title: Characteristics of infectious complications associated with mortality after solid organ transplantation.
abstract: Infection remains a common source of morbidity and mortality after solid organ transplantation. The purpose of this study was to characterize the continuously changing patterns of post-transplantation infections, analyze early post-transplantation infections, and evaluate characteristics associated with mortality. A secondary analysis was performed on prospectively collected data for all episodes of infection occurring between 10 December 1996 and 28 October 1998 on the surgery services at a university medical center. Post-transplantation infections were compared with those in non-transplantation patients randomly matched by severity of illness. Further analysis was performed on post-transplantation infections occurring during the admission of transplantation compared with those in subsequent admissions. To evaluate factors associated with mortality, episodes occurring in survivors and non-survivors were compared. The results demonstrated that infections in transplantation recipients (n = 303) were associated with a younger age and had significantly lower white blood cell counts (WBC) compared with non-transplantation patients. There was no difference in mortality (15.5 vs. 16.5%, p = 0.74). Post-transplantation infectious complications during the initial hospitalization (n = 105) occurred at 38+/-6 compared with 695+/-66 d (p<0.0001) after transplantation and were associated with a longer length of stay (LOS) and increased mortality (30.5 vs. 7.6%, p<0.0001) compared with those occurring in subsequent admissions (n = 198). Although multiple characteristics of post-transplantation infections were associated with mortality, only the Acute Physiology and Chronic Health Evaluation (APACHE) II score was an independent predictor of mortality. Post-transplantation infections remain a significant source of morbidity and mortality. The leukocyte response to infection was suppressed in the transplantation population. Post-transplantation infections which occur during the admission for transplantation have a markedly increased mortality.
authors.affiliation: The Charles O. Strickler Transplant Center, Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA. sjp7t@virginia.edu
authors.forename: S J
authors.initials: SJ
authors.lastname: Pelletier
authors.forename: T D
authors.initials: TD
authors.lastname: Crabtree
authors.forename: T G
authors.initials: TG
authors.lastname: Gleason
authors.forename: D P
authors.initials: DP
authors.lastname: Raymond
authors.forename: C K
authors.initials: CK
authors.lastname: Oh
authors.forename: T L
authors.initials: TL
authors.lastname: Pruett
authors.forename: R G
authors.initials: RG
authors.lastname: Sawyer
mesh_terms: D018806:APACHE; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D015996:Survival Rate