Epidemiology And Risk Factors Of Infections In Kidney Transplant Recipients

Objective:Infection is the leading cause of death and hospitalization in renal transplant recipients.The purpose of this study was to explore the epidemiological characteristics and prognostic risk factors of renal transplant recipients admitted to the hospital after infection,so as to provide guidance for the prevention,clinical diagnosis and treatment,and prognosis evaluation of renal transplant recipients.Methods:The patients with infection after renal transplantation were enrolled in the intensive care unit(ICU)of National Clinical Research Center of Kidney Diseases,Jinling Hospital from January 2013 to July 2019.Clinical data such as time between infection and transplantation,infection site,pathogen,use of immunosuppressive agents,laboratory indexes and prognosis were retrospectively analyzed to explore the characteristics of infection and the risk factors affecting prognosis in renal transplant recipients.Results:From January 2013 to July 2019,a total of 3554 patients were admitted to the kidney ICU,of whom 257 were kidney transplant recipients.Among them,209(81.3%)were patients hospitalized for infection after kidney transplantation,including 150 males and 59 females,with a median age of 46 years(35-54 years).72 patients(34.4%)were infected in the first year after kidney transplantation and 98 patients(46.9%)over 5 years.The most common site of infection was pulmonary infection in 165 cases(78.9%),followed by bloodstream infection in 19 cases(9.1%).The main pathogens were P.jiroveci in 54 cases(25.8%),Klebsiella pneumoniae in 13 cases(6.2%),Escherichia coli in 9(4.3%),Pseudomonas aeruginosa in 7(3.3%),Aspergillus in 6(2.9%)and Cytomegalovirus in 5(2.4%).There were 101 cases of severe infection(48.3%)and 108 cases of non-severe infection(51.7%).There was statistical significance between severe infection and prognosis(P<0.001).After treatment,177 patients(84.7%)improved,32 patients(15.3%)died,12 of the dead patients had P.jiroveci infection,and 11 had bacterial infection.Leukocyte count,C-reactive protein,procalcitonin,interleukin-6,lactate dehydrogenase and body temperature were higher in the death group,while mean arterial pressure,oxygenation index,albumin and Ig G were lower(P<0.05).Logisitc regression results: mean arterial pressure depression,low albumin and CD4+T cell count were independent risk factors for death in renal transplant recipients after severe infection.Conclusions:Infection was most common within 1 year after kidney transplantation,and pulmonary infection was the main site of infection.P.jiroveci is the main pathogen among known pathogens,and patients with multiple infections have a higher risk of death.The overall net state of immunosuppression,increased opportunistic infection and lower nutritional status are the main factors affecting the prognosis of renal transplantation patients.