Nonopportunistic Pneumonia After Kidney Transplant: Risk Factors Associated With Mortality

The second most common infection after kidney transplantation is pneumonia, which has a high complication rate, sometimes even resulting in death. The aim of this study was to identify risk factors associated with mortality in nonopportunistic pneumonia.

We retrospectively studied all kidney transplant recipients with nonopportunistic pneumonia treated at the University Hospital Frankfurt, Germany, between 2004 and 2017. Patient baseline characteristics, laboratory values, and microbiologic tests were analyzed. We focused specifically on acute and chronic graft failure and the immunosuppressive regimen and included a follow-up period of 7.8 years.

One hundred seventy-seven patients (12%) collectively had 270 episodes of pneumonia. Although immunosuppressive therapy was reduced in 42% of patients during infection, there was no increase in graft rejection during hospital stay and follow-up. Significant risk factors for mortality were C-reactive protein > 10 mg/dL and serum albumin < 3 g/dL on admittance, congestive heart failure, autosomal dominant polycystic kidney disease as the underlying renal disease, nosocomial pneumonia, septic shock, intensive care unit admittance, mechanical ventilation, and renal replacement therapy.

Using these factors, patients at risk for death can be identified and the outcome of those might be improved by close monitoring and modified therapies.