LONG-TERM OUTCOMES OF POST-TRANSPLANT INFECTIONS IN ADULT RENAL TRANSPLANT RECIPIENTS

Abstract

Background: Infections are a major cause of morbidity in the form of graft loss and mortality in RTR. A number of factors in pre and peri transplant period increase the susceptibility to PTI affecting the overall graft and patient survival. Methods: An observational study of 644 adult RTR (=>18yrs) between Jan 2010 and Dec 2015, followed till Jun 2019. Primary objective was to study epidemiology of risk factors of PTI. Secondary objective was to evaluate transplant outcomes. Results: PTI were seen in 83.1%, of which majority (64%) occurred in the first year. Of all infections, 55.5% were bacterial, 18.5% viral, 10.8% parasitic, 8% fungal, and remaining 7.1% mycobacterial. UTI (37.4%) was most common infection with E. Coli (18.9%) being the commonest cause. Relative risk with PTI for graft dysfunction was 4 times higher (95%CI 3.5-6.6, p<0.01), graft loss was 3 times higher (95%CI 1.4-6.1p<0.01) and death was 3 times higher (95%CI 1.3-8.1, p=0.01) as compared to non PTI. Recurrence of PTI had 2 times higher risk of graft dysfunction (95%CI 1.2-3.1, p<0.01) and 3 times higher risk of graft loss (95% CI 1.9-5.0(p=0.00). Overall, graft loss was 19.1% and the mortality rate was 12.1% of the study population. The relative risk of fungal infections to cause graft loss was 2 times higher as compared to other infections (95% CI 1.23-2.18, p<0.003). The relative risk of fungal infections to cause death was 2 times higher than other infections (95% CI 1.20-2.56, p <0.008) On multivariate analysis, the predictors of PTI were ATG induction (P<0.01), pre transplant Tuberculosis (P=0.02) and dialysis vintage (P=0.02). On KM survival analysis, graft and patient survival was inferior in PTI at 1,5and 9years; (graft: PTI 94.6%;81.7%;70.3% vs non PTI 98%; 92.2%; 90%, p=0.004, patient: PTI 97.9%;88.2%;81.9% vs non PTI 98.3%; 95.2%; 92.9%, p=0.012). Conclusion: PTI have a significant impact on graft survival (70% vs 90%) and patient survival (82% vs 93%) in RTR, with fungal infections having worse outcomes.