K WALLER1, N DE LA MATA1, K WYBURN2,3, P KELLY1, V RAMACHANDRAN4, K SHAH5, R MORTON5, W RAWLINSON4,6, A WEBSTER1,7
1Centre for Organ Donation Evidence, School of Public Health, University of Sydney, Camperdown, Australia, 2Sydney Medical School, University of Sydney, Camperdown, Australia, 3Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia, 4Serology and Virology Division, NSW Health Pathology, Prince of Wales Hospital, Randwick, Australia, 5NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia, 6Schools of SOMS, BABS and Women’s and Children’s, University of NSW, Randwick, Australia, 7Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
Background: Infections are a major source of morbidity and mortality among transplant recipients.
Aim: We quantified the burden of notifiable infections in a cohort of kidney recipients compared with the general population.
Methods: Eligible participants received a kidney transplant in NSW between 2000 and 2015 inclusive. Laboratory confirmed infections were identified by linkage to the notifiable conditions information management system. Time at risk was from transplant until death date or 31st Dec 2016. Standardized incidence ratios (SIR) were relative to Australian population rates, accounting for sex, age and calendar year, reported with 95% confidence intervals (95%CI). Hospitalisations both listed ICD-10-AM codes for the infection and occurred within 14 days of infection notification. Deaths were classified as coded in the Death register.
Results: There were 2,332 kidney recipients observed for a total 16,787 person-years. Diseases occurring more frequently than the general population were vaccine preventable infections (influenza 189 cases, SIR 6.5, 95%CI 5.6-7.5, invasive pneumococcal disease 13 cases, SIR 9.4, 95%CI 4.4-16.2), gastrointestinal diseases (cryptosporidiosis 20 cases, SIR 18.8, 95%CI 12.1-29.2, giardiasis 11 cases, SIR 2.6, 95%CI 1.5-4.8, listeriosis 3 cases, SIR 47.0, 95%CI 15.2-145.7, rotavirus 12 cases, SIR 12.0, 95%CI 6.8-21.2 and salmonellosis 21 cases, SIR 3.0, 95%CI 2.0-4.6), and other bacterial infections (Legionellosis 4 cases, SIR 8.8, 95%CI 3.3-23.4, tuberculosis 7 cases, SIR 7.3, 95%CI 3.5-15.3). Many cases (121/280, 43%) were associated with hospitalisation. There was one death due to influenza and one death due to tuberculosis.
Conclusion: As expected, many notifiable diseases occur more frequently among kidney transplant recipients than the general population, with associated morbidity and mortality. There is further need for targeted preventive strategies, including vaccination, food hygiene and hand hygiene.
Nicole De La Mata is an early career researcher and biostatistician working with Sydney School of Public Health. Her current research focuses on health outcomes in people with end-stage kidney disease (ESKD), living kidney donors and organ transplant recipients. She has experience in managing and utilizing large observational cohorts and linked health data to evaluate patient outcomes and drive change in health policy. Her interests include cohort studies, data linkage and survival analysis.