scholarly journals Invasive Fungal Diseases in Kidney Transplant Recipients: Risk Factors for Mortality

2020 ◽  
Vol 9 (6) ◽  
pp. 1824 ◽  
Author(s):  
Hyeri Seok ◽  
Kyungmin Huh ◽  
Sun Young Cho ◽  
Cheol-In Kang ◽  
Doo Ryeon Chung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Acute Rejection ◽  
Bacterial Infection ◽  
Kidney Transplant ◽  
Deceased Donor ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Related Mortality

Background: Invasive fungal disease (IFD) is common in solid organ transplant (SOT) recipients and contributes to high morbidity and mortality. Although kidney transplantation (KT) is a commonly performed SOT, data on the risk factors for IFD-related mortality are limited. Methods: A 1:2 retrospective case-control study was performed in an experienced single center in the Republic of Korea. We reviewed the electronic medical records of patients with IFD after KT between February 1995 and March 2015. Results: Of 1963 kidney transplant recipients, 48 (2.5%) were diagnosed with IFD. The median interval from KT to IFD diagnosis was 172 days. Invasive aspergillosis (IA) was the most common, followed by invasive candidiasis (IC). Diabetes mellitus (DM) (odds ratio (OR) 3.72, 95% confidence interval (CI) 1.34–10.31, p = 0.011) and acute rejection (OR 3.41, 95% CI 1.41–8.21, p = 0.006) were associated with IFD development. In the subgroup analyses, concomitant bacterial infection was associated with IC development (OR 20.10, 95% CI 3.60–112.08, p = 0.001), and delayed graft function was associated with IA occurrence (OR 10.60, 95% CI 1.05–106.84, p = 0.045). The 12-week mortality rate in all patients was 50.0%. Mortality rates were significantly higher in older patients (adjusted hazard ratio (aHR) 1.06, 95% CI 1.02–1.11, p = 0.004), or those with DM (aHR 2.61, 95% CI 1.02–6.68, p = 0.044), deceased donor transplantation (aHR 2.68, 95% CI 1.03–6.95, p = 0.043), lymphocyte-depleting antibody usage (aHR 0.26, 95% CI 0.08–0.80, p = 0.019), acute rejection (aHR 0.38, 95% CI 0.15–0.97, p = 0.044), and concomitant bacterial infection (aHR 8.76, 95% CI 1.62–47.51, p = 0.012). Conclusions: A total of 50% of IFD cases occurred six months or later after transplantation. The IFD-related mortality rate was high in kidney transplant recipients despite the low incidence. DM and acute rejection were associated with high mortality, as well as IFD development. As old age, deceased donor transplantation, lymphocyte-depleting antibody usage, and concomitant bacterial infection are risk factors for IFD-related mortality, efforts for its early diagnosis and appropriate treatment are required.

Incidence of and Risk Factors for Multiple Readmissions after Kidney Transplantation

2020 ◽  
Vol 86 (2) ◽  
pp. 116-120
Author(s):  
Jessica Schucht ◽  
Eric G. Davis ◽  
Christopher M. Jones ◽  
Robert M. Cannon
Keyword(s):  
Risk Factors ◽  
Kidney Transplantation ◽  
Acute Rejection ◽  
Deceased Donor ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Donor Kidney Transplantation ◽  
Deceased Donor Kidney Transplantation

Unplanned readmission is often used as a surgical quality metric. A subset of kidney transplant recipients undergos multiple readmissions (MRs), although the incidence and risk factors are not well described. The aim of this study was to evaluate risk factors for MR after deceased donor kidney transplantation. All patients undergoing deceased donor kidney transplantation at a single center over a three-year period were analyzed via retrospective chart review for factors associated with MR. P values <0.05 were considered significant. Of 141 patients, the 30-day readmission rate was 26.2 per cent. MR occurred in 43 (30.5%) patients. Age, race, gender, initial organ function, and dialysis vintage were not associated with MR. Diabetic recipients, those who received basiliximab induction, those with acute rejection, and those with unplanned reoperations were at increased risk for MR. Infection was the most common reason for initial readmission in patients with MR (23.3%). One-year patient survival and death-censored graft survival were reduced for patients with MR. MRs are required for 30 per cent of kidney transplant recipients, primarily because of infection and immunologic causes. Recipients with diabetes and those who have acute rejection are at greatest risk.

Risk factors and prognosis of late acute rejection in Chinese kidney transplant recipients

Nephrology ◽  
2017 ◽  
Vol 22 (12) ◽  
pp. 985-992
Author(s):  
Maggie Ming Yee Mok ◽  
Maggie Kam Man Ma ◽  
Desmond Yat Hin Yap ◽  
Gavin Sheung Wai Chan ◽  
Man Fai Lam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Rejection ◽  
Kidney Transplant ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Risk Factors for Graft Loss in Pediatric Renal Transplant Recipients After Transfer of Care

2016 ◽  
Vol 26 (4) ◽  
pp. 356-364 ◽  
Author(s):  
Bethany Coyne ◽  
Patricia J. Hollen ◽  
Guofen Yan ◽  
Kenneth Brayman
Keyword(s):  
Risk Factors ◽  
Acute Rejection ◽  
Kidney Transplant ◽  
Graft Loss ◽  
National Database ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Transfer Of Care ◽  
Medication Noncompliance

Background: Improvements in transplantation have increased the survival of children after kidney transplantation. These patients have complex needs, and the current medical system is not prepared to effectively transfer the care of these individuals from pediatric to adult health-care systems. Too often, transfer occurs during moments of crisis and is associated with poor outcomes. Objective: The aim of this study was to use a national database, the Scientific Registry of Transplant Recipients, to test the hypothesis that the increased risk of graft loss after transfer of care (from pediatric to adult services) for young adult kidney transplant recipients over a 2- to 3-year posttransfer follow-up period was related to these posttransfer risk factors (medication noncompliance, acute rejection, insurance status). Design: A retrospective, longitudinal, correlational design using secondary data was used to evaluate the transfer of care of 250 kidney transplant recipients (ages 16-25). Results: Seventy-seven (30.8%) individuals lost their graft within 3 years after transfer of care. Medication noncompliance, acute rejection, and serum creatinine >2.0 mg/dL at transfer were significant predictors of graft loss after accounting for multiple other factors. Conclusion: These individuals are at risk for graft loss after transfer of care and may benefit from increased personalized care during this risky period.

scholarly journals Changes in quality of life (QoL) and other patient-reported outcome measures (PROMs) in living-donor and deceased-donor kidney transplant recipients and those awaiting transplantation in the UK ATTOM programme: a longitudinal cohort questionnaire survey with additional qualitative interviews

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e047263
Author(s):  
Andrea Gibbons ◽  
Janet Bayfield ◽  
Marco Cinnirella ◽  
Heather Draper ◽  
Rachel J Johnson ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Outcome Measures ◽  
Deceased Donor ◽  
Patient Reported Outcome Measures ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Post Transplant ◽  
Patient Reported

ObjectiveTo examine quality of life (QoL) and other patient-reported outcome measures (PROMs) in kidney transplant recipients and those awaiting transplantation.DesignLongitudinal cohort questionnaire surveys and qualitative semi-structured interviews using thematic analysis with a pragmatic approach.SettingCompletion of generic and disease-specific PROMs at two time points, and telephone interviews with participants UK-wide.Participants101 incident deceased-donor (DD) and 94 incident living-donor (LD) kidney transplant recipients, together with 165 patients on the waiting list (WL) from 18 UK centres recruited to the Access to Transplantation and Transplant Outcome Measures (ATTOM) programme completed PROMs at recruitment (November 2011 to March 2013) and 1 year follow-up. Forty-one of the 165 patients on the WL received a DD transplant and 26 received a LD transplant during the study period, completing PROMs initially as patients on the WL, and again 1 year post-transplant. A subsample of 10 LD and 10 DD recipients participated in qualitative semi-structured interviews.ResultsLD recipients were younger, had more educational qualifications and more often received a transplant before dialysis. Controlling for these and other factors, cross-sectional analyses at 12 months post-transplant suggested better QoL, renal-dependent QoL and treatment satisfaction for LD than DD recipients. Patients on the WL reported worse outcomes compared with both transplant groups. However, longitudinal analyses (controlling for pre-transplant differences) showed that LD and DD recipients reported similarly improved health status and renal-dependent QoL (p<0.01) pre-transplant to post-transplant. Patients on the WL had worsened health status but no change in QoL. Qualitative analyses revealed transplant recipients’ expectations influenced their recovery and satisfaction with transplant.ConclusionsWhile cross-sectional analyses suggested LD kidney transplantation leads to better QoL and treatment satisfaction, longitudinal assessment showed similar QoL improvements in PROMs for both transplant groups, with better outcomes than for those still wait-listed. Regardless of transplant type, clinicians need to be aware that managing expectations is important for facilitating patients’ adjustment post-transplant.

Risk Factors for Late-Onset Cytomegalovirus Infection or Disease in Kidney Transplant Recipients

2014 ◽  
Vol 97 (5) ◽  
pp. 569-575 ◽  
Author(s):  
Alainna J. Jamal ◽  
Shahid Husain ◽  
Yanhong Li ◽  
Olusegun Famure ◽  
S. Joseph Kim
Keyword(s):  
Risk Factors ◽  
Kidney Transplant ◽  
Cytomegalovirus Infection ◽  
Late Onset ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients
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