Notifiable Infectious Diseases Among Organ Transplant Recipients: A Data-Linked Cohort Study, 2000–2015

Abstract

Background Infections, including common communicable infections such as influenza, frequently cause disease after organ transplantation, although the quantitative extent of infection and disease remains uncertain. Methods A cohort study was conducted to define the burden of notifiable infectious diseases among all solid organ recipients transplanted in New South Wales, Australia, 2000–2015. Data linkage was used to connect transplant registers to hospital admissions, notifiable diseases, and the death register. Standardized incidence ratios (SIRs) were calculated relative to general population notification rates, accounting for age, sex, and calendar year. Infection-related hospitalizations and deaths were identified. Results Among 4858 solid organ recipients followed for 39 183 person-years (PY), there were 792 notifications. Influenza was the most common infection (532 cases; incidence, 1358 [95% CI, 1247–1478] per 100 000 PY), highest within 3 months posttransplant. Next most common was salmonellosis (46 cases; incidence, 117 [95% CI, 87–156] per 100 000 PY), then pertussis (38 cases; incidence, 97 [95% CI, 71–133] per 100 000 PY). Influenza and invasive pneumococcal disease (IPD) showed significant excess cases compared with the general population (influenza SIR, 8.5 [95% CI, 7.8–9.2]; IPD SIR, 9.8 [95% CI, 6.9–13.9]), with high hospitalization rates (47% influenza cases, 68% IPD cases) and some mortality (4 influenza and 1 IPD deaths). By 10 years posttransplant, cumulative incidence of any vaccine-preventable disease was 12%, generally similar by transplanted organ, except higher among lung recipients. Gastrointestinal diseases, tuberculosis, and legionellosis had excess cases among transplant recipients, although there were few sexually transmitted infections and vector-borne diseases. Conclusions There is potential to avoid preventable infections among transplant recipients with improved vaccination programs, health education, and pretransplant donor and recipient screening.

Vaccine-Preventable Infections Among Solid Organ Transplant Recipients in Switzerland

“…These findings are comparable with previous data. 11,14 The influenza-associated hospitalization rate was 38% in our study, similar to the rate in a recent cohort study from Australia 11 but lower than previously reported in a multicenter study 12 in which…”

“…The influenza incidence rate was highest in lung transplant recipients (40.51 per 1000 PY) and lowest in liver transplant recipients (8.47 per 1000 PY). These findings are comparable with previous data . The influenza-associated hospitalization rate was 38% in our study, similar to the rate in a recent cohort study from Australia but lower than previously reported in a multicenter study in which two-thirds of SOT recipients were admitted to the hospital.…”

“…Compatible with the findings of other studies, we found that IPD was relatively uncommon in the population that underwent SOT. The incidence rate of IPD in SOT recipients and in the general population was lower compared with that in a study that assessed IPD in the late 1990s and early 2000s .…”

“…10 However, whether SOT recipients are at increased risk for infections with vaccinepreventable pathogens in comparison with the general population remains largely unexplored. 11 Influenza, [12][13][14] varicella zoster virus (VZV) infection, 15,16 and invasive pneumococcal disease (IPD) [17][18][19] have been identified as important VPIs in the posttransplant setting, and having a lung transplant was previously shown to be associated with an increased risk for influenza compared with other transplanted organs. 14 Epidemiological studies including both the general population and SOT recipients might be useful to identify specific VPIs that are more likely to occur in the population undergoing transplant and may provide important information for future interventional studies to evaluate targeted immunization strategies for SOT recipients.…”

“… 10 However, whether SOT recipients are at increased risk for infections with vaccine-preventable pathogens in comparison with the general population remains largely unexplored. 11 Influenza, 12 , 13 , 14 varicella zoster virus (VZV) infection, 15 , 16 and invasive pneumococcal disease (IPD) 17 , 18 , 19 have been identified as important VPIs in the posttransplant setting, and having a lung transplant was previously shown to be associated with an increased risk for influenza compared with other transplanted organs. 14 …”