Non-Heart Beating Donor Kidney Transplantation Is not Associated with An Increased Risk of Post-Transplant Infection

Abstract

Objectives: The use of kidneys from non-heart beating donors (NHBD) has increased notably over the last years. The impact of such strategy on the risk of post-transplant infection remains unclear. Methods: We performed a prospective cohort study including 225 patients (143 males; mean age: 54.4 ± 14.1 years) who underwent kidney transplant (KT) at our institution from November 2008 to August 2010. We compared the incidence and clinical and microbiological characteristics of post-transplant infection between recipients of brain-dead donor (BDD) and NHBD grafts (154 and 71 patients, respectively). NHBD belonged mostly to categories I and II of the Maastricht classification (uncontrolled donnors). All patients in the NHBD group received induction therapy with antithymocyte globulin (ATG) and antiviral prophylaxis (mainly valganciclovir) during the first 3 months. Multivariate adjusted odds ratios (ORs) for infection were calculated using those covariates found to be significant at P < 0.10 by univariate analysis. Results: As compared to patients in the BDD group, those in the NHBD group were younger (P < 0.001), had fewer years on pre-transplant dialysis (P = 0.004), shorter cold-ischemia times (P < 0.001), and higher number of HLA mismatches (P = 0.052). Delayed graft function (requirement for dialysis within the first week after transplantation) was more frequent in the NHBD group (84.5% vs. 52.6%; P < 0.001), as well as donor/recipient cytomegalovirus (CMV) mismatch (12.7% vs. 5,8%; P = 0.079). Incidence rates of overall infection in the NHBD and BDD groups were 1.94 and 3.25 episodes per 1,000 transplant-days, respectively (P < 0.0001). Incidence rate of early infection (during the first month) was also lower in the NHBD group than in the BDD group (8.4 vs. 14.12 episodes per 1,000 transplant-days, respectively; P = 0.006). Patients in the NHBD group exhibited lower cumulative incidences of bacterial infection (P = 0.044), acute graft pyelonephritis (P = 0.081), CMV infection (P = 0.016), and non-CMV viral infection (P = 0.028). We found no differences in the incidence of other types of infection. On the regression model, and after adjusting for age, induction therapy, and cold-ischemia time, among other variables, the receipt of a NHBD graft did not remain as an independent risk factor for post-transplant infection (OR 0.63; 95% CI 0.35-1.15; P = 0.191). Conclusion: In our experience, and despite the higher occurrence of delayed graft function and CMV mismatch and the universal use of ATG induction, KT from uncontrolled NHBD does not entail an increased risk of post-transplant infection.