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Transpl Int. 2016 Feb;29(2):241-52. doi: 10.1111/tri.12711. Epub 2015 Dec 9.

Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice.

Author information

  • 1Division of Nephrology, University of Michigan, Ann Arbor, MI, USA.
  • 2Division of Nephrology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
  • 3Saint Louis University Center for Transplant Research, Saint Louis University Hospital, St. Louis, MO, USA.
  • 4Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
  • 5Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
  • 6Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH, USA.
  • 7Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.

Abstract

We examined United States Renal Data System registry records for Medicare-insured kidney transplant recipients in 2000-2011 to study the clinical and cost impacts of urinary tract infections (UTI), pneumonia, and sepsis in the first year post-transplant among a contemporary, national cohort. Infections were identified by billing diagnostic codes. Among 60 702 recipients, 45% experienced at least one study infection in the first year post-transplant, including UTI in 32%, pneumonia in 13%, and sepsis in 12%. Older recipient age, female sex, diabetic kidney failure, nonstandard criteria organs, sirolimus-based immunosuppression, and steroids at discharge were associated with increased risk of first-year infections. By time-varying, multivariate Cox regression, all study infections predicted increased first-year mortality, ranging from 41% (aHR 1.41, 95% CI 1.25-1.56) for UTI alone, 6- to 12-fold risk for pneumonia or sepsis alone, to 34-fold risk (aHR 34.38, 95% CI 30.35-38.95) for those with all three infections. Infections also significantly increased first-year costs, from $17 691 (standard error (SE) $591) marginal cost increase for UTI alone, to approximately $40 000-$50 000 (SE $1054-1238) for pneumonia or sepsis alone, to $134 773 (SE $1876) for those with UTI, pneumonia, and sepsis. Clinical and economic impacts persisted in years 2-3 post-transplant. Early infections reflect important targets for management protocols to improve post-transplant outcomes and reduce costs of care.

© 2015 Steunstichting ESOT.

KEYWORDS:

economics; infections; kidney transplantation; medicare; registries

PMID:
26563524
[PubMed - in process]
PMCID:
PMC4805426
[Available on 2017-02-01]
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