]: 2.152.222.29, P <.001) and 1.92-fold higher DCGF risk (aHR: 1.841.911.98, P <.001) for kidney transplant recipients who developed an infection, although the magnitude of this higher risk varied across infection types (for example, 3.11-fold higher mortality risk for sepsis vs 1.62-fold for a UTI). Post-KT infections are common and substantially impact mortality and DCGF, even in the modern era. Kidney transplant recipients at high risk for infections might benefit from enhanced surveillance or follow-up to mitigate these risks.
AB - Infections remain a major threat to successful kidney transplantation (KT). To characterize the landscape and impact of post-KT infections in the modern era, we used United States Renal Data System (USRDS) data linked to the Scientific Registry of Transplant Recipients (SRTR) to study 141 661 Medicare-primary kidney transplant recipients from January 1, 1999 to December 31, 2014. Infection diagnoses were ascertained by International Classification of Diseases, Ninth Revision (ICD-9) codes. The cumulative incidence of a post-KT infection was 36.9% at 3 months, 53.7% at 1 year, and 78.0% at 5 years. The most common infections were urinary tract infection (UTI; 46.8%) and pneumonia (28.2%). Five-year mortality for kidney transplant recipients who developed an infection was 24.9% vs 7.9% for those who did not, and 5-year death-censored graft failure (DCGF) was 20.6% vs 10.1% (P <.001). This translated to a 2.22-fold higher mortality risk (adjusted hazard ratio [aHR]: 2.152.222.29, P <.001) and 1.92-fold higher DCGF risk (aHR: 1.841.911.98, P <.001) for kidney transplant recipients who developed an infection, although the magnitude of this higher risk varied across infection types (for example, 3.11-fold higher mortality risk for sepsis vs 1.62-fold for a UTI). Post-KT infections are common and substantially impact mortality and DCGF, even in the modern era. Kidney transplant recipients at high risk for infections might benefit from enhanced surveillance or follow-up to mitigate these risks.
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U2 - 10.1111/ajt.16106
DO - 10.1111/ajt.16106
M3 - Article
C2 - 32506639
AN - SCOPUS:85087154510
VL - 21
SP - 198
EP - 207
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 1
ER -