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. 2016 Feb;29(2):241-52.
doi: 10.1111/tri.12711. Epub 2015 Dec 9.

Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice

Abhijit S Naik  1 , Vikas R Dharnidharka  2 , Mark A Schnitzler  3 , Daniel C Brennan  4 , Dorry L Segev  5 , David Axelrod  6 , Huiling Xiao  3 , Lauren Kucirka  5 , Jiajing Chen  7 , Krista L Lentine  3
Affiliations

Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice

Abhijit S Naik et al. Transpl Int. 2016 Feb.

Abstract

We examined United States Renal Data System registry records for Medicare-insured kidney transplant recipients in 2000-2011 to study the clinical and cost impacts of urinary tract infections (UTI), pneumonia, and sepsis in the first year post-transplant among a contemporary, national cohort. Infections were identified by billing diagnostic codes. Among 60 702 recipients, 45% experienced at least one study infection in the first year post-transplant, including UTI in 32%, pneumonia in 13%, and sepsis in 12%. Older recipient age, female sex, diabetic kidney failure, nonstandard criteria organs, sirolimus-based immunosuppression, and steroids at discharge were associated with increased risk of first-year infections. By time-varying, multivariate Cox regression, all study infections predicted increased first-year mortality, ranging from 41% (aHR 1.41, 95% CI 1.25-1.56) for UTI alone, 6- to 12-fold risk for pneumonia or sepsis alone, to 34-fold risk (aHR 34.38, 95% CI 30.35-38.95) for those with all three infections. Infections also significantly increased first-year costs, from $17 691 (standard error (SE) $591) marginal cost increase for UTI alone, to approximately $40 000-$50 000 (SE $1054-1238) for pneumonia or sepsis alone, to $134 773 (SE $1876) for those with UTI, pneumonia, and sepsis. Clinical and economic impacts persisted in years 2-3 post-transplant. Early infections reflect important targets for management protocols to improve post-transplant outcomes and reduce costs of care.

Keywords: economics; infections; kidney transplantation; medicare; registries.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors have no conflicts of interest related to this work.

Figures

Figure 1
Figure 1
Adjusted associations of first-year infections with risk of death after transplantation. Adjusted for all recipient, donor and transplant factors in Table 1. Please see Appendix 2 for complete survival regression results.
Figure 2
Figure 2
Total predicted period costs according to first-year infection status for an average transplant recipient.
See this image and copyright information in PMC

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