MO957LONG TERM OUTCOME OF POST-TRANSPLANT INFECTIONS IN ADULT RENAL TRANSPLANT RECIPIENTS. (29th May 2021) - Prasad, Narayan
Abstract: Background and Aims: Infections are a significant cause of morbidity in the form of graft loss and mortality in RTR. Several factors in the pre and peri transplant period increase the susceptibility to PTI, affecting the overall graft and patient survival. Method: An observational study of 644 adult RTR (=>18yrs) between Jan 2010 and Dec 2015, followed till Jun 2019. The primary objective was to study the epidemiology of risk factors of PTI. The secondary objective was to evaluate transplant outcomes. Results: PTI were seen in 83.1%, of which majority (64%) occurred in the first year. Of all infections, 55.5% were bacterial, 18.5% viral, 10.8% parasitic, 8% fungal, and remaining 7.1% mycobacterial. UTI (37.4%) was most common infection with E. Coli (18.9%) being the commonest cause. Relative risk with PTI for graft dysfunction was 3 times higher (95% CI 1.70-3.57, p=0.00), 3 times higher for graft failure (95% CI 1.35-4.93, p=0.002) compared to non-PTI group and death was 3 times higher (95%CI 1.3-7.2, p=0.01) as compared to non-PTI. Overall, graft loss was 19.4% and the mortality rate was 12.1% of the study population. The relative risk of fungal infections to cause graft loss was 2 times higher as compared to other infections (95% CI 1.23-2.18, p<0.003). The relative risk of fungal infections to cause death was 2 times higher than other infections (95% CI 1.20-2.56, p <0.008) On multivariate analysis, the predictors of PTI were ATG induction (P<0.01), pre transplant Tuberculosis (P=0.02) and dialysis vintage (P=0.02). On KM survival analysis, graft and patient survival was inferior in PTI at 1, 5and 9years; (graft: 94.6%; 81.8%;70.1% vs non PTI 97.2%; 92.2%; 88.1%, p = 0.006, patient: PTI 97.1 %; 88.2%; and 81.9%vs non PTI 99.1%, 95.8%; 92.9%, p=0.012) Conclusion: PTI have a significant impact on graft survival (70% vs 88%) and patient survival (82% vs 93%) in RTR, with fungal infections having worse outcomes.