Infection-related death has declined over time among kidney transplant recipients, but 1 in 5 still die from infection, including many with a functioning graft, according to findings from a new Australian study published in the Clinical Journal of the American Society of Nephrology.

Among all 12,519 recipients of a first kidney transplant in Australia and New Zealand during 1997 to 2015 (median age 46 years; 63% men; 15% diabetic), 2197 (18%) died, including 416 (3.3%) from infection. Infection-related mortality declined significantly from 53.1 to 43.9 per 10,000 person-years from 1997–2000 to 2011–2015. Kidney transplant recipients, however, had a 7.8-fold higher risk for infectious-related death compared with the general Australian population.

Samuel Chan, MD, of Metro South Hospital and Health Service in Woolloongabba, Brisbane, and colleagues identified several factors related with higher infection-related mortality: age older than 60 years, female sex, indigenous ethnicity, earlier transplant era, T cell-depleting therapy (antithymocyte globulin), and deceased donor kidney transplantation. Live donor transplantation was associated with 47% lower risk for infection-related mortality. The team suggested that longer ischemic times, delayed graft function, and differences in immunosuppressant dosages might explain worse infection-related survival after deceased donor transplantation.

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Infections caused by bacteria, fungi, viruses, protozoa, and other organisms accounted for 54%, 18%, 9%, 4%, and 16% of infection-related deaths, according to Dr Chan and his colleagues. Most patients who died from fungal and protozoal infections died within the first 12 months after transplantation, whereas those who died from viral and bacterial infections died much later. Deaths from urosepsis occurred much later than deaths due to infection in other body sites.

Although the study findings may not be generalizable outside of Australia and New Zealand, the information may aid shared decision making by patients and clinicians, according to the investigators.

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Chan S, Pascoe EM, Clayton PA, et al. Infection-related mortality in recipients of a kidney transplant in Australia and New Zealand (published online August 27, 2019). Clin J Am Soc Nephrol. doi:10.2215/CJN.03200319