Alshaikh Eman A, Astor Brad C, Muth Brenda, Jorgenson Margaret, Swanson Kurt, Garg Neetika, Aziz Fahad, Mohamed Maha, Mandelbrot Didier, Parajuli Sandesh
Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Transplant Direct. 2023 Aug 28;9(9):e1526. doi: 10.1097/TXD.0000000000001526. eCollection 2023 Sep.
Delayed graft function (DGF) among deceased donor kidney transplant recipients (DDKTRs) is a well-known risk factor for allograft rejection, decreased graft survival, and increased cost. Although DGF is associated with an increased risk of rejection, it is unclear whether it also increases the risk of infection.
We reviewed all adult DDKTRs at our center between 2010 and 2018. The primary outcomes of interest were BK viremia, cytomegalovirus viremia, pneumonia, and urinary tract infection (UTI) within the first year of transplant. Additional analysis was made with censoring follow-up at the time of allograft rejection.
A total of 1512 DDKTRs were included, of whom 468 (31%) had DGF. As expected, several recipient, donor, and baseline immunological characteristics differed by DGF status. After adjustment, DGF was significantly associated with an increased risk of BK viremia (hazard ratio: 1.34; 95% confidence interval, 1.0-1.81; = 0.049) and UTI (hazard ratio: 1.70; 95% confidence interval, 1.31-2.19; < 0.001) but not cytomegalovirus viremia or pneumonia. Associations were similar in models censored at the time of rejection.
DGF is associated with an increased risk of early infectious complications, mainly UTI and BK viremia. Close monitoring and appropriate management are warranted for better outcomes in this unique population.
在 deceased donor kidney transplant recipients (DDKTRs) 中，移植肾功能延迟 (DGF) 是同种异体移植排斥、移植肾存活期缩短及成本增加的一个众所周知的风险因素。虽然 DGF 与排斥风险增加相关，但尚不清楚它是否也会增加感染风险。
我们回顾了 2010 年至 2018 年期间我们中心所有成年 DDKTRs。感兴趣的主要结局是移植后第一年内的 BK 病毒血症、巨细胞病毒血症、肺炎和尿路感染 (UTI)。在同种异体移植排斥发生时进行删失随访并进行额外分析。
共纳入 1512 例 DDKTRs，其中 468 例 (31%) 发生 DGF。正如预期的那样，根据 DGF 状态，一些受者、供者和基线免疫特征有所不同。调整后，DGF 与 BK 病毒血症风险增加显著相关（风险比：1.34；95% 置信区间，1.0 - 1.81；P = 0.049）和 UTI（风险比：1.70；95% 置信区间，1.31 - 2.19；P < 0.001），但与巨细胞病毒血症或肺炎无关。在排斥发生时进行删失的模型中，相关性相似。
DGF 与早期感染并发症风险增加相关，主要是 UTI 和 BK 病毒血症。对于这一特殊人群，需要密切监测并进行适当管理以获得更好的结局。
