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Kidney Week

Abstract: PO2135

Bacteremia in Kidney Transplant Recipients with Septic Arthritis Is Perilous

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Alstott, James D., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Jorgenson, Margaret R., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Saddler, Christopher, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Parajuli, Sandesh, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Garg, Neetika, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Mohamed, Maha A., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Mandelbrot, Didier A., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Djamali, Arjang, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Aziz, Fahad, University of Wisconsin-Madison, Madison, Wisconsin, United States
Background

Features and clinical sequelae of septic arthritis in the general population have been described; however, the epidemiology and outcomes of septic arthritis in kidney transplant recipients (KTRs) is limited, and the potential impact on graft function has not been reported.

Methods

A single-center, retrospective, observational cohort study including patients with a history of kidney transplant and subsequent septic arthritis between 1/1997-12/2017 was performed.

Results

During the 20-year study period 6,184 patients received kidney and kidney-pancreas transplants, of these 65 (1%) patients had documented diagnosis of septic arthritis. 51 patients had kidney alone transplants and 14 had simultaneous kidney and pancreas transplants. The mean age at the time of transplant was 50 ± 10.4 years. The mean time from the transplant to the septic arthritis diagnosis was 6.6 ± 6 years. The most commonly affected joint was the knee (38%), followed by the shoulder (11%) and hip (9%). Joints with hardware accounted for 14 (21.5%) cases. Staphylococcus species were the most commonly isolated bacteria (52%) followed by gram-negative rods (14%). Only two patients had fungus isolated from joint aspiration (one histoplasma and one aspergillus). Antimicrobials were used in all of the patients. The majority of patients were treated with either joint aspiration (39%) or I&D (39%). The need for curative amputation was uncommon (4%). When evaluating subsequent graft function, the mean eGFR declined 12 ± 8 ml/min/1.73 m2 at one year after diagnosis. The presence of bacteremia at time of diagnosis was associated with significant worse joint (HR 5.37, p 0.01, 95%Cl 1.57 to 18.41) and graft outcomes (HR 5.37, p 0.0004, 95%Cl 1.51 to 9.35). By last follow up, 21 patients lost their allografts and 28 patients died with functional kidney graft.

Conclusion

Septic arthritis is an uncommon complication in KTRs. When seen, it typically occurs >1 year after transplant with similar pathogens and management as in the general population. However, it appears to be associated with negative graft effects. A high index of suspicion, timely diagnosis, and appropriate management are needed to ensure optimal outcomes for septic arthritis in KTRs