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Abstract
Background
Infectious diseases (IDs) are highly relevant after solid organ transplantation in terms of morbidity and mortality, being among the most common causes of death. Patients undergoing kidney retransplantation (re-K-Tx) have been already receiving immunosuppressive therapy over a prolonged period, potentially facilitating subsequent infections. Comparing ID events after re-K-Tx and first kidney transplantation (f-K-Tx) can delineate patterns and risks of ID events associated with prolonged immunosuppression.
Methods
We included adult patients with records on f-K-Tx and re-K-Tx in the Swiss Transplant Cohort Study. We analyzed ID events after f-K-Tx and re-K-Tx within the same patients and compared infection rates, causative pathogens, and infection sites. Recurrent time-to-event analyses were performed for comparison of infection rates.
Results
A total of 59 patients with a median age of 47 years (range, 18–73) were included. Overall, 312 ID events in 52 patients occurred. In multivariable recurrent event modeling, the rate of ID events was significantly lower after re-K-Tx (hazard ratio, 0.70; P = .02). More bacterial (68.9% vs 60.4%) and fungal (4.0% vs 1.1%) infections were observed after f-K-Tx but fewer viral infections (27.0% vs 38.5%) as compared with re-K-Tx (P = .11). After f-K-Tx, urinary and gastrointestinal tract infections were more frequent; after re-K-Tx, respiratory tract and surgical site infections were more frequent (P < .001).
Conclusions
ID events were less frequent after re-K-Tx. Affected sites differed significantly after f-K-Tx vs re-K-Tx.
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Details
1 Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich , Zurich , Switzerland
2 Division of Infectious Diseases, University Hospital of Geneva , Geneva , Switzerland
3 Transplantation and Clinical Virology, Department of Biomedicine, University of Basel , Basel , Switzerland
4 Faculty of Biology and Medicine, University of Lausanne , Lausanne , Switzerland
5 Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital of St Gallen , St Gallen , Switzerland
6 Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
7 Division of Nephrology and Hypertension, Inselspital, Bern University Hospital , Bern , Switzerland
8 Clinic for Nephrology, Cantonal Hospital of St Gallen , St Gallen , Switzerland
9 Clinic for Transplantation Immunology and Nephrology, University Hospital Basel , Basel , Switzerland
10 Transplantation Center, Lausanne University Hospital , Lausanne , Switzerland
11 Division of Nephrology, Department of Medicine, University Hospital of Geneva , Geneva , Switzerland
12 Division of Nephrology, University Hospital Zurich , Zurich , Switzerland