Early Post-Transplant Bacterial Infections Predict Long-Term Mortality in Kidney Transplant Recipients: A 10-Year...

Area of Science:

• Nephrology
• Transplantation Immunology
• Infectious Diseases

Background:

• Kidney transplant recipients (KTRs) require lifelong immunosuppression, increasing susceptibility to bacterial infections.
• These infections can significantly impact patient survival and long-term graft function.
• Early identification and management of infections are crucial for improving outcomes.

Purpose of the Study:

• To evaluate the impact of early bacterial infections on long-term mortality in KTRs.
• To identify clinical and procedural predictors associated with early post-transplant infections.
• To inform strategies for reducing infection-related morbidity and mortality.

Main Methods:

• Retrospective analysis of KTRs with at least 12 months follow-up (2014-2024).
• Bacterial infections classified as early (≤6 months) or late (>6 months) post-transplant.
• Cox regression and logistic regression analyses used to identify predictors of mortality and early infection.

Main Results:

• Early bacterial infections occurred in 35.4% of patients, independently associated with a threefold increase in mortality risk (aHR=3.03).
• Diabetic nephropathy-related end-stage kidney disease (aHR=4.14) and older recipient age (aHR=1.10/year) were significant mortality predictors.
• Low albumin/hemoglobin and ureteral stent placement predicted early infection; urinary tract infections were most common.

Conclusions:

• Early bacterial infections and diabetic nephropathy-related end-stage kidney disease are significant predictors of long-term mortality post-kidney transplant.
• Optimizing nutritional status, judicious ureteral stent use, and antibiotic stewardship are key to reducing early infection risk.
• Targeted interventions and close surveillance of high-risk KTRs can improve long-term survival.