title: Potential role of post-transplant hypogammaglobulinemia in the risk of Clostridium difficile infection after kidney transplantation: a case-control study.
abstract: OBJECTIVE
  To identify reversible risk factors for Clostridium difficile infection (CDI) after kidney transplantation (KT) that could lead to a reduction in its incidence and associated complications.
  
  
  METHODS
  We performed a single-center case-control study in which 41 patients undergoing KT between February 2009 and July 2013 who developed a first episode of post-transplant CDI were included as cases. Patients transplanted at the same calendar day (± 2 weeks) as each case with no evidence of CDI and comparable risk exposure period were chosen as controls (2:1 ratio). Serum immunoglobulin and complement levels were systematically measured at baseline and months 1 and 6 after transplantation.
  
  
  RESULTS
  Multivariate regression analysis identified age-adjusted Charlson comorbidity index (odds ratio [OR] per unitary increment 1.31; P value = 0.043), delayed graft function (OR 2.76; P value = 0.039), prior cytomegalovirus (CMV) disease (OR 6.85; P value = 0.011) and prior acute graft rejection (OR 5.92; P value = 0.008) as risk factors for post-transplant CDI. Cases with their first episode of CDI occurring beyond the first month were more likely to have IgG hypogammaglobulinemia (HGG) at month 1 (P value = 0.002), whereas cases with CDI beyond the sixth month were more likely to have HGG of any class at month 6 (P value = 0.003). Poor outcome (graft loss and/or all-cause mortality) was more common among cases (adjusted hazard ratio 5.69; P value = 0.001).
  
  
  CONCLUSIONS
  The occurrence of CDI exerts a detrimental effect on graft and patient outcome. Post-transplant HGG was a potentially modifiable risk factor for CDI in KT recipients.
authors: Unit of Infectious Diseases, Hospital Universitario "12 de Octubre" (Centro de Actividades Ambulatorias, 2ª planta, bloque D, Avda. de Córdoba, s/n, 28041), Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain, josabater@hotmail.com.
authors: Julia
authors: J
authors: Origüen
authors: Mario
authors: M
authors: Fernández-Ruiz
authors: Carlos
authors: C
authors: Lumbreras
authors: María Ángeles
authors: MÁ
authors: Orellana
authors: Francisco
authors: F
authors: López-Medrano
authors: Tamara
authors: T
authors: Ruiz-Merlo
authors: Rafael
authors: R
authors: San Juan
authors: Ana
authors: A
authors: García-Reyne
authors: Esther
authors: E
authors: González
authors: Natalia
authors: N
authors: Polanco
authors: Estela
authors: E
authors: Paz-Artal
authors: Amado
authors: A
authors: Andrés
authors: José María
authors: JM
authors: Aguado
mesh_terms: D000328:Adult; D000361:Agammaglobulinemia / Q000150:complications* / Q000209:etiology / Q000517:prevention & control; D000368:Aged; D016022:Case-Control Studies; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D015996:Survival Rate