Abstract: SA-PO502
Prevalence and Clinical Outcomes in Kidney Transplant Patients with Viral and Fungal Opportunistic Infections and Malignancies
Session Information
- Transplantation: Balancing Rejection and Infection
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Lubetzky, Michelle L., Montefiore Medical Center, New York, New York, United States
- Hayde, Nicole A., None, Bronx, New York, United States
- Kamal, Layla, Montefiore Medical Center, Bronx, New York, United States
- Ajaimy, Maria, Montefiore Medical Center, Bronx, New York, United States
- Bedi, Puneet, Brookdale University Hospital Medical Center, Brooklyn, New York, United States
- Akalin, Enver, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
Background
Opportunistic infections (OI) and malignancy after kidney transplant (KTX) are associated with increased morbidity and mortality. We aimed to assess clinical outcomes in patients with these complications.
Methods
We performed a single-center retrospective review of KTX patients from January 2009 until December 2014. Patients with opportunistic viral infections (BK virus or cytomegalovirus (CMV)), fungal infections, or malignancies were reviewed and compared to patients without these complications.
Results
During a median follow-up of 3.8 years (2.4-5.3), out of a total 677 patients, 222 developed OI or malignancy (32.8%); 19.2% had BK viremia, 1.5% BK nephropathy, 9.5% CMV viremia, 2.1% invasive CMV infection, 2.5% fungal infection, and 5.6% had malignancies. There was no difference between the groups in terms of age, race, gender, induction type, or etiology of kidney disease (Table). One year and most recent serum creatinine levels were significantly higher in the OI/Malignancy group (p<0.01). There were significantly higher rates of acute rejection in the OI/Malignancy group (p<0.01). There was significantly more graft loss (22.5%) in the OI/malignancy group compared to only 4.2% in the non OI group (p<0.01). Additionally patient survival was lower in the OI/malignancy group (p=0.05). Graft loss in the OI/malignancy group was more likely to be due to chronic rejection (58% vs. 31.6% p=0.06); in most cases rejection occurred in the setting of reduced immunosuppression.
Conclusion
Opportunistic infections and malignancies develop in 33% of kidney transplant recipients, and are associated with lower graft and patient survival and increased risk of acute rejection.