Bacteremia Worsens Kidney Transplant Outcomes

Bacteremia commonly develops after kidney transplantation and may reduce both graft and patient survival, Canadian investigators reported at the 2017 American Transplant Congress in Chicago.

Of 1325 kidney transplant recipients seen at their hospital from 2004 to 2014 (mean age 50.4 years; 60.1% male), Sandeep Brar, MD, and colleagues of Toronto General Hospital found that 155 patients experienced bacteremia at least once over 5966 person-years of follow-up. Escherichia coli (31.0%) and coagulase-negative Staphylococcus aureus (25.1%) were the most common pathogens. Bacteremia was diagnosed by positive blood culture. For common skin contaminants, 2 cultures were needed from separate sites or occasions; for other organisms, such as gram-negative species, 1 culture was required.

With regard to timing of the first bacteremia episode, 6.8% occurred at 6 months after transplantation, 8.4% at 2 years, and 11.9% at 5 years. Investigators identified the following factors as significantly associated with increased risk: recipient history of diabetes, median time on dialysis, dialysis modality, delayed graft function, donor age, and donor estimated glomerular filtration rate (eGFR). Of the 1325 patients, 28.5% had diabetes and 73.5% received hemodialysis prior to transplantation.

The first episode of bacteremia was associated with a 2.35 times greater risk of total graft failure, a 2.03 times greater risk of death-censored graft failure, and a 2.7 times increased risk of death with graft function, the investigators reported.

“Identifying high-risk patients for targeted preventive strategies may reduce the burden and adverse consequences of this important complication,” Dr Brar and colleagues concluded in their study abstract.

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Brar S, Wang Y, Cannitelli A, Li Y, et al. Bacteremia in kidney transplant recipients: Incidence, risk factors, and outcomes. [abstract]. Am J Transplant 2017;17 (suppl 3). Presented at the 2017 American Transplant Congress in Chicago,  April 29–May 3, 2017. Abstract A185.