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Type: Journal article
Title: Infection-related mortality in recipients of a kidney transplant in Australia and New Zealand
Author: Chan, S.
Pascoe, E.M.
Clayton, P.A.
McDonald, S.P.
Lim, W.H.
Sypek, M.P.
Palmer, S.C.
Isbel, N.M.
Francis, R.S.
Campbell, S.B.
Hawley, C.M.
Johnson, D.W.
Citation: Clinical Journal of the American Society of Nephrology, 2019; 14(10):1484-1492
Publisher: American Society of Nephrology
Issue Date: 2019
ISSN: 1555-9041
Statement of
Samuel Chan, Elaine M. Pascoe, Philip A. Clayton, Stephen P. McDonald, Wai H. Lim, Matthew P. Sypek, Suetonia C. Palmer, Nicole M. Isbel, Ross S. Francis, Scott B. Campbell, Carmel M. Hawley and David W. Johnson
Abstract: Background and Objectives: The burden of infectious disease is high among kidney transplant recipients because of concomitant immunosuppression. In this study the incidence of infectious-related mortality and associated factors were evaluated. Design, Setting, Participants, & Measurements: In this registry-based retrospective, longitudinal cohort study, recipients of a first kidney transplant in Australia and New Zealand between 1997 and 2015 were included. Cumulative incidence of infectious-related mortality was estimated using competing risk regression (using noninfectious mortality as a competing risk event), and compared with age-matched, populated-based data using standardized incidence ratios. Results: Among 12,519 patients, (median age 46 years, 63% men, 15% diabetic, 6% Indigenous ethnicity), 2197 (18%) died, of whom 416 (19%) died from infection. The incidence of infection-related mortality during the study period (1997-2015) was 45.8 (95% confidence interval [95% CI], 41.6 to 50.4) per 10,000 patient-years. The incidence of infection-related mortality reduced from 53.1 (95% CI, 45.0 to 62.5) per 10,000 person-years in 1997-2000 to 43.9 (95% CI, 32.5 to 59.1) per 10,000 person-years in 2011-2015 (P<0.001) Compared with the age-matched general population, kidney transplant recipients had a markedly higher risk of infectious-related death (standardized incidence ratio, 7.8; 95% CI, 7.1 to 8.6). Infectious mortality was associated with older age (≥60 years adjusted subdistribution hazard ratio [SHR], 4.16; 95% CI, 2.15 to 8.05; reference 20-30 years), female sex (SHR, 1.62; 95% CI, 1.19 to 2.29), Indigenous ethnicity (SHR, 2.87; 95% CI, 1.84 to 4.46; reference white), earlier transplant era (2011-2015: SHR, 0.39; 95% CI, 0.20 to 0.76; reference 1997-2000), and use of T cell-depleting therapy (SHR, 2.43; 95% CI, 1.36 to 4.33). Live donor transplantation was associated with lower risk of infection-related mortality (SHR, 0.53; 95% CI, 0.37 to 0.76). Conclusions: Infection-related mortality in kidney transplant recipients is significantly higher than the general population, but has reduced over time. Risk factors include older age, female sex, Indigenous ethnicity, T cell-depleting therapy, and deceased donor transplantation. Podcast: This article contains a podcast at
Keywords: Kidney transplant; Australia, New Zealand
Rights: Copyright © 2019 by the American Society of Nephrology
DOI: 10.2215/cjn.03200319
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