Infection represented the leading cause of mortality after organ transplantation in a large cohort of patients

Ref ID: 19235

Author:

G. Sanclemente*, I. Hoyo, C. Cervera, M. Almela, M.A. Marcos, F. Cofan, F. Perez-Villa, M. Navasa, A. Moreno

Author address:

Barcelona, ES

Full conference title:

23rd European Congress of Clinical Microbiology and
Infectious Diseases

Date: 27 April 2014

Abstract:

Objectives. Infections are a major cause of mortality in solid organ transplant (SOT) recipients. The aim of this study was to analyze the incidence and causes of infectious-related mortality in a large cohort of SOT recipients.
Methods. We prospectively collected the information of patients who underwent SOT from July 2003 to July 2012. Date and causes of death were recorded for deceased patients.
Results. A total of 2013 solid organ transplants were done (1037 kidney, 693 liver, 128 heart, 158 kidney-pancreas, 37 pancreas alone and 50 double transplants). Median time of follow-up was 542 days (IQR 346-961). One hundred and seventy patients died during follow-up (8.1%). Incidence of mortality was 5% in kidney, 12% in liver and 18% in heart transplant recipients. For deceased patients, median days of survival was 150 days (IQR 42-663), being highest in kidney transplants (199.5 days) and lowest in heart transplant patients (93 days). During the first year, 110 patients died (38 the first month, 22.4%), and 60 patients died after the first year post-transplantation (35.2%). Mortality was related to an infectious event in 92 cases (54%). Infection was the first cause of death at any time after transplantation. In all type of transplants, infection was the most frequent cause of death except for heart transplantation, where cardiovascular aetiology predominated. The most frequent sources of infection were: pneumonia 53 episodes (57.6%), intraabdominal 17 (18.5%) and complicated skin and soft tissue infection 8 (8.7%). Isolated microorganisms responsible of death were as follows: bacteria (P. aeruginosa 21 episodes [22.8%, 17 of which were multidrug resistant], E. coli 10 [10.8%, 4 of which were extended-spectrum beta-lactamases producing strains], S. aureus 5 [5.4%, 1 methicillin resistant]), fungi (Aspergillus 16 [17.4%], 2 P. jirovecii, 1 Candida, 1 Criptococcus), and virus (2 cytomegalovirus, 2 HBV, 1 herpes simplex, 1 adenovirus and 1 influenza). The most frequent cause of death was invasive aspergillosis (15/60, 25%) in the first year after transplantation, and multidrug-resistant bacteria (47%), predominantly MDR P. aeruginosa (11/32, 34%), after the first year.
Conclusions. Infection is the leading cause of mortality in SOT. One third of all patients died due to lung infection. In the first year after transplantation the most frequent pathogen causing mortality was Aspergillus. After that, half of patients died due to multidrug resistant bacteria.

Abstract Number: P2141

Conference Year: 2013

Link to conference website: http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=166218&XNSPRACHE_ID=2&XNKONGRESS_ID=180&XNMASK

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