SAN DIEGO—Most renal transplant recipients require at least one hospitalization after transplantation surgery, and infections are among the most common reasons, new findings suggest.

Most of these hospitalizations occur within six months after transplantation, indicating the need for close follow-up during this time period, said lead investigator Elena Beam, MD, an internal medicine resident at Mayo Clinic in Rochester, Minn. “We found in the first year after transplantation that a majority of patients ended up getting hospitalized and the usual stay was three days,” Dr. Beam said. “This is something that increases cost of care.”

Dr. Beam presented study findings at IDWeek, a joint meeting of the Infectious Diseases Society of American and three other organizations.

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The study showed that infections were the cause of 60% of hospitalizations within one year of surgery. Renal complications were a factor in 48% of hospitalizations and post-surgical wound complications accounted for 19%.

The presence of diabetes mellitus before transplantation and allograft rejection were the major risk factors associated with hospitalization secondary to an infectious cause.

Dr. Beam and her colleagues analyzed data from 285 kidney transplant recipients with a median age of 57 years. They collected data on each hospitalization due to infectious complications. They looked at indications for hospitalizations, duration of stay, and time from transplantation. The study cohort was 59% male and 84% of patients received the kidney allograft from living donors.

At one month after transplantation, 22% of patients were hospitalized; 43% were hospitalized at one year. During the entire follow up period, 51% of the cohort experienced at least one hospitalization. Ninety-six hospitalizations were related to infections, which accounted for 31% of all indications for hospitalization. Urinary tract and skin and soft tissue infections were the most common indications for infection-related hospitalization. 

A pre-transplant diagnosis of diabetes mellitus and diabetic nephropathy as the underlying cause for renal transplant were associated with a significant twofold increased the risk for infection-related hospitalization. Urological abnormalities increased the risk for hospitalization by a significant 86%. Allograft rejection increased the risk for hospitalization twofold.

The study could lead to new ways of decreasing hospitalizations among renal transplant recipients and the morbidity and mortality associated with each hospitalization, Dr. Beam said. “By knowing the patients who are at highest risk, we can keep a closer eye on them and we can also counsel patients that they need to look out for infections and what the signs of infection may be,” Dr. Beam told Renal & Urology News. “In addition, clinicians can use this information to identify the patients at highest risk of hospitalization following kidney transplantation and institute close outpatient follow-up and higher vigilance for complications in this population.”