Kusejko Katharina, Neofytos Dionysios, van Delden Christian, Hirsch Hans H, Meylan Pascal, Boggian Katia, Hirzel Cedric, Garzoni Christian, Sidler Daniel, Schnyder Aurelia, Schaub Stefan, Golshayan Déla, Haidar Fadi, Bonani Marco, Kouyos Roger D, Mueller Nicolas J, Schreiber Peter W
Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
Open Forum Infect Dis. 2024 Feb 6;11(3):ofae055. doi: 10.1093/ofid/ofae055. eCollection 2024 Mar.
Infectious diseases (IDs) are highly relevant after solid organ transplantation in terms of morbidity and mortality, being among the most common causes of death. Patients undergoing kidney retransplantation (re-K-Tx) have been already receiving immunosuppressive therapy over a prolonged period, potentially facilitating subsequent infections. Comparing ID events after re-K-Tx and first kidney transplantation (f-K-Tx) can delineate patterns and risks of ID events associated with prolonged immunosuppression.
We included adult patients with records on f-K-Tx and re-K-Tx in the Swiss Transplant Cohort Study. We analyzed ID events after f-K-Tx and re-K-Tx within the same patients and compared infection rates, causative pathogens, and infection sites. Recurrent time-to-event analyses were performed for comparison of infection rates.
A total of 59 patients with a median age of 47 years (range, 18-73) were included. Overall, 312 ID events in 52 patients occurred. In multivariable recurrent event modeling, the rate of ID events was significantly lower after re-K-Tx (hazard ratio, 0.70; = .02). More bacterial (68.9% vs 60.4%) and fungal (4.0% vs 1.1%) infections were observed after f-K-Tx but fewer viral infections (27.0% vs 38.5%) as compared with re-K-Tx ( = .11). After f-K-Tx, urinary and gastrointestinal tract infections were more frequent; after re-K-Tx, respiratory tract and surgical site infections were more frequent ( < .001).
ID events were less frequent after re-K-Tx. Affected sites differed significantly after f-K-Tx vs re-K-Tx.
在实体器官移植后，感染性疾病（IDs）在发病率和死亡率方面具有高度相关性，是最常见的死亡原因之一。接受肾脏再次移植（re-K-Tx）的患者已经接受了长时间的免疫抑制治疗，这可能会促使随后发生感染。比较re-K-Tx和首次肾脏移植（f-K-Tx）后的ID事件可以描绘出与长期免疫抑制相关的ID事件模式和风险。
我们纳入了瑞士移植队列研究中具有f-K-Tx和re-K-Tx记录的成年患者。我们分析了同一患者f-K-Tx和re-K-Tx后的ID事件，并比较了感染率、致病病原体和感染部位。进行了复发事件时间分析以比较感染率。
共纳入59例患者，中位年龄为47岁（范围18 - 73岁）。总体而言，52例患者发生了312次ID事件。在多变量复发事件建模中，re-K-Tx后ID事件的发生率显著较低（风险比，0.70；P = .02）。与re-K-Tx相比，f-K-Tx后观察到更多的细菌感染（68.9%对60.4%）和真菌感染（4.0%对1.1%），但病毒感染较少（27.0%对38.5%）（P = .11）。f-K-Tx后，泌尿系统和胃肠道感染更为常见；re-K-Tx后，呼吸道和手术部位感染更为常见（P < .001）。
re-K-Tx后ID事件较少见。f-K-Tx与re-K-Tx后受影响的部位有显著差异。
