Predictive Factors of Infection in the First Year after Kidney Transplantation

• Published in: Transplantation proceedings 2013-12, Vol.45 (10), p.3620-3623
• Main Authors: Galindo Sacristán, P, Pérez Marfil, A, Osorio Moratalla, J.M, de Gracia Guindo, C, Ruiz Fuentes, C, Castilla Barbosa, Y.A, García Jiménez, B, de Teresa Alguacil, J, Barroso Martin, F.J, Osuna Ortega, A
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Monoclonal - adverse effects; Biomarkers - blood; Body Mass Index; Communicable Diseases - diagnosis; Communicable Diseases - epidemiology; Communicable Diseases - microbiology; Communicable Diseases - virology; Creatinine - blood; Cytomegalovirus Infections - epidemiology; Cytomegalovirus Infections - virology; Diabetes Complications - etiology; Escherichia coli Infections - epidemiology; Escherichia coli Infections - microbiology; Humans; Immunosuppressive Agents - adverse effects; Kidney Transplantation - adverse effects; Length of Stay; Male; Prevalence; Recombinant Fusion Proteins - adverse effects; Risk Factors; Severity of Illness Index; Spain; Stents - adverse effects; Surgery; Time Factors; Treatment Outcome; Urinary Tract Infections - epidemiology; Urinary Tract Infections - microbiology; Urinary Tract Infections - virology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2013.11.009

Abstract Background Infectious disease, a complication favored by immunosuppression, is the main cause of 1st-year mortality in solid organ transplantation. In renal transplant recipients (RTRs), urinary tract infection (UTI) is the most common, and the microorganisms that are isolated depend on chronology. Methods We present an observational study comprising 129 RTRs from January 2010 to December 2011 who were followed during the 1st year after transplantation. We analyzed occurrence of infections, predisposing factors, timing, severity, site of infection, and microorganisms. Results The patients had a total of 424 infectious episodes during the 1st year (3.29 episodes/patient/year). The predominant focus was the urinary tract, with at least 1 episode in 69.8% of patients. Bacteremia was recorded in 25.6% of patients and surgical wound infection in 20.9%. Cytomegalovirus infection or disease was diagnosed in 46.5%. Severe infections occurred in 30.2%. The predominant pathogen was E. coli. There was a significant correlation between hospital stay and the number of infections ( P  = .000; r  = 0.407) and between body mass index and hospital stay ( P  = .001; r  = 0.282). Severe infections were more frequent in diabetics, patients with a double-J stent, and those treated with basiliximab. Patients with cytomegalovirus replication had a higher number of infections (4.1 ± 1.2 vs 2.2 ± 2; P  = .000) and significantly higher annual serum creatinine (1.65 ± 0.7 vs 1.31 ± 0.3 mg/dL; P  = .003). Conclusions The prevalence of infections in the 1st year after kidney transplantation is very high, occurring mainly in the early period, in the urinary tract, and due to E. coli . Cytomegalovirus replication is associated with a higher number of infections and higher serum creatinine at 1 year. Body mass index is a predictor of early infection and of bacteremia in the post-transplantation period. Basiliximab induction and having a double-J stent were predictors of severe infections.