Infection-Related Mortality in Recipients of a Kidney Transplant in Australia and New Zealand

Samuel Chan, Elaine M. Pascoe, Philip A. Clayton, Stephen P. McDonald, Wai H. Lim, Matthew P. Sypek, Suetonia C. Palmer, Nicole M. Isbel, Ross S. Francis, Scott B. Campbell, Carmel M. Hawley, David W. Johnson

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND OBJECTIVES: The burden of infectious disease is high among kidney transplant recipients because of concomitant immunosuppression. In this study the incidence of infectious-related mortality and associated factors were evaluated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this registry-based retrospective, longitudinal cohort study, recipients of a first kidney transplant in Australia and New Zealand between 1997 and 2015 were included. Cumulative incidence of infectious-related mortality was estimated using competing risk regression (using noninfectious mortality as a competing risk event), and compared with age-matched, populated-based data using standardized incidence ratios. RESULTS: Among 12,519 patients, (median age 46 years, 63% men, 15% diabetic, 6% Indigenous ethnicity), 2197 (18%) died, of whom 416 (19%) died from infection. The incidence of infection-related mortality during the study period (1997-2015) was 45.8 (95% confidence interval [95% CI], 41.6 to 50.4) per 10,000 patient-years. The incidence of infection-related mortality reduced from 53.1 (95% CI, 45.0 to 62.5) per 10,000 person-years in 1997-2000 to 43.9 (95% CI, 32.5 to 59.1) per 10,000 person-years in 2011-2015 (P<0.001) Compared with the age-matched general population, kidney transplant recipients had a markedly higher risk of infectious-related death (standardized incidence ratio, 7.8; 95% CI, 7.1 to 8.6). Infectious mortality was associated with older age (≥60 years adjusted subdistribution hazard ratio [SHR], 4.16; 95% CI, 2.15 to 8.05; reference 20-30 years), female sex (SHR, 1.62; 95% CI, 1.19 to 2.29), Indigenous ethnicity (SHR, 2.87; 95% CI, 1.84 to 4.46; reference white), earlier transplant era (2011-2015: SHR, 0.39; 95% CI, 0.20 to 0.76; reference 1997-2000), and use of T cell-depleting therapy (SHR, 2.43; 95% CI, 1.36 to 4.33). Live donor transplantation was associated with lower risk of infection-related mortality (SHR, 0.53; 95% CI, 0.37 to 0.76). CONCLUSIONS: Infection-related mortality in kidney transplant recipients is significantly higher than the general population, but has reduced over time. Risk factors include older age, female sex, Indigenous ethnicity, T cell-depleting therapy, and deceased donor transplantation. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_08_27_CJN03200319.mp3.

Original languageEnglish
Pages (from-to)1484-1492
Number of pages9
JournalClinical journal of the American Society of Nephrology : CJASN
Volume14
Issue number10
DOIs
Publication statusPublished - 7 Oct 2019

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New Zealand
Confidence Intervals
Transplants
Kidney
Mortality
Infection
Webcasts
Incidence
Cell- and Tissue-Based Therapy
Cohort Studies
Transplantation
Tissue Donors
T-Lymphocytes
Immunosuppression
Population
Communicable Diseases
Longitudinal Studies
Registries

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Chan, Samuel ; Pascoe, Elaine M. ; Clayton, Philip A. ; McDonald, Stephen P. ; Lim, Wai H. ; Sypek, Matthew P. ; Palmer, Suetonia C. ; Isbel, Nicole M. ; Francis, Ross S. ; Campbell, Scott B. ; Hawley, Carmel M. ; Johnson, David W. / Infection-Related Mortality in Recipients of a Kidney Transplant in Australia and New Zealand. In: Clinical journal of the American Society of Nephrology : CJASN. 2019 ; Vol. 14, No. 10. pp. 1484-1492.
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abstract = "BACKGROUND AND OBJECTIVES: The burden of infectious disease is high among kidney transplant recipients because of concomitant immunosuppression. In this study the incidence of infectious-related mortality and associated factors were evaluated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this registry-based retrospective, longitudinal cohort study, recipients of a first kidney transplant in Australia and New Zealand between 1997 and 2015 were included. Cumulative incidence of infectious-related mortality was estimated using competing risk regression (using noninfectious mortality as a competing risk event), and compared with age-matched, populated-based data using standardized incidence ratios. RESULTS: Among 12,519 patients, (median age 46 years, 63{\%} men, 15{\%} diabetic, 6{\%} Indigenous ethnicity), 2197 (18{\%}) died, of whom 416 (19{\%}) died from infection. The incidence of infection-related mortality during the study period (1997-2015) was 45.8 (95{\%} confidence interval [95{\%} CI], 41.6 to 50.4) per 10,000 patient-years. The incidence of infection-related mortality reduced from 53.1 (95{\%} CI, 45.0 to 62.5) per 10,000 person-years in 1997-2000 to 43.9 (95{\%} CI, 32.5 to 59.1) per 10,000 person-years in 2011-2015 (P<0.001) Compared with the age-matched general population, kidney transplant recipients had a markedly higher risk of infectious-related death (standardized incidence ratio, 7.8; 95{\%} CI, 7.1 to 8.6). Infectious mortality was associated with older age (≥60 years adjusted subdistribution hazard ratio [SHR], 4.16; 95{\%} CI, 2.15 to 8.05; reference 20-30 years), female sex (SHR, 1.62; 95{\%} CI, 1.19 to 2.29), Indigenous ethnicity (SHR, 2.87; 95{\%} CI, 1.84 to 4.46; reference white), earlier transplant era (2011-2015: SHR, 0.39; 95{\%} CI, 0.20 to 0.76; reference 1997-2000), and use of T cell-depleting therapy (SHR, 2.43; 95{\%} CI, 1.36 to 4.33). Live donor transplantation was associated with lower risk of infection-related mortality (SHR, 0.53; 95{\%} CI, 0.37 to 0.76). CONCLUSIONS: Infection-related mortality in kidney transplant recipients is significantly higher than the general population, but has reduced over time. Risk factors include older age, female sex, Indigenous ethnicity, T cell-depleting therapy, and deceased donor transplantation. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_08_27_CJN03200319.mp3.",
keywords = "Australia, diabetes mellitus, female, humans, immunosuppression, incidence, Infection, kidney failure, kidney transplantation, living donors, male, mortality, New Zealand, registries, retrospective studies, risk factors, survival trends, t-lymphocytes, time factors, treatment outcome",
author = "Samuel Chan and Pascoe, {Elaine M.} and Clayton, {Philip A.} and McDonald, {Stephen P.} and Lim, {Wai H.} and Sypek, {Matthew P.} and Palmer, {Suetonia C.} and Isbel, {Nicole M.} and Francis, {Ross S.} and Campbell, {Scott B.} and Hawley, {Carmel M.} and Johnson, {David W.}",
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Chan, S, Pascoe, EM, Clayton, PA, McDonald, SP, Lim, WH, Sypek, MP, Palmer, SC, Isbel, NM, Francis, RS, Campbell, SB, Hawley, CM & Johnson, DW 2019, 'Infection-Related Mortality in Recipients of a Kidney Transplant in Australia and New Zealand' Clinical journal of the American Society of Nephrology : CJASN, vol. 14, no. 10, pp. 1484-1492. https://doi.org/10.2215/CJN.03200319

Infection-Related Mortality in Recipients of a Kidney Transplant in Australia and New Zealand. / Chan, Samuel; Pascoe, Elaine M.; Clayton, Philip A.; McDonald, Stephen P.; Lim, Wai H.; Sypek, Matthew P.; Palmer, Suetonia C.; Isbel, Nicole M.; Francis, Ross S.; Campbell, Scott B.; Hawley, Carmel M.; Johnson, David W.

In: Clinical journal of the American Society of Nephrology : CJASN, Vol. 14, No. 10, 07.10.2019, p. 1484-1492.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Infection-Related Mortality in Recipients of a Kidney Transplant in Australia and New Zealand

AU - Chan, Samuel

AU - Pascoe, Elaine M.

AU - Clayton, Philip A.

AU - McDonald, Stephen P.

AU - Lim, Wai H.

AU - Sypek, Matthew P.

AU - Palmer, Suetonia C.

AU - Isbel, Nicole M.

AU - Francis, Ross S.

AU - Campbell, Scott B.

AU - Hawley, Carmel M.

AU - Johnson, David W.

PY - 2019/10/7

Y1 - 2019/10/7

N2 - BACKGROUND AND OBJECTIVES: The burden of infectious disease is high among kidney transplant recipients because of concomitant immunosuppression. In this study the incidence of infectious-related mortality and associated factors were evaluated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this registry-based retrospective, longitudinal cohort study, recipients of a first kidney transplant in Australia and New Zealand between 1997 and 2015 were included. Cumulative incidence of infectious-related mortality was estimated using competing risk regression (using noninfectious mortality as a competing risk event), and compared with age-matched, populated-based data using standardized incidence ratios. RESULTS: Among 12,519 patients, (median age 46 years, 63% men, 15% diabetic, 6% Indigenous ethnicity), 2197 (18%) died, of whom 416 (19%) died from infection. The incidence of infection-related mortality during the study period (1997-2015) was 45.8 (95% confidence interval [95% CI], 41.6 to 50.4) per 10,000 patient-years. The incidence of infection-related mortality reduced from 53.1 (95% CI, 45.0 to 62.5) per 10,000 person-years in 1997-2000 to 43.9 (95% CI, 32.5 to 59.1) per 10,000 person-years in 2011-2015 (P<0.001) Compared with the age-matched general population, kidney transplant recipients had a markedly higher risk of infectious-related death (standardized incidence ratio, 7.8; 95% CI, 7.1 to 8.6). Infectious mortality was associated with older age (≥60 years adjusted subdistribution hazard ratio [SHR], 4.16; 95% CI, 2.15 to 8.05; reference 20-30 years), female sex (SHR, 1.62; 95% CI, 1.19 to 2.29), Indigenous ethnicity (SHR, 2.87; 95% CI, 1.84 to 4.46; reference white), earlier transplant era (2011-2015: SHR, 0.39; 95% CI, 0.20 to 0.76; reference 1997-2000), and use of T cell-depleting therapy (SHR, 2.43; 95% CI, 1.36 to 4.33). Live donor transplantation was associated with lower risk of infection-related mortality (SHR, 0.53; 95% CI, 0.37 to 0.76). CONCLUSIONS: Infection-related mortality in kidney transplant recipients is significantly higher than the general population, but has reduced over time. Risk factors include older age, female sex, Indigenous ethnicity, T cell-depleting therapy, and deceased donor transplantation. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_08_27_CJN03200319.mp3.

AB - BACKGROUND AND OBJECTIVES: The burden of infectious disease is high among kidney transplant recipients because of concomitant immunosuppression. In this study the incidence of infectious-related mortality and associated factors were evaluated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this registry-based retrospective, longitudinal cohort study, recipients of a first kidney transplant in Australia and New Zealand between 1997 and 2015 were included. Cumulative incidence of infectious-related mortality was estimated using competing risk regression (using noninfectious mortality as a competing risk event), and compared with age-matched, populated-based data using standardized incidence ratios. RESULTS: Among 12,519 patients, (median age 46 years, 63% men, 15% diabetic, 6% Indigenous ethnicity), 2197 (18%) died, of whom 416 (19%) died from infection. The incidence of infection-related mortality during the study period (1997-2015) was 45.8 (95% confidence interval [95% CI], 41.6 to 50.4) per 10,000 patient-years. The incidence of infection-related mortality reduced from 53.1 (95% CI, 45.0 to 62.5) per 10,000 person-years in 1997-2000 to 43.9 (95% CI, 32.5 to 59.1) per 10,000 person-years in 2011-2015 (P<0.001) Compared with the age-matched general population, kidney transplant recipients had a markedly higher risk of infectious-related death (standardized incidence ratio, 7.8; 95% CI, 7.1 to 8.6). Infectious mortality was associated with older age (≥60 years adjusted subdistribution hazard ratio [SHR], 4.16; 95% CI, 2.15 to 8.05; reference 20-30 years), female sex (SHR, 1.62; 95% CI, 1.19 to 2.29), Indigenous ethnicity (SHR, 2.87; 95% CI, 1.84 to 4.46; reference white), earlier transplant era (2011-2015: SHR, 0.39; 95% CI, 0.20 to 0.76; reference 1997-2000), and use of T cell-depleting therapy (SHR, 2.43; 95% CI, 1.36 to 4.33). Live donor transplantation was associated with lower risk of infection-related mortality (SHR, 0.53; 95% CI, 0.37 to 0.76). CONCLUSIONS: Infection-related mortality in kidney transplant recipients is significantly higher than the general population, but has reduced over time. Risk factors include older age, female sex, Indigenous ethnicity, T cell-depleting therapy, and deceased donor transplantation. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_08_27_CJN03200319.mp3.

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KW - diabetes mellitus

KW - female

KW - humans

KW - immunosuppression

KW - incidence

KW - Infection

KW - kidney failure

KW - kidney transplantation

KW - living donors

KW - male

KW - mortality

KW - New Zealand

KW - registries

KW - retrospective studies

KW - risk factors

KW - survival trends

KW - t-lymphocytes

KW - time factors

KW - treatment outcome

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DO - 10.2215/CJN.03200319

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JO - Clinical Journal of the American Society of Nephrology

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