Epidemiology of infections requiring hospitalization during long-term follow-up of pancreas transplantation

Nassir Rostambeigi, Yogish C Kudva, Seby John, Sham Mailankody, Rachel A. Pedersen, Patrick G. Dean, Mikel Prieto, Fernando G Cosio, Walter K Kremers, Randall C. Walker, Roshini S. Abraham, Mark D Stegall

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

BACKGROUND: Pancreas transplantation (PT) provides the best glycemic control option for diabetes mellitus but is associated with significant morbidities related to infectious disease. METHODS: We performed a retrospective study of a cohort of consecutive PT recipients in whom PT was performed from 1998 to 2006 (n=216) and followed up them until July 2008. Data regarding infections, rejection, infection chemoprophylaxis, graft failure, absolute lymphocyte counts (ALCs), and mortalities were collected. RESULTS: Simultaneous pancreas and kidney, pancreas transplantation alone, and pancreas after kidney (PAK) transplantations were performed in 42, 67, and 107 patients, with a mean (standard deviation) age at transplantation of 46.8 (8.03), 40.6 (10.1), and 43.7 (8.19) years. Of the simultaneous pancreas and kidney, pancreas transplantation alone, and PAK transplant recipients, 54.7%, 37.3%, and 58.8% were men. Overall, 63% developed a serious infection during the median follow-up of 6.4 years. Mean (range) number of infectious episodes was 2.3 (1-12), with mostly bacterial infections both within (68%) and after 1 year (78%). Incidence of bacterial and viral infections was greatest in the first 3 months after transplantation. Fungal infections were more constant. Bladder exocrine drainage was associated with higher risk of infection (hazard ratio=2.5, P<0.001). Infection within the first 3 months after transplantation was related to higher mortality after the first 3 months (hazard ratio=3.19). ALC was associated with the risk of first infections (P=0.005) and bacterial infections (P<0.001). CONCLUSIONS: Incidence of infections after PT was 63% and mostly bacterial. Bladder drainage increases infection risk and low ALC partially predicts episodes. Limitations include retrospective design, unequal composition of PT groups, and lack of data between kidney and PT for PAK.

Original languageEnglish (US)
Pages (from-to)1126-1133
Number of pages8
JournalTransplantation
Volume89
Issue number9
DOIs
StatePublished - May 2010

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Pancreas Transplantation
Epidemiology
Hospitalization
Pancreas
Infection
Kidney Transplantation
Lymphocyte Count
Bacterial Infections
Transplantation
Drainage
Urinary Bladder
Kidney
Mortality
Mycoses
Incidence
Chemoprevention
Virus Diseases
Communicable Diseases
Diabetes Mellitus
Retrospective Studies

Keywords

  • Graft function
  • Immunology
  • Pancreas transplantation
  • Serious infections
  • Transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Epidemiology of infections requiring hospitalization during long-term follow-up of pancreas transplantation. / Rostambeigi, Nassir; Kudva, Yogish C; John, Seby; Mailankody, Sham; Pedersen, Rachel A.; Dean, Patrick G.; Prieto, Mikel; Cosio, Fernando G; Kremers, Walter K; Walker, Randall C.; Abraham, Roshini S.; Stegall, Mark D.

In: Transplantation, Vol. 89, No. 9, 05.2010, p. 1126-1133.

Research output: Contribution to journalArticle

Rostambeigi, N, Kudva, YC, John, S, Mailankody, S, Pedersen, RA, Dean, PG, Prieto, M, Cosio, FG, Kremers, WK, Walker, RC, Abraham, RS & Stegall, MD 2010, 'Epidemiology of infections requiring hospitalization during long-term follow-up of pancreas transplantation', Transplantation, vol. 89, no. 9, pp. 1126-1133. https://doi.org/10.1097/TP.0b013e3181d54bb9
Rostambeigi, Nassir ; Kudva, Yogish C ; John, Seby ; Mailankody, Sham ; Pedersen, Rachel A. ; Dean, Patrick G. ; Prieto, Mikel ; Cosio, Fernando G ; Kremers, Walter K ; Walker, Randall C. ; Abraham, Roshini S. ; Stegall, Mark D. / Epidemiology of infections requiring hospitalization during long-term follow-up of pancreas transplantation. In: Transplantation. 2010 ; Vol. 89, No. 9. pp. 1126-1133.
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abstract = "BACKGROUND: Pancreas transplantation (PT) provides the best glycemic control option for diabetes mellitus but is associated with significant morbidities related to infectious disease. METHODS: We performed a retrospective study of a cohort of consecutive PT recipients in whom PT was performed from 1998 to 2006 (n=216) and followed up them until July 2008. Data regarding infections, rejection, infection chemoprophylaxis, graft failure, absolute lymphocyte counts (ALCs), and mortalities were collected. RESULTS: Simultaneous pancreas and kidney, pancreas transplantation alone, and pancreas after kidney (PAK) transplantations were performed in 42, 67, and 107 patients, with a mean (standard deviation) age at transplantation of 46.8 (8.03), 40.6 (10.1), and 43.7 (8.19) years. Of the simultaneous pancreas and kidney, pancreas transplantation alone, and PAK transplant recipients, 54.7{\%}, 37.3{\%}, and 58.8{\%} were men. Overall, 63{\%} developed a serious infection during the median follow-up of 6.4 years. Mean (range) number of infectious episodes was 2.3 (1-12), with mostly bacterial infections both within (68{\%}) and after 1 year (78{\%}). Incidence of bacterial and viral infections was greatest in the first 3 months after transplantation. Fungal infections were more constant. Bladder exocrine drainage was associated with higher risk of infection (hazard ratio=2.5, P<0.001). Infection within the first 3 months after transplantation was related to higher mortality after the first 3 months (hazard ratio=3.19). ALC was associated with the risk of first infections (P=0.005) and bacterial infections (P<0.001). CONCLUSIONS: Incidence of infections after PT was 63{\%} and mostly bacterial. Bladder drainage increases infection risk and low ALC partially predicts episodes. Limitations include retrospective design, unequal composition of PT groups, and lack of data between kidney and PT for PAK.",
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AU - Rostambeigi, Nassir

AU - Kudva, Yogish C

AU - John, Seby

AU - Mailankody, Sham

AU - Pedersen, Rachel A.

AU - Dean, Patrick G.

AU - Prieto, Mikel

AU - Cosio, Fernando G

AU - Kremers, Walter K

AU - Walker, Randall C.

AU - Abraham, Roshini S.

AU - Stegall, Mark D

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N2 - BACKGROUND: Pancreas transplantation (PT) provides the best glycemic control option for diabetes mellitus but is associated with significant morbidities related to infectious disease. METHODS: We performed a retrospective study of a cohort of consecutive PT recipients in whom PT was performed from 1998 to 2006 (n=216) and followed up them until July 2008. Data regarding infections, rejection, infection chemoprophylaxis, graft failure, absolute lymphocyte counts (ALCs), and mortalities were collected. RESULTS: Simultaneous pancreas and kidney, pancreas transplantation alone, and pancreas after kidney (PAK) transplantations were performed in 42, 67, and 107 patients, with a mean (standard deviation) age at transplantation of 46.8 (8.03), 40.6 (10.1), and 43.7 (8.19) years. Of the simultaneous pancreas and kidney, pancreas transplantation alone, and PAK transplant recipients, 54.7%, 37.3%, and 58.8% were men. Overall, 63% developed a serious infection during the median follow-up of 6.4 years. Mean (range) number of infectious episodes was 2.3 (1-12), with mostly bacterial infections both within (68%) and after 1 year (78%). Incidence of bacterial and viral infections was greatest in the first 3 months after transplantation. Fungal infections were more constant. Bladder exocrine drainage was associated with higher risk of infection (hazard ratio=2.5, P<0.001). Infection within the first 3 months after transplantation was related to higher mortality after the first 3 months (hazard ratio=3.19). ALC was associated with the risk of first infections (P=0.005) and bacterial infections (P<0.001). CONCLUSIONS: Incidence of infections after PT was 63% and mostly bacterial. Bladder drainage increases infection risk and low ALC partially predicts episodes. Limitations include retrospective design, unequal composition of PT groups, and lack of data between kidney and PT for PAK.

AB - BACKGROUND: Pancreas transplantation (PT) provides the best glycemic control option for diabetes mellitus but is associated with significant morbidities related to infectious disease. METHODS: We performed a retrospective study of a cohort of consecutive PT recipients in whom PT was performed from 1998 to 2006 (n=216) and followed up them until July 2008. Data regarding infections, rejection, infection chemoprophylaxis, graft failure, absolute lymphocyte counts (ALCs), and mortalities were collected. RESULTS: Simultaneous pancreas and kidney, pancreas transplantation alone, and pancreas after kidney (PAK) transplantations were performed in 42, 67, and 107 patients, with a mean (standard deviation) age at transplantation of 46.8 (8.03), 40.6 (10.1), and 43.7 (8.19) years. Of the simultaneous pancreas and kidney, pancreas transplantation alone, and PAK transplant recipients, 54.7%, 37.3%, and 58.8% were men. Overall, 63% developed a serious infection during the median follow-up of 6.4 years. Mean (range) number of infectious episodes was 2.3 (1-12), with mostly bacterial infections both within (68%) and after 1 year (78%). Incidence of bacterial and viral infections was greatest in the first 3 months after transplantation. Fungal infections were more constant. Bladder exocrine drainage was associated with higher risk of infection (hazard ratio=2.5, P<0.001). Infection within the first 3 months after transplantation was related to higher mortality after the first 3 months (hazard ratio=3.19). ALC was associated with the risk of first infections (P=0.005) and bacterial infections (P<0.001). CONCLUSIONS: Incidence of infections after PT was 63% and mostly bacterial. Bladder drainage increases infection risk and low ALC partially predicts episodes. Limitations include retrospective design, unequal composition of PT groups, and lack of data between kidney and PT for PAK.

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