Abstract: FR-PO910
Outcomes of Two Diarrhea-Causing Infections in Kidney Transplant Recipients
Session Information
- Transplantation: Translational and Transplant Pathology
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Rolak, Stacey, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
- Di Bartolomeo, Sarah Elizabeth, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
- Astor, Brad C., University of Wisconsin, Madison, Wisconsin, United States
- Parajuli, Sandesh, UW Health, Madison, Wisconsin, United States
Background
Diarrhea caused by infection from Clostridium difficile (CD) or Norovirus (NV) is a common complication in immunosuppressed kidney transplant recipients (KTRs). There is limited data comparing the outcomes of these infections in KTRs. Comparing the outcomes of these two prevalent infections may inform preventive and therapeutic strategies in patient management.
Methods
We examined KTRs transplanted at our center between 01/01/1994 to 12/31/2014 who suffered from CD or NV infection-related diarrhea. Those who suffered CD or NV infection were matched with controls randomly selected from surviving recipients without these infections to that point in time with a 5:1 ratio. Outcomes examined include number of CD or NV infections, interval from transplant to infection, and graft failure.
Results
Of 4941 kidney transplants performed during the study period, 294 developed primary CD and 64 developed NV. Mean interval from transplant to infection was 1401±1621 days for CD infection and 1355±1357 days for NV infection. Polycystic kidney disease, diabetes, and glomerulonephritis were more common in the CD group compared to NV (p<0.05). Median uncensored graft survival following infection was 456 days for CD, 541 days for NV, and 1276 days for controls. Cox proportional hazard regression demonstrated that those with CD had higher risk of graft failure than controls (HR 2.43, 95% CI 2.07 to 2.87, p<0.01). Graft failure in the CD group and NV group were higher than for the control group at different times (Table 1).
Conclusion
Both CD and NV infection are associated with deleterious effects on kidney graft survival. Prevention and early management of these infections may prolong graft survival.
Table 1. Graft failure in CD, NV, and control study groups.
| Graft failure by 6 months of infection | Graft failure by 12 months of infection | Graft failure by 36 months of infection | Graft failure by 5 years of infection | |
| CD | 21% | 30% | 47% | 60% |
| NV | 5% | 10% | 30% | 44% |
| Control | 3% | 6% | 20% | 32% |
Funding
- Private Foundation Support