Do Infectious Diseases After Kidney Retransplantation Differ From Those After First Kidney Transplantation?

Kusejko, Katharina; Neofytos, Dionysios; van Delden, Christian; Hirsch, Hans H; Meylan, Pascal; Boggian, Katia; Hirzel, Cedric; Garzoni, Christian; Sidler, Daniel; Schnyder, Aurelia; Schaub, Stefan; Golshayan, Déla; Haidar, Fadi; Bonani, Marco; Kouyos, Roger D; Mueller, Nicolas J; Schreiber, Peter W (2024). Do Infectious Diseases After Kidney Retransplantation Differ From Those After First Kidney Transplantation? Open Forum Infectious Diseases, 11(3) Oxford University Press 10.1093/ofid/ofae055

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BACKGROUND

Infectious diseases (IDs) are highly relevant after solid organ transplantation in terms of morbidity and mortality, being among the most common causes of death. Patients undergoing kidney retransplantation (re-K-Tx) have been already receiving immunosuppressive therapy over a prolonged period, potentially facilitating subsequent infections. Comparing ID events after re-K-Tx and first kidney transplantation (f-K-Tx) can delineate patterns and risks of ID events associated with prolonged immunosuppression.

METHODS

We included adult patients with records on f-K-Tx and re-K-Tx in the Swiss Transplant Cohort Study. We analyzed ID events after f-K-Tx and re-K-Tx within the same patients and compared infection rates, causative pathogens, and infection sites. Recurrent time-to-event analyses were performed for comparison of infection rates.

RESULTS

A total of 59 patients with a median age of 47 years (range, 18-73) were included. Overall, 312 ID events in 52 patients occurred. In multivariable recurrent event modeling, the rate of ID events was significantly lower after re-K-Tx (hazard ratio, 0.70; P = .02). More bacterial (68.9% vs 60.4%) and fungal (4.0% vs 1.1%) infections were observed after f-K-Tx but fewer viral infections (27.0% vs 38.5%) as compared with re-K-Tx (P = .11). After f-K-Tx, urinary and gastrointestinal tract infections were more frequent; after re-K-Tx, respiratory tract and surgical site infections were more frequent (P < .001).

CONCLUSIONS

ID events were less frequent after re-K-Tx. Affected sites differed significantly after f-K-Tx vs re-K-Tx.

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