title: Infectious complications in indigenous renal transplant recipients in Western Australia.
abstract: BACKGROUND
  Infectious complications remain a significant risk following renal transplantation.
  
  
  OBJECTIVE
  To examine the burden and pattern of infection following renal transplantation in Aboriginal and Torres Strait Islander (ATSI) compared to non-ATSI.
  
  
  METHODS
  A retrospective cohort study of 141 consecutive adult renal transplant recipients in Western Australia between 2005 and 2011 was conducted. We determined baseline serological status for relevant organisms, the number of patients with specific infections, infectious admission in the first year post-transplantation and the rate of infectious death during follow up.
  
  
  RESULTS
  There were 57 ATSI and 84 non-ATSI renal transplant recipients. ATSI compared to non-ATSI had a high rate of cytomegalovirus (CMV) seropositivity (98.2% vs 73.2%, P < 0.001), HBcAb positivity (100% vs 13.3%, P < 0.001) and strongyloides seropositivity (ATSI 3/12 tested). In the first year post-transplant, ATSI compared to non-ASTI had a higher rate of pneumonia (17.9% vs 3.6% of patients, P = 0.006), and non-significant trend to higher rates of gastrointestinal parasitic infection (7.0% vs 1.2% of patients, P = 0.158), invasive fungal infection (10.5% vs 4.8% of patients, P = 0.316), and hospitalisation because of infection (10.0 vs 5.5 days, P = 0.071). Overall 5-year cumulative survival was lower for ATSI versus non-ATSI (0.64 vs 0.86, P = 0.022) with two-thirds of ATSI deaths attributed to infection.
  
  
  CONCLUSIONS
  ATSI are at high risk of infectious complications after renal transplantation associated with a burden of hospitalisation and death. Augmented screening and prophylaxis for infectious diseases should be considered. Further study needs to identify contributing environmental and immunity factors.
authors.affiliation: Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia.|Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Boan
authors.affiliation: Renal Transplantation Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia.
authors.forename: Ramyasuda
authors.initials: R
authors.lastname: Swaminathan
authors.affiliation: Renal Transplantation Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia.
authors.forename: Ashley
authors.initials: A
authors.lastname: Irish
mesh_terms: D000328:Adult; D001437:Bacteriuria / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology; D015331:Cohort Studies; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology; D012189:Retrospective Studies; D066027:Transplant Recipients; D014904:Western Australia / Q000208:ethnology; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Aboriginal; Aboriginal and Torres Strait Islander; indigenous; kidney transplantation; renal transplantation; transplant infectious disease