Factors Associated with Mortality and Admission in Intensive Care for Kidney and Kidney-Pancreas Transplant Recipients with Respiratory Infection

Abstract

Background and Objective: Kidney transplantation is a therapy of choice for chronic kidney disease at an advanced stage, however, such intervention has postoperative complications and adverse effects related to immunosuppressive therapy, namely infectious conditions. This study aims to investigate risk factors for mortality and admission to intensive care in kidney transplant recipients with respiratory tract infections.

Methods: Prospective observational study carried out between December 2017 and March 2020 in a single reference center for organ transplantation in the state of Minas Gerais, Brazil. We included 70 kidney or kidney-pancreas transplant (adults?) patients hospitalized with high suspicion or pulmonary infection. Patients were followed up to the outcome and received standard care. Variables whose comparison showed a p-value less than 0.20 entered the multiple logistic regression analysis. The multivariate models presented death and ICU admission as outcomes. 

Results: XXIt was observed that the highest incidence of infectious events occurred in the female population, associated with the outcome of death or ICU (p = 0.029). There was a significant association between the use of calcineurin inhibitors and death or ICU (p=0.036). Patients who died or were transferred to ICU had a higher proportion (62.1%) of CMV. Those who did not (9.8%) (p<0.001), as well as the proportion of heart failure (27.3%, p=0.042). 

Conclusion: Cytomegalovirus infection and heart failure associated with immunosuppression by calcineurin inhibitors or Methylprednisolone in females leads to a worse prognosis on the occurrence of respiratory tract infection in kidney transplant patients.