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

the Korean Organ Transplantation Registry Study Group

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8 Scopus citations

Abstract

Background: As in younger recipients, post-transplant infection is a frequent and devastating complication after kidney transplantation (KT) in older recipients. However, few studies have analyzed characteristics of post-transplant infection in older kidney recipients. In this study of a nation-wide cohort of older kidney recipients, we investigated the current epidemiology, risk factors, and clinical impacts of early post-transplant infection, which was defined as infectious complications requiring hospitalization within the first 6 months after KT. Methods: Three thousand seven hundred thirty-eight kidney recipients registered in the Korean Organ Transplantation Registry between 2014 and 2017 were enrolled. Recipients were divided into two groups, younger (n = 3081) and older (n = 657), with a cutoff age of 60 years. We observed characteristics of early post-transplant infection, and investigated risk factors for the development of infection. We also analyzed the association of early post-transplant infection with clinical outcomes including cardiac events, rejection, graft loss, and all-cause mortality. Results: The incidence of early post-transplant infection was more frequent in older recipients (16.9% in younger group and 22.7% in older group). Bacteria were the most common causative pathogens of early post-transplant infection, and the most frequent site of infection was the urinary tract in both older and younger recipients. Older recipients experienced more mycobacterial infections, co-infections, and multiple site infections compared with younger recipients. In older recipients, female sex (HR 1.398, 95% CI 1.199–1.631), older donor age (HR 1.010, 95% CI 1.004–1.016), longer hospitalization after KT (HR 1.010, 95% CI 1.006–1.014), and experience of acute rejection (HR 2.907, 95% CI 2.471–3.419) were independent risk factors for the development of early post-transplant infection. Experiencing infection significantly increases the incidence of rejection, graft loss, and all-cause mortality. Conclusion: Our results illustrate current trends, risk factors, and clinical impacts of early post-transplant infection after KT in older recipients. Considering the poor outcomes associated with early post-transplant infection, careful screening of recipients at high risk for infection and monitoring of recipients who experience infection are advised. In addition, since older recipients exhibit different clinical characteristics than younger recipients, further studies are needed to establish effective strategies for treating older recipients.

Original languageEnglish
Article number519
JournalBMC Geriatrics
Volume20
Issue number1
DOIs
StatePublished - Dec 2020

Bibliographical note

Funding Information:
This research was supported by a fund (2014-ER6301–00, 2014-ER6301–01, 2014-ER6301–02, 2017-ER6301–00) by Research of Korea Centers for Disease Control and Prevention. The funder had no role in study design, data collection or analysis, interpretation of data, decision to publish, or preparation of the manuscript.

Funding Information:
The Korean Organ Transplantation Registry Study Group: Curie Ahn, Jaeseok Yang, Jin Min Kong, Oh Jung Kwon, Deok Gie Kim, Cheol-Woong Jung, Yeong Hoon Kim, Joong Kyung Kim, Chan-Duck Kim, Ji Won Min, Sung Kwang Park, Yeon Ho Park, Park Jae Berm, Jung Hwan Park, Jong-Won Park, Tae Hyun Ban, Sang Heon Song, Seung Hwan Song, Ho Sik Shin, Chul Woo Yang, Hye Eun Yoon, Kang Wook Lee, Dong Ryeol Lee, Dong Won Lee, Sam Yeol Lee, Sang-Ho Lee, Su Hyung Lee, Jung Jun Lee, Lee Jung Pyo, Jeong-Hoon Lee, Jin Seok Jeon, Heungman Jun, Kyung Hwan Jeong, Ku Yong Chung, Hong Rae Cho, Ju Man Ki, Dong-Wan Chae, Soo Jin Na Choi, Duck Jong Han, Seungyeup Han, and Kyu Ha Huh.

Publisher Copyright:
© 2020, The Author(s).

Keywords

  • Infectious complication
  • Kidney transplantation
  • Older kidney recipient

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