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Clin J Am Soc Nephrol. 2019 Aug 27. pii: CJN.03200319. doi: 10.2215/CJN.03200319. [Epub ahead of print]

Infection-Related Mortality in Recipients of a Kidney Transplant in Australia and New Zealand: Infection-related mortality in kidney transplant recipients.

Chan S1,2,3,4, Pascoe EM2,3,4, Clayton PA5,6,7, McDonald SP5,6,7, Lim WH5,8, Sypek MP5,6,7, Palmer SC9, Isbel NM2,3, Francis RS2,3, Campbell SB5,2,3, Hawley CM5,2,3,4, Johnson DW5,2,3,4.

Author information

1
Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, South Australia, Australia; samuel.chan@uqconnect.edu.au.
2
Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
3
Faculty of Medicine, Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.
4
Translational Research Institute, Brisbane, Queensland, Australia.
5
Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, South Australia, Australia.
6
Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
7
School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
8
Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Western Australia, Australia; and.
9
Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.

Abstract

BACKGROUND AND OBJECTIVES:

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.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

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.

RESULTS:

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).

CONCLUSIONS:

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.

PODCAST:

This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_08_27_CJN03200319.mp3.

KEYWORDS:

Australia; Infection; New Zealand; diabetes mellitus; female; humans; immunosuppression; incidence; kidney failure; kidney transplantation; living donors; male; mortality; registries; retrospective studies; risk factors; survival trends; t-lymphocytes; time factors; treatment outcome

PMID:
31455690
DOI:
10.2215/CJN.03200319

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