Incidence Rate of Post-Kidney Transplant Infection: A Retrospective Cohort Study Examining Infection Rates at a Large Canadian Multicenter Tertiary-Care Facility

Abstract

Background:Reducing post-operative infections among kidney transplant patients is critical to improve long-term outcomes. With shifting disease demographics and implementation of new transplantation protocols, frequent evaluation of infection rate and type is necessary.Objective:Our objectives were to assess the incidence and types of post-operative infections in kidney transplant recipients at a large tertiary-care facility and determine sample sizes needed for future intervention trials.Design:Retrospective cohort study.Setting:The Ottawa Hospital, Ottawa, Ontario.Patients:Adult kidney transplant patients, N = 142.Measurements:Demographic data, transplant protocol, infections up to 2 years following transplantation.Methods:Infections within 2 years following transplantation in all kidney transplant recipients between January 2011 and December 2012 were reviewed. Sample sizes were determined using all-cause infection rates and infection-free survival data.Results:Of 142 patients, 44 (31.0%) had at least one infection. The incidence of infection was 36.2 per 100 patient-years by 2 years post-transplant. A total of 32 (22.5%) patients had 56 infection-related hospitalizations with 73.2% occurring in the first year. In the first 2 years, urinary tract infections had the highest incidence (18.1 per 100 patient-years) followed by skin (3.9 per 100 patient-years), cytomegalovirus (3.9 per 100 patient-years), and bacteremia (3.9 per 100 patient-years). Results indicate that 206 patients per study arm would be needed to show a 30% reduction in the 2-year incidence of infection post-transplantation.Limitations:Infection rates may be slightly underestimated due to the relatively short 2-year follow-up; however, the highest infection-risk period was captured within this time frame.Conclusions:Infections post-kidney transplant are still common, particularly urinary tract infections. They are associated with significant morbidity and hospitalization. Given the feasible sample sizes calculated in this study, intervention trials are indicated to further reduce infection rates within the first 2 years post-kidney transplantation.

Clinical outcomes of polyvalent immunoglobulin use in solid organ transplant recipients: A systematic review and meta‐analysis – Part II: Non‐kidney transplant

“…Patients with primary or secondary hypogammaglobulinemia tend to have increased rates of respiratory tract infections. 50,51 Therefore, IG prophylaxis may work in a greater degree in reducing infection and infection-related mortality in lung and heart transplant recipients as compared to kidney, liver, or others due to different risk profiles. 44 While lung and heart transplant recipients are at increased risk of pneumonia, 48,49 kidney transplant recipients are at higher risk of urinary tract infection.…”

“…44 While lung and heart transplant recipients are at increased risk of pneumonia, 48,49 kidney transplant recipients are at higher risk of urinary tract infection. 50,51 Therefore, IG prophylaxis may work in a greater degree in reducing infection and infection-related mortality in lung and heart transplant recipients as compared to kidney, liver, or others due to different risk profiles.…”

Clinical outcomes of polyvalent immunoglobulin use in solid organ transplant recipients: A systematic review and meta‐analysis

“…Sample size of each included studies was also small (median 50). We previously estimated sample size required to examine an effect of an intervention that at least 206 patients per study arm would be needed to show a 30% reduction in the two‐year incidence of infection post KT . Sample size would even be higher if expected effect size is smaller.…”

The fallacy of pre–kidney transplantation “dental clearance”

“…5 Almost a third of 142 adult kidney transplant recipients followed up in a retrospective cohort study in Canada were found to have developed an infection within 2 years after transplantation; urinary tract infections had the highest incidence, followed by a similar incidence of skin infection, cytomegalovirus infection, and bacteremia. 5 The sources of bacteremia were not identified, but the majority of infections included Escherichia coli, and none included Streptococcus species. 4 Indeed, oral sources of systemic infection in kidney transplant recipients are rarely reported in the literature.…”