Abstract: SA-PO481
Hospitalization Trends for CMV Disease in Kidney Transplant Recipients in the United States, 2004–2014
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
- Garg, Neetika, University of Wisconsin, Madison, Madison, Wisconsin, United States
- Kumar, Nilay, University of Wisconsin, Madison, Madison, Wisconsin, United States
- Parajuli, Sandesh, UW Health, Middleton, Wisconsin, United States
- Singh, Tripti, None, Madison, Wisconsin, United States
- Aziz, Fahad, University of Wisconsin, Madison, Wisconsin, United States
- Mohamed, Maha A., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
- Muth, Brenda L., University of Wisconsin, Madison, Wisconsin, United States
- Djamali, Arjang, School of Medicine and Public Health, Madison, Wisconsin, United States
- Mandelbrot, Didier A., U of Wisconsin Hospital, Madison, Wisconsin, United States
Background
CMV infection is a frequent complication of kidney transplantation, especially with increasing use of more aggressive immunosuppressive regimens. How the burden of inpatient hospitalization related to this diagnosis has changed over time in the United States is not known.
Methods
We used the National Inpatient Sample 2004 – 2014 to identify hospitalizations with primary or secondary diagnosis of CMV disease (ICD-9 code: 078.5) in the setting of known history of kidney transplantation. Survey analysis techniques were used to generate national estimates. Data regarding prevalent kidney transplant recipient population was obtained from OPTN/SRTR. Linear and logistic regressions were used to test trends in hospitalization rate, acute kidney injury (AKI), dialysis-requiring AKI, length of stay (LOS) and cost.
Results
2,126 hospitalizations over the 11-year study period were representative of 10,215 hospitalizations for CMV disease nationally. Mean age was 52 years; 44.3% were women. Rate of hospitalization remained stable during the study period (6.3 to 5.3 per thousand prevalent recipient population, p-trend=0.75). However, a trend towards increasing in-hospital mortality (1.8% to 2.9%, p-trend=0.07) along with significant increases in rates of AKI, dialysis-requiring AKI, LOS and cost were noted (Table 1). This was accompanied by an increase in comorbidity burden as measured by Mean Charlson Comorbidity Index (0.80 to 2.02, p<0.001) during the study period.
Conclusion
Our study findings may reflect a shift towards outpatient management of CMV disease with hospitalization only for the sickest patients in the United States. Patient outcomes were worse and resource utilization (duration and cost of hospitalization) was higher for those admitted in more recent years.
Table 1
| 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | p-trend | |
| Hospitalization rate (per 1000 prevalent kidney transplant recipients) | 6.29 | 5.76 | 4.84 | 4.85 | 6.54 | 7.35 | 6.01 | 5.31 | 5.09 | 6.01 | 5.30 | 0.75 |
| In-hospital mortality (%) | 1.8 | 0.5 | 2.2 | 1.9 | 1.8 | 3.5 | 1.9 | 5.6 | 3.7 | 1.8 | 2.9 | 0.07 |
| AKI (%) | 9.5 | 13.0 | 7.0 | 18.7 | 21.3 | 21.2 | 27.2 | 27.6 | 33.2 | 31.6 | 32.7 | <0.001 |
| Dialysis-requiring AKI (%) | 0.6 | 1.1 | 0.7 | 1.3 | 2.2 | 1.7 | 0.5 | 3.7 | 2.7 | 2.6 | 2.9 | 0.02 |
| LOS (days, mean) | 7.7 | 7.3 | 6.9 | 8.1 | 8.2 | 8.8 | 8.9 | 9.9 | 9.6 | 8.4 | 8.5 | 0.01 |
| Inflation-adjusted cost ($, mean) | 16,323 | 16,213 | 16,690 | 21,968 | 25,420 | 26,845 | 25,709 | 29,604 | 25,249 | 22,216 | 29,723 | <0.001 |