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. 2022 Sep 4;14(17):3660.
doi: 10.3390/nu14173660.

Infection in Living Donor Liver Transplantation Leads to Increased Risk of Adverse Renal Outcomes

Kao-Ming Hsu  1 , Pei-Ru Lin  2 , Ping-Fang Chiu  1   3   4 , Yao-Peng Hsieh  1   4   5   6
Affiliations

Infection in Living Donor Liver Transplantation Leads to Increased Risk of Adverse Renal Outcomes

Kao-Ming Hsu et al. Nutrients. .

Abstract

(1) Background: Little is known about the subsequent renal function change following incident infectious diseases in living-donor liver transplant (LT) recipients. (2) Methods: We studied patients who underwent living-donor LT from January 2003 to January 2019 to evaluate the association of incident hospitalization with major infections or pneumonia with adverse renal outcomes, including a sustained 40% reduction in estimated glomerular filtration rate (eGFR) and renal composite outcome (a 40% decline in eGFR, end-stage renal disease, or death.). Multivariable-adjusted time-dependent Cox models with infection as a time-varying exposure were used to estimate hazard ratio (HR) with 95% confidence interval (CI) for study outcomes. (3) Results: We identified 435 patients (mean age 54.6 ± 8.4 years and 76.3% men), of whom 102 had hospitalization with major infections during follow-up; the most common cause of infection was pneumonia (38.2%). In multiple Cox models, hospitalization with a major infection was associated with an increased risk of eGFR decline > 40% (HR, 3.32; 95% CI 2.13−5.16) and renal composite outcome (HR, 3.41; 95% CI 2.40−5.24). Likewise, pneumonia was also associated with an increased risk of eGFR decline > 40% (HR, 2.47; 95% CI 1.10−5.56) and renal composite outcome (HR, 4.37; 95% CI 2.39−8.02). (4) Conclusions: Our results illustrated the impact of a single infection episode on the future risk of adverse renal events in LT recipients. Whether preventive and prophylactic care bundles against infection and judicious modification of the immunosuppressive regimen benefit renal outcomes may deserve further study.

Keywords: chronic kidney disease; infection; liver transplantation; pneumonia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curve of the cumulative incidence rate of eGFR decline > 40% for patients with and without infection (Mantel and Byar’s test, p < 0.001).
Figure 2
Figure 2
Kaplan–Meier curve of the cumulative incidence rate of renal composite outcome for patients with and without infection (Mantel and Byar’s test, p < 0.001).
Figure 3
Figure 3
Kaplan–Meier curve of the cumulative incidence rate of eGFR decline > 40% for patients with and without pneumonia (Mantel and Byar’s test, p < 0.001).
Figure 4
Figure 4
Kaplan–Meier curve of the cumulative incidence rate of renal composite outcome for patients with and without pneumonia (Mantel and Byar’s test, p < 0.001).
See this image and copyright information in PMC

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