Infection biggest cause of rehospitalization after kidney transplant
MedWire News: The biggest cause of rehospitalization in the year after a kidney transplant is infection, with renal dysfunction also contributing high numbers, reports a team of Tunisian researchers.
Risk factors for rehospitalization among these patients included use of mycophenolate and cyclosporine, they add, in the journal Transplantation Proceedings.
"To prevent and minimize rehospitalization during the first year, a specific preventive program based on infection prevention and graft function monitoring should be established," write Karima Boubaker and colleagues from the Charles Nicolle Hospital in Tunis.
Of 419 transplant recipients treated at their hospital between 1986 and 2009, there were 296 rehospitalizations within one year of treatment. Rehospitalization was defined as a hospital admission that occurred for any reason after discharge from the initial transplantation hospital visit.
In all, 121 patients were rehospitalized once, 47 patients were rehospitalized twice, 15 patients were rehospitalized three times, 5 patients were rehospitalized four times, 2 patients were rehospitalized five times, and 1 patient returned to hospital a total of six occasions. Patients' ages ranged between 12 and 61 years at time of rehospitalization, and the median length of stay was between 14 and 16 days.
Patients who received a cadaveric graft (n=145) were significantly more likely to be rehospitalized than those who received a living graft (n=192), at 56% versus 44%.
Half of all rehospitalizations (49.6%) were due to infection, with 30.7% due to graft dysfunction, 2.4% because of cardiovascular events, and 2.4% because of diabetic ketoacidosis.
The significant risk factors associated with rehospitalization were a cadaveric graft, use of mycophenolate mofetil and/or cyclosporine, and cytomegalovirus infection.
Indeed, "it has been found that the shift in the treatment protocol from azathioprine-based to a mycophenolate mofetil regimen decreased rejection rate but increased infection rate," note Boubaker et al.
They found no association between rehospitalization and either graft or patient survival.
The increased risk for infection in this cohort echoes what previous research says; that infections are most common within 6 months of transplantation. In fact, 50% of infectious episodes in the current study occurred within the first month after transplant.
"The key factors to preventing and minimizing the impact of infection in kidney transplant recipients are early diagnosis, low-dose immunosuppression, the experience level of the transplant team, and careful attention to the risks posed by endemic problems," concludes the research team.
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By Sarah Guy