Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Transplant. 2021 Jan;21(1):198-207. doi: 10.1111/ajt.16106. Epub 2020 Jun 28.
Infections remain a major threat to successful kidney transplantation (KT). To characterize the landscape and impact of post-KT infections in the modern era, we used United States Renal Data System (USRDS) data linked to the Scientific Registry of Transplant Recipients (SRTR) to study 141 661 Medicare-primary kidney transplant recipients from January 1, 1999 to December 31, 2014. Infection diagnoses were ascertained by International Classification of Diseases, Ninth Revision (ICD-9) codes. The cumulative incidence of a post-KT infection was 36.9% at 3 months, 53.7% at 1 year, and 78.0% at 5 years. The most common infections were urinary tract infection (UTI; 46.8%) and pneumonia (28.2%). Five-year mortality for kidney transplant recipients who developed an infection was 24.9% vs 7.9% for those who did not, and 5-year death-censored graft failure (DCGF) was 20.6% vs 10.1% (P < .001). This translated to a 2.22-fold higher mortality risk (adjusted hazard ratio [aHR]: 2.22 , P < .001) and 1.92-fold higher DCGF risk (aHR: 1.91 , P < .001) for kidney transplant recipients who developed an infection, although the magnitude of this higher risk varied across infection types (for example, 3.11-fold higher mortality risk for sepsis vs 1.62-fold for a UTI). Post-KT infections are common and substantially impact mortality and DCGF, even in the modern era. Kidney transplant recipients at high risk for infections might benefit from enhanced surveillance or follow-up to mitigate these risks.
感染仍然是成功肾移植（KT）的主要威胁。为了描述现代时代肾移植后感染的特征和影响，我们使用美国肾脏数据系统（USRDS）数据与移植受者科学登记处（SRTR）相关联，研究了 1999 年 1 月 1 日至 2014 年 12 月 31 日期间的 141661 名 Medicare 主要肾移植受者。感染诊断通过国际疾病分类，第九版（ICD-9）代码确定。肾移植后感染的累积发生率为 3 个月时为 36.9%，1 年时为 53.7%，5 年时为 78.0%。最常见的感染是尿路感染（UTI；46.8%）和肺炎（28.2%）。发生感染的肾移植受者的 5 年死亡率为 24.9%，而未发生感染的肾移植受者为 7.9%，5 年死亡风险校正移植物失功（DCGF）为 20.6%，而未发生感染的肾移植受者为 10.1%（P<.001）。这意味着感染患者的死亡率风险增加了 2.22 倍（校正后风险比[aHR]：2.22，P<.001），DCGF 风险增加了 1.92 倍（aHR：1.91，P<.001），尽管这种更高风险的幅度因感染类型而异（例如，败血症的死亡率风险高 3.11 倍，而 UTI 则为 1.62 倍）。肾移植后感染很常见，即使在现代时代，也会严重影响死亡率和 DCGF。感染风险高的肾移植受者可能受益于增强的监测或随访，以降低这些风险。
