Infectious Complications in Renal Transplantation: Prevalence and Outcomes from a Multicenter Case–control Study
Nouf E. Alotaibi, Maram M. Alsulami, Bilal Mohsin, Mohammed Bosaeed, Rahaf Alqahtani, Afnan Mohammed Jarwan, Aseelah Faisal Alsomaly, Rawa Majed Altaweel, Waleed Abdullah Alharbi, Taraf Hamoud Kamkoum, Meaad Khadhran Alqarni, Rayan M. Alasmari, Hind Saeed Alotaibi, Raghad Abdullah Alzahrani, Naief Alhowaiti, Aseel Attar, Mohammed Qurban, Hayfa Mandourah, Lujain Bashamakh, Lama Hefni, Reema A. Alfehied, Manar A. Alzahrani, Yasir Adnan Alfi, Abdulrahman Altheaby, Ramesh Kumar, Ghassan Alghamdi, Salem Alqurashi, Nahil Sadagah, Khalid Al SulaimanBackground:
Understanding the prevalence and impact of post-renal transplant infectious complications, including both bacterial and viral infections, is vital for improving patient outcomes. This study aims to assess the prevalence of infectious diseases, along with their related outcomes and complications, within two years of renal transplantation in adult recipients.
Methods:
This multicenter case–control study was carried out across four transplant centers in Saudi Arabia, enrolling adult patients who underwent renal transplantation from January 2016 to December 2021. Patients were categorized into infection and noninfection groups and matched 1:1. The primary outcome was the prevalence of infectious complications following renal transplantation; other outcomes were considered secondary.
Results:
Out of 788 renal transplant patients, 364 developed infections within 2 years, with a prevalence of 46.2%. Bacterial infections predominated, with urinary tract infections (UTIs) being the most common infection (64.3%), followed by bloodstream infections (19.2%). After exact matching, the two-year graft rejection rate was significantly higher in the infection group (adjusted odds ratio [aOR] =1.69, 95% confidence interval [CI]: 1.060–2.704). Furthermore, multivariable stepwise logistic regression identified recurrent UTIs as a strong independent risk factor for rejection (aOR = 47.45), while chronic intermittent catheterization was protective (aOR = 0.67). Patients with infections had a higher and statistically significant risk of graft failure (aOR = 2.67, 95% CI: 1.098–6.479). In contrast, all-cause mortality failed to reach statistical significance.
Conclusion:
Infectious complications, predominantly bacterial but also including viral infections, were common after kidney transplantation and significantly increased the risk of 2-year graft rejection, especially with recurrent UTIs.