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Serum iron parameters in the early post‐transplant period and infection risk in kidney transplant recipients
Author(s) -
FernándezRuiz M.,
LópezMedrano F.,
Andrés A.,
Morales J.M.,
Lumbreras C.,
SanJuan R.,
Polanco N.,
González E.,
Aguado J.M.
Publication year - 2013
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12137
Subject(s) - medicine , interquartile range , hazard ratio , transferrin saturation , ferritin , gastroenterology , kidney transplantation , transplantation , confidence interval , confounding , proportional hazards model , serum iron , hemoglobin , serum ferritin
Background The impact of iron metabolism on the risk of infectious complications has been demonstrated in various immunosuppressed populations. However, no previous studies have assessed this potential association in kidney transplant ( KT ) recipients. Methods We prospectively analyzed 228 patients undergoing KT at our institution from N ovember 2008 to F ebruary 2011. Serum iron parameters (iron level, ferritin, total iron‐binding capacity, unsaturated iron‐binding capacity, transferrin, and transferrin saturation) were assessed within the first 2 weeks after transplantation (median interval, 3 days; interquartile [Q 1 –Q 3 ] range, 1–6 days), and before the occurrence of the first infectious episode (median interval, 26 days; Q 1 –Q 3 range, 11–76 days). Primary outcome was the occurrence of any episode of infection during the first year. Multivariate‐adjusted hazard ratios ( aHR s) were estimated by C ox regression models. Results Patients with ferritin level ≥500 ng/mL had higher incidence rates (per 1000 transplant‐days) of overall infection ( P = 0.017), bacterial infection ( P = 0.002), and bloodstream infection ( P = 0.011) during the first post‐transplant year. One‐year infection‐free survival rate was lower in these recipients (26% vs. 41%; P = 0.004). On multivariate analysis, after adjusting for potential confounders, ferritin emerged as an independent predictor of overall infection ( aHR [per unitary increment], 1.001; P = 0.006), and bacterial infection ( aHR [per unitary increment], 1.001; P = 0.020). Conclusion Monitoring of serum iron parameters in the early post‐transplant period may be useful in predicting the occurrence of infection in KT recipients, although further studies should be carried out to confirm this preliminary finding.