Do Infectious Diseases After Kidney Retransplantation Differ From Those After First Kidney Transplantation?

• Published in: Open forum infectious diseases Vol. 11; no. 3; p. ofae055
• Main Authors: Kusejko, Katharina, Neofytos, Dionysios, van Delden, Christian, Hirsch, Hans H, Meylan, Pascal, Boggian, Katia, Hirzel, Cedric, Garzoni, Christian, Sidler, Daniel, Schnyder, Aurelia, Schaub, Stefan, Golshayan, Déla, Haidar, Fadi, Bonani, Marco, Kouyos, Roger D, Mueller, Nicolas J, Schreiber, Peter W
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.03.2024
• Subjects: infections; organ allocation; kidney retransplantation
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofae055

Abstract Background Infectious diseases (IDs) are highly relevant after solid organ transplantation in terms of morbidity and mortality, being among the most common causes of death. Patients undergoing kidney retransplantation (re-K-Tx) have been already receiving immunosuppressive therapy over a prolonged period, potentially facilitating subsequent infections. Comparing ID events after re-K-Tx and first kidney transplantation (f-K-Tx) can delineate patterns and risks of ID events associated with prolonged immunosuppression. Methods We included adult patients with records on f-K-Tx and re-K-Tx in the Swiss Transplant Cohort Study. We analyzed ID events after f-K-Tx and re-K-Tx within the same patients and compared infection rates, causative pathogens, and infection sites. Recurrent time-to-event analyses were performed for comparison of infection rates. Results A total of 59 patients with a median age of 47 years (range, 18–73) were included. Overall, 312 ID events in 52 patients occurred. In multivariable recurrent event modeling, the rate of ID events was significantly lower after re-K-Tx (hazard ratio, 0.70; P = .02). More bacterial (68.9% vs 60.4%) and fungal (4.0% vs 1.1%) infections were observed after f-K-Tx but fewer viral infections (27.0% vs 38.5%) as compared with re-K-Tx (P = .11). After f-K-Tx, urinary and gastrointestinal tract infections were more frequent; after re-K-Tx, respiratory tract and surgical site infections were more frequent (P < .001). Conclusions ID events were less frequent after re-K-Tx. Affected sites differed significantly after f-K-Tx vs re-K-Tx. Lay Summary Patients living with a donor kidney need to take immunosuppressive medication to avoid organ rejection. As a result of the suppressed immune function, infections are a frequent complication. Kidney transplants do not often last the whole life of the patient, leading to a retransplantation. It is unknown whether the risk for infections is different after retransplantation. In this study, we analyzed 312 infections from 59 patients who underwent kidney retransplantation in the Swiss Transplant Cohort Study. Interestingly, we observed a lower infection rate after retransplantation. We found that bacterial infections were more frequent after the first transplantation, viral infections were more frequent after retransplantation, and there were differences in infection sites. Our results highlight that the risk for infections is different after a retransplantation. Hence, prophylactic strategies to avoid posttransplant infections might be adapted for patients undergoing retransplantation. Graphical Abstract Graphical abstract This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/do-infectious-diseases-after-kidney-re-transplantation-differ-from-those-after-first-kidney-transplantation/update