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Factors and outcomes in association with sepsis differ between simultaneous pancreas/kidney and single kidney transplant recipients
Author(s) -
Schachtner Thomas,
Zaks Marina,
Otto Natalie M.,
Kahl Andreas,
Reinke Petra
Publication year - 2018
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.12848
Subject(s) - medicine , sepsis , incidence (geometry) , bacteremia , gastroenterology , pneumonia , septic shock , antibiotics , physics , microbiology and biotechnology , optics , biology
Background As immunosuppressive therapy has improved in simultaneous pancreas/kidney transplant recipients ( SPKTR s), infection has become the major limitation of disease‐free survival. Methods We studied all SPKTR s and deceased‐donor kidney transplant recipients ( KTR s) between 2003 and 2015. Thirty‐six of 134 SPKTR s (26.9%) were diagnosed with sepsis among which 13/36 SPKTR s (36.1%) developed severe sepsis/septic shock. A control group of 98 SPKTR s without sepsis and 61/538 KTR s (11.3%) with sepsis were used for comparison. Results Among SPKTR s, female sex, low BMI , CMV seronegativity, CMV disease, and acute cellular rejection increased the risk for sepsis ( P < .05). Patient and allograft survival was comparable among SPKTR s with and without sepsis ( P > .05), but showed inferior kidney allograft function ( P < .05). While urosepsis was less common among SPKTR s (45%), pneumonia (33%) and peritonitis (15%) as site of infections were more frequent ( P < .05). Here, gram‐positive and fungal sepsis were more common among SPKTR s compared to KTR s ( P < .05). SPKTR s showed a higher incidence and an earlier onset of sepsis compared to KTR s ( P < .001). SPKTR s with severe sepsis/septic shock were more likely to show pneumonia as site of infection with gram‐positive/polymicrobial bacteremia ( P < .05). Mortality from severe sepsis was 29% among SPKTR s compared to 58% among KTR s ( P < .05). Conclusion Differences in incidence, site, causative pathogens, and onset of sepsis between SPKTR s and KTR s may be attributed to more intense immunosuppression, major surgery, and complications of diabetes among SPKTR s. Lower sepsis‐related mortality may reflect younger age and more timely diagnosis, but also supports recent findings of less sepsis‐related mortality among recipients of solid organ transplantation.