title: Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice.
abstract: We examined United States Renal Data System registry records for Medicare-insured kidney transplant recipients in 2000-2011 to study the clinical and cost impacts of urinary tract infections (UTI), pneumonia, and sepsis in the first year post-transplant among a contemporary, national cohort. Infections were identified by billing diagnostic codes. Among 60 702 recipients, 45% experienced at least one study infection in the first year post-transplant, including UTI in 32%, pneumonia in 13%, and sepsis in 12%. Older recipient age, female sex, diabetic kidney failure, nonstandard criteria organs, sirolimus-based immunosuppression, and steroids at discharge were associated with increased risk of first-year infections. By time-varying, multivariate Cox regression, all study infections predicted increased first-year mortality, ranging from 41% (aHR 1.41, 95% CI 1.25-1.56) for UTI alone, 6- to 12-fold risk for pneumonia or sepsis alone, to 34-fold risk (aHR 34.38, 95% CI 30.35-38.95) for those with all three infections. Infections also significantly increased first-year costs, from $17 691 (standard error (SE) $591) marginal cost increase for UTI alone, to approximately $40 000-$50 000 (SE $1054-1238) for pneumonia or sepsis alone, to $134 773 (SE $1876) for those with UTI, pneumonia, and sepsis. Clinical and economic impacts persisted in years 2-3 post-transplant. Early infections reflect important targets for management protocols to improve post-transplant outcomes and reduce costs of care.
authors.affiliation: Division of Nephrology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Abhijit S
authors.initials: AS
authors.lastname: Naik
authors.affiliation: Division of Nephrology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Vikas R
authors.initials: VR
authors.lastname: Dharnidharka
authors.affiliation: Saint Louis University Center for Transplant Research, Saint Louis University Hospital, St. Louis, MO, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.affiliation: Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.affiliation: Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.affiliation: Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH, USA.
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
authors.affiliation: Saint Louis University Center for Transplant Research, Saint Louis University Hospital, St. Louis, MO, USA.
authors.forename: Huiling
authors.initials: H
authors.lastname: Xiao
authors.affiliation: Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Kucirka
authors.affiliation: Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.
authors.forename: Jiajing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Saint Louis University Center for Transplant Research, Saint Louis University Hospital, St. Louis, MO, USA.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005102:Health Expenditures; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000191:economics* / Q000209:etiology; D018805:Sepsis / Q000191:economics* / Q000209:etiology; D014552:Urinary Tract Infections / Q000191:economics* / Q000209:etiology
keywords: economics; infections; kidney transplantation; medicare; registries