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Infection-related hospitalizations after kidney transplantation in children: incidence, risk factors, and cost

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Abstract

Background

Infection is the leading cause of death and hospitalization in renal transplant recipients. We describe posttransplant infections requiring hospitalization, their risk factors and cost in a national pediatric kidney transplantation cohort.

Methods

Data on renal transplant recipients <20 years were extracted from the French National Medicoadministrative Hospital Discharge database between 2008 and 2013 and matched with the Renal Transplant Database. We used Cox regression to study risk factors of hospitalization and calculated the instantaneous risk of hospitalization per month for all infections and by infection type.

Results

Five hundred and ninety-three patients were included, and 660 infection-related hospitalizations were identified in 260 patients. The leading cause of hospitalization was urinary tract infection (UTI), followed by viral infection (16.6 and 15.6 per 100 person-years, respectively). Risk factors were younger age at transplantation, high number of HLA mismatches, and use cyclosporine rather than tacrolimus as first anticalcineurin treatment. Risk factors varied by infection type. Female gender, uropathy, cold ischemia time, and cyclosporine were associated with increased risk of UTI, while only age at transplantation inversely correlated with virus-related hospitalizations. Instantaneous risk of all infections decreased with time, except for cytomegalovirus (CMV) infection that displayed a peak at 6 months posttransplantation after prophylaxis withdrawal. Total cost of infection-related hospitalizations was 1600 kilo-euro (k€) (933 €/person-years).

Conclusions

This study highlights the high burden of infection in transplanted pediatric patients, especially the youngest. This should be considered both for pretransplantation information and designing procedures aiming to decrease hospitalization rate and duration.

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Abbreviations

CAKUT:

Congenital abnormalities of the kidney and urinary tracts

HAR:

Hospital admission rate

PY:

Patient-years

UTI:

Urinary tract infection

References

  1. Gillen DL, Stehman-Breen CO, Smith JM, McDonald RA, Warady BA, Brandt JR, Wong CS (2008) Survival advantage of pediatric recipients of a first kidney transplant among children awaiting kidney transplantation. Am J Transplant 8:2600–2606

    Article  CAS  PubMed  Google Scholar 

  2. Harambat J, Hogan J, Macher MA, Couchoud C (2013) ESRD in children and adolescents. Nephrol Ther 9(Suppl 1):S167–S179

    Article  PubMed  Google Scholar 

  3. Evans RW, Manninen DL, Garrison LP Jr, Hart LG, Blagg CR, Gutman RA, Hull AR, Lowrie EG (1985) The quality of life of patients with end-stage renal disease. N Engl J Med 312:553–559

    Article  CAS  PubMed  Google Scholar 

  4. Vogelzang JL, van Stralen KJ, Jager KJ, Groothoff JW (2013) Trend from cardiovascular to non-cardiovascular late mortality in patients with renal replacement therapy since childhood. Nephrol Dial Transplant 28:2082–2089

    Article  PubMed  Google Scholar 

  5. United States Renal Data System (USRDS) Annual report 2016. https://www.usrds.org/2016/view/v2_05.aspx

  6. Dharnidharka VR, Stablein DM, Harmon WE (2004) Post-transplant infections now exceed acute rejection as cause for hospitalization: a report of the NAPRTCS. Am J Transplant 4:384–389

    Article  PubMed  Google Scholar 

  7. Lofaro D, Vogelzang JL, van Stralen KJ, Jager KJ, Groothoff JW (2016) Infection-related hospitalizations over 30 years of follow-up in patients starting renal replacement therapy at pediatric age. Pediatr Nephrol 31:315–323

    Article  PubMed  Google Scholar 

  8. Garcia GG, Harden P, Chapman J (2012) The global role of kidney transplantation. Lancet 379:e36–e38

    Article  PubMed  Google Scholar 

  9. Wong G, Howard K, Chapman JR, Chadban S, Cross N, Tong A, Webster AC, Craig JC (2012) Comparative survival and economic benefits of deceased donor kidney transplantation and dialysis in people with varying ages and co-morbidities. PLoS One 7:e29591

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. 2009 Public Health Care Tariff Calculations http://www.ameli.fr/

  11. Chavers BM, Solid CA, Gilbertson DT, Collins AJ (2007) Infection-related hospitalization rates in pediatric versus adult patients with end-stage renal disease in the United States. J Am Soc Nephrol 18:952–959

    Article  PubMed  Google Scholar 

  12. Puliyanda DP, Stablein DM, Dharnidharka VR (2007) Younger age and antibody induction increase the risk for infection in pediatric renal transplantation: a NAPRTCS report. Am J Transplant 7:662–666

    Article  CAS  PubMed  Google Scholar 

  13. Vidal E, Torre-Cisneros J, Blanes M, Montejo M, Cervera C, Aguado JM, Len O, Carratala J, Cordero E, Bou G, Munoz P, Ramos A, Gurgui M, Borrell N, Fortun J (2012) Bacterial urinary tract infection after solid organ transplantation in the RESITRA cohort. Transpl Infect Dis 14:595–603

    Article  CAS  PubMed  Google Scholar 

  14. Srinivasan A, Wang C, Yang J, Inaba H, Shenep JL, Leung WH, Hayden RT (2011) Parainfluenza virus infections in children with hematologic malignancies. Pediatr Infect Dis J 30:855–859

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ahsan N, Johnson C, Gonwa T, Halloran P, Stegall M, Hardy M, Metzger R, Shield C 3rd, Rocher L, Scandling J, Sorensen J, Mulloy L, Light J, Corwin C, Danovitch G, Wachs M, VanVeldhuisen P, Salm K, Tolzman D, Fitzsimmons WE (2001) Randomized trial of tacrolimus plus mycophenolate mofetil or azathioprine versus cyclosporine oral solution (modified) plus mycophenolate mofetil after cadaveric kidney transplantation: results at 2 years. Transplantation 72:245–250

    Article  CAS  PubMed  Google Scholar 

  16. Gonwa T, Johnson C, Ahsan N, Alfrey EJ, Halloran P, Stegall M, Hardy M, Metzger R, Shield C 3rd, Rocher L, Scandling J, Sorensen J, Mulloy L, Light J, Corwin C, Danovitch G, Wachs M, VanVeldhuisen P, Leonhardt M, Fitzsimmons WE (2003) Randomized trial of tacrolimus + mycophenolate mofetil or azathioprine versus cyclosporine + mycophenolate mofetil after cadaveric kidney transplantation: results at three years. Transplantation 75:2048–2053

    Article  CAS  PubMed  Google Scholar 

  17. O’Leary JG, Samaniego M, Barrio MC, Potena L, Zeevi A, Djamali A, Cozzi E (2016) The influence of immunosuppressive agents on the risk of de novo donor-specific HLA antibody production in solid organ transplant recipients. Transplantation 100:39–53

    Article  PubMed  Google Scholar 

  18. Trompeter R, Filler G, Webb NJ, Watson AR, Milford DV, Tyden G, Grenda R, Janda J, Hughes D, Ehrich JH, Klare B, Zacchello G, Bjorn Brekke I, McGraw M, Perner F, Ghio L, Balzar E, Friman S, Gusmano R, Stolpe J (2002) Randomized trial of tacrolimus versus cyclosporin microemulsion in renal transplantation. Pediatr Nephrol 17:141–149

    Article  PubMed  Google Scholar 

  19. Gaber AO, Kahan BD, Van Buren C, Schulman SL, Scarola J, Neylan JF (2008) Comparison of sirolimus plus tacrolimus versus sirolimus plus cyclosporine in high-risk renal allograft recipients: results from an open-label, randomized trial. Transplantation 86:1187–1195

    Article  CAS  PubMed  Google Scholar 

  20. Brennan DC, Daller JA, Lake KD, Cibrik D, Del Castillo D (2006) Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med 355:1967–1977

    Article  CAS  PubMed  Google Scholar 

  21. Lebranchu Y, Bridoux F, Buchler M, Le Meur Y, Etienne I, Toupance O, Hurault de Ligny B, Touchard G, Moulin B, Le Pogamp P, Reigneau O, Guignard M, Rifle G (2002) Immunoprophylaxis with basiliximab compared with antithymocyte globulin in renal transplant patients receiving MMF-containing triple therapy. Am J Transplant 2:48–56

    Article  CAS  PubMed  Google Scholar 

  22. Mourad G, Rostaing L, Legendre C, Garrigue V, Thervet E, Durand D (2004) Sequential protocols using basiliximab versus antithymocyte globulins in renal-transplant patients receiving mycophenolate mofetil and steroids. Transplantation 78:584–590

    Article  CAS  PubMed  Google Scholar 

  23. Clark G, Walsh G, Deshpande P, Koffman G (2002) Improved efficacy of basiliximab over antilymphocyte globulin induction therapy in paediatric renal transplantation. Nephrol Dial Transplant 17:1304–1309

    Article  CAS  PubMed  Google Scholar 

  24. Martin-Pena A, Cordero E, Fijo J, Sanchez-Moreno A, Martin-Govantes J, Torrubia F, Cisneros J (2009) Prospective study of infectious complications in a cohort of pediatric renal transplant recipients. Pediatr Transplant 13:457–463

    Article  PubMed  Google Scholar 

  25. Dharnidharka VR, Araya CE, Wadsworth CS, McKinney MC, Howard RJ (2008) Assessing the value of ureteral stent placement in pediatric kidney transplant recipients. Transplantation 85:986–991

    Article  PubMed  Google Scholar 

  26. Gurkan A, Yakupoglu YK, Dinckan A, Erdogdu T, Tuncer M, Erdogan O, Demirbas A, Akaydin M (2006) Comparing two ureter reimplantation techniques in kidney transplant recipients. Transpl Int 19:802–806

    Article  PubMed  Google Scholar 

  27. Herthelius M, Oborn H (2006) Bladder dysfunction in children and adolescents after renal transplantation. Pediatr Nephrol 21:725–728

    Article  PubMed  Google Scholar 

  28. Van der Weide MJ, Cornelissen EA, Van Achterberg T, Smits JP, Feitz WF (2006) Dysfunction of lower urinary tract in renal transplant children with nephrologic disease. Urology 67:1060–1065 discussion 1065

    Article  PubMed  Google Scholar 

  29. Fila M, Dechartes A, Maisin A, Dossier C, Zhao W, Deschenes G, Baudouin V (2015) Comparison between valganciclovir and aciclovir/valaciclovir for CMV prophylaxis in pediatric renal transplantation. Saudi J Kidney Dis Transpl 26:453–459

    Article  CAS  PubMed  Google Scholar 

  30. Humar A, Lebranchu Y, Vincenti F, Blumberg EA, Punch JD, Limaye AP, Abramowicz D, Jardine AG, Voulgari AT, Ives J, Hauser IA, Peeters P (2010) The efficacy and safety of 200 days valganciclovir cytomegalovirus prophylaxis in high-risk kidney transplant recipients. Am J Transplant 10:1228–1237

    Article  CAS  PubMed  Google Scholar 

  31. Naik AS, Dharnidharka VR, Schnitzler MA, Brennan DC, Segev DL, Axelrod D, Xiao H, Kucirka L, Chen J, Lentine KL (2016) Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice. Transpl Int 29:241–252

    Article  PubMed  Google Scholar 

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Authors’ contributions

Julien Hogan and Cécile Couchoud participated in manuscript conception, data analysis, and manuscript writing.

Christine Pietrement, Anne-Laure Sellier-Leclerc, Ferielle Louillet, and Rémi Salomon participated in data collection and manuscript writing.

Marie-Alice Macher and Etienne Berard participated in manuscript conception, data collection, and manuscript writing.

All the authors have revised the article and approve the final version.

Author information

Authors and Affiliations

  1. Pediatric Nephrology Department, Hôpital Robert Debré, APHP, 48 bld Sérurier, 75019, Paris, France

    Julien Hogan & Marie-Alice Macher

  2. Registre REIN, Agence de la Biomédecine, La Plaine Saint-Denis, France

    Julien Hogan & Cécile Couchoud

  3. Pediatric Nephrology Department, American Mémorial Hospital, Reims, France

    Christine Pietrement

  4. Pediatric Nephrology Department, Hôpital Femme Mère Enfant, Bron, France

    Anne-Laure Sellier-Leclerc

  5. Pediatric Nephrology Department, Hôpital Charles Nicolle, Rouen, France

    Ferielle Louillet

  6. Pediatric Nephrology Department, Hôpital Necker Enfants Malades, Paris, France

    Rémi Salomon

  7. Pediatric Nephrology Department, Fondation Lenval, Nice, France

    Etienne Berard

Authors
  1. Julien Hogan
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  2. Christine Pietrement
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  3. Anne-Laure Sellier-Leclerc
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  4. Ferielle Louillet
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  5. Rémi Salomon
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  6. Marie-Alice Macher
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  7. Etienne Berard
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  8. Cécile Couchoud
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Corresponding author

Correspondence to Julien Hogan.

Ethics declarations

The French Advisory Committee on Information Processing in Material Research in the Field of Health (CCTIRS) and the National Commission for Information Technology and Privacy (Commission Nationale de l’Informatique et des Libertés) approved in 2003 data collection and analysis conducted by the REIN registry. REIN is the French ESRD registry includind the data of the patients on dialysis and of the transplanted patients. Organization, data collection and quality control of the REIN registry have been described by Couchoud et al. (The renal epidemiology and information network (REIN): a new registry for end-stage renal disease in France. Nephrol Dial Transplant 2006; 21: 411–418).

Disclosures

The authors declare no conflicts of interest.

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Hogan, J., Pietrement, C., Sellier-Leclerc, AL. et al. Infection-related hospitalizations after kidney transplantation in children: incidence, risk factors, and cost. Pediatr Nephrol 32, 2331–2341 (2017). https://doi.org/10.1007/s00467-017-3737-x

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  • DOI: https://doi.org/10.1007/s00467-017-3737-x

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