title: Epidemiology and risk factors for late infection in solid organ transplant recipients.
abstract: BACKGROUND
  Information concerning the risk factors and outcome of late infection (LI) after solid organ transplantation (SOT) still remains scarce.
  
  
  METHODS
  We prospectively analyzed all patients undergoing SOT from July 2003 to March 2008, who survived the first 6 months after surgery and with a minimum 1-year follow-up. Risk factors associated with the development of bacterial and cytomegalovirus (CMV) LI and survival were identified.
  
  
  RESULTS
  Overall, 942 SOT recipients (491 kidney, 280 liver, 65 heart, and 106 double transplants) were included. During the study period 147 patients (15.6%) developed 276 episodes of LI (incidence rate, 0.43 per 1000 transplantation-days). Bacteria were the most prevalent etiology (88.0%). Primary sources of infection included urinary tract (36.9%), intra-abdominal (16.7%), and sepsis without source (13.4%). Independent risk factors for late bacterial infection were: age (hazard ratio [HR] [per year] 1.0; 95% confidence interval [CI]: 1.0-1,0), female gender (HR 1.7; 95%CI: 1.1-2.6), anti-hepatitis C virus (HCV) positive serostatus (HR 1.8; 95%CI: 1.1-3.0), chronic allograft dysfunction (HR 3.2; 95%CI: 1.7-6.1), early CMV disease (HR 2.2; 95%CI 1.2-4.1), and early bacterial infection (HR 2.5; 95%CI 1.6-3.8). The occurrence of chronic allograft dysfunction was an independent risk factor for late CMV disease (HR 6.5; 95%CI: 1.7-24.6), whereas immunosuppression based on mammalian target of rapamycin inhibitors protected against the development of late CMV disease (HR 0.3; 95%CI: 0.1-1.0). Cox model selected anti-HCV positive serostatus (adjusted HR [aHR] 2.67; 95%CI: 1.27-5.59), age (aHR [per year] 1.06; 95%CI: 1.02-1.10), and the occurrence of LI (aHR 9.12; 95%CI: 3.90-21.33) as independent factors for mortality.
  
  
  CONCLUSIONS
  LI did not constitute an uncommon complication in our cohort, and patients at risk may benefit from close clinical monitoring.
authors.affiliation: Department of Infectious Diseases-CIBERHED, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Cervera
authors.forename: M
authors.initials: M
authors.lastname: Fernández-Ruiz
authors.forename: A
authors.initials: A
authors.lastname: Valledor
authors.forename: L
authors.initials: L
authors.lastname: Linares
authors.forename: A
authors.initials: A
authors.lastname: Antón
authors.forename: M
authors.initials: M
authors.lastname: Ángeles Marcos
authors.forename: G
authors.initials: G
authors.lastname: Sanclemente
authors.forename: I
authors.initials: I
authors.lastname: Hoyo
authors.forename: F
authors.initials: F
authors.lastname: Cofán
authors.forename: M J
authors.initials: MJ
authors.lastname: Ricart
authors.forename: F
authors.initials: F
authors.lastname: Pérez-Villa
authors.forename: M
authors.initials: M
authors.lastname: Navasa
authors.forename: T
authors.initials: T
authors.lastname: Pumarola
authors.forename: A
authors.initials: A
authors.lastname: Moreno
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000150:complications / Q000453:epidemiology; D015331:Cohort Studies; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000453:epidemiology; D009894:Opportunistic Infections / Q000150:complications* / Q000453:epidemiology*; D016377:Organ Transplantation; D010272:Parasitic Diseases / Q000150:complications / Q000453:epidemiology; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014777:Virus Diseases / Q000150:complications / Q000453:epidemiology
chemical_list: D007166:Immunosuppressive Agents