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Abstract: FR-PO1138

Nocardiosis in Renal Transplant Patients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Gibson, Maya, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Yang, Nianlan, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Waller, Jennifer L., Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Nahman, N. Stanley, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Martin, Kathryn M., Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Kheda, Mufaddal, Auburn University, Leesburg, Georgia, United States
  • Mohammed, Azeem, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Young, Lufei, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Bollag, Wendy B., Medical College of Georgia at Augusta University, Augusta, Georgia, United States
  • Baer, Stephanie L., Augusta VA Medical Center, Augusta, Georgia, United States
Background

Kidney transplant (Tx) patients are chronically immunosuppressed and are at increased risk for opportunistic infections, including the gram positive rod Nocardia. Nocardiosis is rare, with an incidence of 0.4%-3.6% in solid organ Tx recipients. The disease is difficult to diagnose, and targeted therapy is required for treatment. In kidney Tx patients specifically, information on the incidence and risk factors for Nocardia infection is limited. To address this issue in a large at-risk population, we utilized the United States Renal Data System (USRDS) to investigate the incidence and risk factors for Nocardia in over 200,000 kidney Tx patients. Sequelae of allograft failure or rejection after infection was also examined.

Methods

Demographics, clinical risk factors, Nocardia diagnosis, and allograft failure following Nocardia infection were queried in kidney Tx patients from the USRDS using ICD-9 codes and CMS Form 2728. Generalized linear models incorporating the number of person years at risk were used to examine risk factors for Nocardia and the adjusted relative risks (aRR) and 95% confidence intervals were determined.

Results

We queried 203,233 kidney Tx patients and 657 (0.32%) were diagnosed with Nocardia. Pneumonia was the most frequent presentation (15.2%) followed by brain abscess (8.4%). Factors that increased the risk for Nocardia included granulomatous disease (aRR=7.65), history of allograft rejection (4.82), tacrolimus use (2.45), and age > 65 years (2.11). Azathioprine use (0.73), hepatitis C (0.56) and tobacco use (0.74) were associated with decreased risk. Patients with nocardiosis had associated high percentages of graft failure (67.28%) and kidney rejection (60.58%).

Conclusion

In this large kidney Tx population, nocardiosis affected 0.3% of patients and presented most often as pneumonia or brain abscess. A history of granulomatous disease, allograft rejection, and tacrolimus use increased the risk for infection, presumably due to higher rates of immunosuppression associated with these comorbid events. This study may improve early recognition of nocardiosis in kidney Tx patients.