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Single-center analysis of infectious complications in older adults during the first year after kidney transplantation

  • Marion Hemmersbach-Miller
  • Barbara D. Alexander
  • Debra L. Sudan
  • Carl Pieper
  • Kenneth E. Schmader
Original Article
  • 116 Downloads

Abstract

Infections are among the top three causes of death of older adults in the first year after kidney transplantation (KT). Our aim was to describe infectious complications among KT recipients aged ≥ 65 during the first 12 months post-transplant. Single-center retrospective cohort study. Ninety-one KTs had been performed in patients ≥ 65 years of age between 2011 and 2015. 92.3% of the patients developed at least one infection. Infectious episodes increased the risk of future infection by 10% (p = 0.0018) with each infection portending a greater risk. At a patient level, viral (71.4%) and bacterial (70.2%) infections predominated. Urinary tract infections were the most frequent complication (30.3%), followed by cytomegalovirus infections (22.7%). Infections were the main reason for readmission. 7.7% of the patients developed rejection; and overall 3.3% lost their graft. Mortality at 1 year was 9.9%. Older KT recipients have a high incidence of infectious complications the first year after KT. Infections were the number one reason for readmission, and an infection episode predicted future infections for the individual patient. Despite these complications, the majority of older KT recipients were alive with a functioning graft at 1 year.

Keywords

Kidney transplantation Infection Aged Epidemiology 

Notes

Funding

Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health under award number 5T32AI100851 (MHM, BDA). Dr. Schmader was supported by the National Institute on Aging, Duke Pepper Older Americans Independence Center P30AG028716.

Compliance with ethical standards

Ethical approval

For this type of study formal consent is not required.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

References

  1. 1.
    Meier-Kriesche HU, Ojo AO, Hanson JA, Kaplan B (2001) Exponentially increased risk of infectious death in older renal transplant recipients. Kidney Int 59(4):1539–1543.  https://doi.org/10.1046/j.1523-1755.2001.0590041539.x CrossRefGoogle Scholar
  2. 2.
    Gruver AL, Hudson LL, Sempowski GD (2007) Immunosenescence of ageing. J Pathol 211(2):144–156.  https://doi.org/10.1002/path.2104 CrossRefGoogle Scholar
  3. 3.
    Kinnunen S, Karhapaa P, Juutilainen A, Finne P, Helantera I (2018) Secular trends in infection-related mortality after kidney transplantation. Clin J Am Soc Nephrol 13(5):755–762.  https://doi.org/10.2215/cjn.11511017 CrossRefGoogle Scholar
  4. 4.
    Saran R, Li Y, Robinson B, Ayanian J, Balkrishnan R, Bragg-Gresham J, Chen JT, Cope E, Gipson D, He K, Herman W, Heung M, Hirth RA, Jacobsen SS, Kalantar-Zadeh K, Kovesdy CP, Leichtman AB, Lu Y, Molnar MZ, Morgenstern H, Nallamothu B, O'Hare AM, Pisoni R, Plattner B, Port FK, Rao P, Rhee CM, Schaubel DE, Selewski DT, Shahinian V, Sim JJ, Song P, Streja E, Kurella Tamura M, Tentori F, Eggers PW, Agodoa LY, Abbott KC (2015) US renal data system 2014 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 66(1 Suppl 1):Svii):S1–S305.  https://doi.org/10.1053/j.ajkd.2015.05.001 Google Scholar
  5. 5.
    Matas AJ, Smith JM, Skeans MA, Thompson B, Gustafson SK, Stewart DE, Cherikh WS, Wainright JL, Boyle G, Snyder JJ, Israni AK, Kasiske BL (2015) OPTN/SRTR 2013 annual data report: kidney. Am J Transplant 15(Suppl 2):1–34.  https://doi.org/10.1111/ajt.13195 CrossRefGoogle Scholar
  6. 6.
    Saucedo-Crespo H, Haakinson DJ, Croome KP, Mai ML, Taner CB, Heilman RL, Gonwa T (2016) Prognostic factors in kidney transplantation in the septuagenarian: a multicenter analysis. Clin Transpl 30(7):828–835.  https://doi.org/10.1111/ctr.12756 CrossRefGoogle Scholar
  7. 7.
    Hod T, Goldfarb-Rumyantzev AS (2015) Clinical issues in renal transplantation in the elderly. Clin Transpl 29(2):167–175.  https://doi.org/10.1111/ctr.12481 CrossRefGoogle Scholar
  8. 8.
    McAdams-DeMarco MA, James N, Salter ML, Walston J, Segev DL (2014) Trends in kidney transplant outcomes in older adults. J Am Geriatr Soc 62(12):2235–2242.  https://doi.org/10.1111/jgs.13130 Google Scholar
  9. 9.
    Trouillhet I, Benito N, Cervera C, Rivas P, Cofan F, Almela M, Angeles Marcos M, Puig de la Bellacasa J, Pumarola T, Oppenheimer F, Moreno-Camacho A (2005) Influence of age in renal transplant infections: cases and controls study. Transplantation 80(7):989–992CrossRefGoogle Scholar
  10. 10.
    Neri F, Furian L, Cavallin F, Ravaioli M, Silvestre C, Donato P, La Manna G, Pinna AD, Rigotti P (2017) How does age affect the outcome of kidney transplantation in elderly recipients? Clin Transpl 31(10).  https://doi.org/10.1111/ctr.13036
  11. 11.
    Horvath MM, Rusincovitch SA, Brinson S, Shang HC, Evans S, Ferranti JM (2014) Modular design, application architecture, and usage of a self-service model for enterprise data delivery: the Duke Enterprise Data Unified Content Explorer (DEDUCE). J Biomed Inform 52:231–242.  https://doi.org/10.1016/j.jbi.2014.07.006 CrossRefGoogle Scholar
  12. 12.
    Ljungman P, Boeckh M, Hirsch HH, Josephson F, Lundgren J, Nichols G, Pikis A, Razonable RR, Miller V, Griffiths PD (2016) Definitions of cytomegalovirus infection and disease in transplant patients for use in clinical trials. Clin Infect Dis.  https://doi.org/10.1093/cid/ciw668
  13. 13.
    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381.  https://doi.org/10.1016/j.jbi.2008.08.010 CrossRefGoogle Scholar
  14. 14.
    CDC (2017) CDC/NHSN surveillance definitions for specific types of infections. https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf
  15. 15.
    Kang SS, Park WY, Jin K, Park SB, Han S (2017) Kidney transplantation in Korean patients with end-stage renal disease aged 65 and older: a single-center experience. Transplant Proc 49(5):987–991.  https://doi.org/10.1016/j.transproceed.2017.03.060 CrossRefGoogle Scholar
  16. 16.
    Cippa PE, Schiesser M, Ekberg H, van Gelder T, Mueller NJ, Cao CA, Fehr T, Bernasconi C (2015) Risk stratification for rejection and infection after kidney transplantation. Clin J Am Soc Nephrol 10(12):2213–2220.  https://doi.org/10.2215/cjn.01790215 CrossRefGoogle Scholar
  17. 17.
    Kauffman HM, McBride MA, Cors CS, Roza AM, Wynn JJ (2007) Early mortality rates in older kidney recipients with comorbid risk factors. Transplantation 83(4):404–410.  https://doi.org/10.1097/01.tp.0000251780.01031.81 CrossRefGoogle Scholar
  18. 18.
    Mendonca HM, Dos Reis MA, de Castro de Cintra Sesso R, Camara NO, Pacheco-Silva A (2007) Renal transplantation outcomes: a comparative analysis between elderly and younger recipients. Clin Transplant 21(6):755–760.  https://doi.org/10.1111/j.1399-0012.2007.00734.x Google Scholar
  19. 19.
    Cho H, Yu H, Shin E, Kim YH, Park SK, Jo MW (2016) Risk factors for graft failure and death following geriatric renal transplantation. PLoS One 11(4):e0153410.  https://doi.org/10.1371/journal.pone.0153410 CrossRefGoogle Scholar
  20. 20.
    Meier-Kriesche H, Ojo AO, Arndorfer JA, Leichtman AB, Lake K, Cibrik DM, Punch JD, Armstrong DR, Kaplan B (2001) Need for individualized immunosuppression in elderly renal transplant recipients. Transplant Proc 33(1–2):1190–1191CrossRefGoogle Scholar
  21. 21.
    Mandelbrot DA, Fleishman A, Rodrigue JR, Norman SP, Samaniego M (2017) Practices in the evaluation of potential kidney transplant recipients who are elderly: a survey of U.S. transplant centers. Clin Transpl 31(10).  https://doi.org/10.1111/ctr.13088
  22. 22.
    Rao PS, Merion RM, Ashby VB, Port FK, Wolfe RA, Kayler LK (2007) Renal transplantation in elderly patients older than 70 years of age: results from the scientific registry of transplant recipients. Transplantation 83(8):1069–1074.  https://doi.org/10.1097/01.tp.0000259621.56861.31 CrossRefGoogle Scholar
  23. 23.
    Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341(23):1725–1730.  https://doi.org/10.1056/nejm199912023412303 CrossRefGoogle Scholar
  24. 24.
    Hernandez D, Alonso-Titos J, Armas-Padron AM, Ruiz-Esteban P, Cabello M, Lopez V, Fuentes L, Jironda C, Ros S, Jimenez T, Gutierrez E, Sola E, Frutos MA, Gonzalez-Molina M, Torres A (2018) Mortality in elderly waiting-list patients versus age-matched kidney transplant recipients: where is the risk? Kidney Blood Press Res 43(1):256–275.  https://doi.org/10.1159/000487684 CrossRefGoogle Scholar
  25. 25.
    Legeai C, Andrianasolo RM, Moranne O, Snanoudj R, Hourmant M, Bauwens M, Soares J, Jacquelinet C, Couchoud C, Macher MA (2018) Benefits of kidney transplantation for a national cohort of patients aged 70 years and older starting renal replacement therapy. Am J Transplant.  https://doi.org/10.1111/ajt.15110
  26. 26.
    Gill JS, Schaeffner E, Chadban S, Dong J, Rose C, Johnston O, Gill J (2013) Quantification of the early risk of death in elderly kidney transplant recipients. Am J Transplant 13(2):427–432.  https://doi.org/10.1111/j.1600-6143.2012.04323.x CrossRefGoogle Scholar
  27. 27.
    Ojo AO (2006) Cardiovascular complications after renal transplantation and their prevention. Transplantation 82(5):603–611.  https://doi.org/10.1097/01.tp.0000235527.81917.fe CrossRefGoogle Scholar
  28. 28.
    Reese PP, Shults J, Bloom RD, Mussell A, Harhay MN, Abt P, Levine M, Johansen KL, Karlawish JT, Feldman HI (2015) Functional status, time to transplantation, and survival benefit of kidney transplantation among wait-listed candidates. Am J Kidney Dis 66(5):837–845.  https://doi.org/10.1053/j.ajkd.2015.05.015 CrossRefGoogle Scholar
  29. 29.
    Alangaden GJ, Thyagarajan R, Gruber SA, Morawski K, Garnick J, El-Amm JM, West MS, Sillix DH, Chandrasekar PH, Haririan A (2006) Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transpl 20(4):401–409.  https://doi.org/10.1111/j.1399-0012.2006.00519.x CrossRefGoogle Scholar
  30. 30.
    Ak O, Yildirim M, Kucuk HF, Gencer S, Demir T (2013) Infections in renal transplant patients: risk factors and infectious agents. Transplant Proc 45(3):944–948.  https://doi.org/10.1016/j.transproceed.2013.02.080 CrossRefGoogle Scholar
  31. 31.
    Parasuraman R, Julian K (2013) Urinary tract infections in solid organ transplantation. Am J Transplant 13(Suppl 4):327–336.  https://doi.org/10.1111/ajt.12124 CrossRefGoogle Scholar
  32. 32.
    Camargo LF, Esteves AB, Ulisses LR, Rivelli GG, Mazzali M (2014) Urinary tract infection in renal transplant recipients: incidence, risk factors, and impact on graft function. Transplant Proc 46(6):1757–1759.  https://doi.org/10.1016/j.transproceed.2014.05.006 CrossRefGoogle Scholar
  33. 33.
    Ooms L, IJ J, Voor In 't Holt A, Betjes M, Vos M, Terkivatan T (2017) Urinary Tract Infections After Kidney Transplantation: A Risk Factor Analysis of 417 Patients. Ann Transplant 22:402–408CrossRefGoogle Scholar
  34. 34.
    Veroux M, Giuffrida G, Corona D, Gagliano M, Scriffignano V, Vizcarra D, Tallarita T, Zerbo D, Virgilio C, Sciacca A, Cappello D, Stefani S, Veroux P (2008) Infective complications in renal allograft recipients: epidemiology and outcome. Transplant Proc 40(6):1873–1876.  https://doi.org/10.1016/j.transproceed.2008.05.065 CrossRefGoogle Scholar
  35. 35.
    De Keyzer K, Van Laecke S, Peeters P, Vanholder R (2011) Human cytomegalovirus and kidney transplantation: a clinician’s update. Am J Kidney Dis 58(1):118–126.  https://doi.org/10.1053/j.ajkd.2011.04.010 CrossRefGoogle Scholar
  36. 36.
    Karuthu S, Blumberg EA (2012) Common infections in kidney transplant recipients. Clin J Am Soc Nephrol 7(12):2058–2070.  https://doi.org/10.2215/cjn.04410512 CrossRefGoogle Scholar
  37. 37.
    Santos CA, Brennan DC, Fraser VJ, Olsen MA (2014) Delayed-onset cytomegalovirus disease coded during hospital readmission after kidney transplantation. Transplantation 98(2):187–194.  https://doi.org/10.1097/tp.0000000000000030 CrossRefGoogle Scholar
  38. 38.
    Bressollette-Bodin C, Coste-Burel M, Hourmant M, Sebille V, Andre-Garnier E, Imbert-Marcille BM (2005) A prospective longitudinal study of BK virus infection in 104 renal transplant recipients. Am J Transplant 5(8):1926–1933.  https://doi.org/10.1111/j.1600-6143.2005.00934.x CrossRefGoogle Scholar
  39. 39.
    Hirsch HH, Knowles W, Dickenmann M, Passweg J, Klimkait T, Mihatsch MJ, Steiger J (2002) Prospective study of polyomavirus type BK replication and nephropathy in renal-transplant recipients. N Engl J Med 347(7):488–496.  https://doi.org/10.1056/NEJMoa020439 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Infectious DiseasesDuke University Medical CenterDurhamUSA
  2. 2.Division of Abdominal Transplant SurgeryDuke University Medical CenterDurhamUSA
  3. 3.Department of Biostatistics and BioinformaticsDuke UniversityDurhamUSA
  4. 4.Division of GeriatricsDuke University Medical CenterDurhamUSA
  5. 5.GRECCDurham VADurhamUSA

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