Post-transplant infections now exceed acute rejection as cause for hospitalization: a report of the NAPRTCS

Am J Transplant. 2004 Mar;4(3):384-9. doi: 10.1111/j.1600-6143.2004.00350.x.

Abstract

Newer immunosuppressive agents have dramatically reduced the rates of acute graft rejection (AR) over the last decade but may have exacerbated the problem of post-transplant infections (PTI). We analyzed data from the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) to determine the risks of hospitalization from PTI vs. AR in the years 1987-2000. For patients transplanted in 1987, the AR-associated hospitalization rate exceeded the equivalent hospitalization rate for PTI at both early (1-6 months) and later time points (6-24 months). In contrast, for patients transplanted in the year 2000, the PTI-associated hospitalization rate was twice that for AR-associated hospitalization during each time period. During the first two years post-transplant, rates of AR hospitalization trended significantly downwards (p < 0.001) while rates of PTI-associated hospitalization stayed constant. In the 6-24-month time period post-transplant, the risk of bacterial and viral infection-related hospitalization rose significantly from 1987 to 2000 (p < 0.001 for trend by transplant year). We conclude that the causes of hospitalization at all times up to 24 months post-transplant, including the critical early 6 months, have shifted away from AR to PTI.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Child, Preschool
  • Communicable Diseases / epidemiology*
  • Female
  • Graft Rejection / epidemiology*
  • Hospitalization / statistics & numerical data*
  • Hospitalization / trends
  • Humans
  • Infant
  • Male
  • Mycoses / epidemiology
  • Opportunistic Infections / epidemiology*
  • Time Factors
  • Transplantation*