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Infection-Related Mortality in Recipients of a Kidney Transplant in Australia and New Zealand.

Authors
  • Chan, Samuel1, 2, 3, 4
  • Pascoe, Elaine M2, 3, 4
  • Clayton, Philip A5, 6, 7
  • McDonald, Stephen P5, 6, 7
  • Lim, Wai H5, 8
  • Sypek, Matthew P5, 6, 7
  • Palmer, Suetonia C9
  • Isbel, Nicole M2, 3
  • Francis, Ross S2, 3
  • Campbell, Scott B5, 2, 3
  • Hawley, Carmel M5, 2, 3, 4
  • Johnson, David W5, 2, 3, 4
  • 1 Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, South Australia, Australia; [email protected] , (Australia)
  • 2 Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. , (Australia)
  • 3 Faculty of Medicine, Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia. , (Australia)
  • 4 Translational Research Institute, Brisbane, Queensland, Australia. , (Australia)
  • 5 Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, South Australia, Australia. , (Australia)
  • 6 Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia. , (Australia)
  • 7 School of Medicine, University of Adelaide, Adelaide, South Australia, Australia. , (Australia)
  • 8 Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Western Australia, Australia; and. , (Australia)
  • 9 Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand. , (New Zealand)
Type
Published Article
Journal
Clinical Journal of the American Society of Nephrology
Publisher
American Society of Nephrology
Publication Date
Oct 07, 2019
Volume
14
Issue
10
Pages
1484–1492
Identifiers
DOI: 10.2215/CJN.03200319
PMID: 31455690
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The burden of infectious disease is high among kidney transplant recipients because of concomitant immunosuppression. In this study the incidence of infectious-related mortality and associated factors were evaluated. In this registry-based retrospective, longitudinal cohort study, recipients of a first kidney transplant in Australia and New Zealand between 1997 and 2015 were included. Cumulative incidence of infectious-related mortality was estimated using competing risk regression (using noninfectious mortality as a competing risk event), and compared with age-matched, populated-based data using standardized incidence ratios. Among 12,519 patients, (median age 46 years, 63% men, 15% diabetic, 6% Indigenous ethnicity), 2197 (18%) died, of whom 416 (19%) died from infection. The incidence of infection-related mortality during the study period (1997-2015) was 45.8 (95% confidence interval [95% CI], 41.6 to 50.4) per 10,000 patient-years. The incidence of infection-related mortality reduced from 53.1 (95% CI, 45.0 to 62.5) per 10,000 person-years in 1997-2000 to 43.9 (95% CI, 32.5 to 59.1) per 10,000 person-years in 2011-2015 (P<0.001) Compared with the age-matched general population, kidney transplant recipients had a markedly higher risk of infectious-related death (standardized incidence ratio, 7.8; 95% CI, 7.1 to 8.6). Infectious mortality was associated with older age (≥60 years adjusted subdistribution hazard ratio [SHR], 4.16; 95% CI, 2.15 to 8.05; reference 20-30 years), female sex (SHR, 1.62; 95% CI, 1.19 to 2.29), Indigenous ethnicity (SHR, 2.87; 95% CI, 1.84 to 4.46; reference white), earlier transplant era (2011-2015: SHR, 0.39; 95% CI, 0.20 to 0.76; reference 1997-2000), and use of T cell-depleting therapy (SHR, 2.43; 95% CI, 1.36 to 4.33). Live donor transplantation was associated with lower risk of infection-related mortality (SHR, 0.53; 95% CI, 0.37 to 0.76). Infection-related mortality in kidney transplant recipients is significantly higher than the general population, but has reduced over time. Risk factors include older age, female sex, Indigenous ethnicity, T cell-depleting therapy, and deceased donor transplantation. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_08_27_CJN03200319.mp3. Copyright © 2019 by the American Society of Nephrology.

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