SUN-294 IMPACT OF POST-TRANSPLANT INFECTIONS ON LONG TERM OUTCOMES OF RENAL ALLOGRAFT RECIPIENTS

Abstract

Post Transplant Infections (PTI) are a major cause of morbidity in the form of graft loss and mortality in renal transplant recipients. Infections account for the major cause of death of the patients with functioning graft in developing Asian countries. A number of factors in the pre and peri transplant period increase the susceptibility to post-transplant infections affecting the overall graft and patient survival. The aim of this study is to analyze the epidemiology of infectious episodes; their risk factors in adult renal transplant recipients and to evaluate their long term graft and patient outcomes. An observational study of 644 adult renal transplant recipients(=>18years) between Jan 2010 and Dec 2015 followed till Jun 2019. The number, site, and treatment of infections were noted in each case. The risk factors for post-transplant infections were also analyzed. The outcomes in terms of graft survival and patient survival on subsequent follow-up were also analysed. Kaplan Meier survival analysis was used to compare the outcomes in patients with and without infection. PTI were seen in 83.1%; a 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 with E. Coli (18.9%) being the commonest. 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 1.4-6.1; p<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). 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 with inferior with PTI as compared to non-PTI. The 1-, 5-and 9-years graft survival with PTI was 94.6%;81.7%;70.3% and non PTI 98%; 92.2%; 90%; p=0.004 respectively; and patient survival with PTI 97.9%;88.2%;81.9% and non PTI 98.3%; 95.2%; 92.9%;p=0.012 respectively. Post-transplant infections fungal infections, in particular, had a significant impact on long term graft loss and mortality in renal transplant recipients. The predictors of PTI were ATG induction, pre-transplant Tuberculosis, and dialysis vintage.