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Kidney Week

Abstract: PO2116

Peripheral Arterial Disease and Risk of Infection-Related Complications After Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Dinh, Alex, University of California San Francisco, San Francisco, California, United States
  • Copeland, Timothy P., University of California San Francisco, San Francisco, California, United States
  • Mcculloch, Charles E., University of California San Francisco, San Francisco, California, United States
  • Adey, Deborah B., University of California San Francisco, San Francisco, California, United States
  • Ku, Elaine, University of California San Francisco, San Francisco, California, United States
Background

Infection-related hospitalizations after kidney transplantation are a common complication associated with significant morbidity and increased healthcare costs. Peripheral arterial disease (PAD) is a common comorbidity associated with poor wound healing and frailty, and may be an unrecognized risk factor for serious infections.

Methods

We included adults who received a kidney transplant in the US between 2006 and 2016. We used Fine-Gray models to assess the relationship between PAD and the composite outcome of infection-related hospitalization or infection-related death within the first year after transplant, while accounting for the competing risks of non-infection-related death or graft failure. We evaluated for presence of interactions between PAD and specific factors including age<60, diabetes, and donor type (living vs. deceased) for the outcome.

Results

Out of 108,133 kidney transplant recipients (KTRs), 22,442 experienced the composite outcome in the first year after transplantation. In adjusted models, PAD was associated with a 38% higher hazard of the primary outcome (95% CI 1.34-1.43) [Figure]. Statistically significant interactions were present between PAD and donor type and age category. In subgroup analyses, PAD was associated with a higher risk for the composite outcome in living donor KTRs and with slightly higher risk in younger vs. older KTRs.

Conclusion

PAD was associated with an increased risk of infection-related hospitalization or death in the first year after transplantation, especially in subgroups who traditionally may not be evaluated for PAD prior to transplant, such as living donor KTRs and younger populations. Better screening for PAD even in young populations may improve our ability to reduce the risk of complications post-transplant.

Models Adjusted for Sex, Race, BMI, Dialysis Vintage, Diabetes, Stroke, Primary Cause of Kidney Failure, Smoking History, and Transplant Year, and age or donor type depending on the subpopulation of interest; *P-interaction < 0.05.