The Burden and Impact of Early Post-Transplant Multidrug-resistant Organism Detection Among Renal Transplant Recipients, 2005-2021 Público

Abstract

Background

Understanding the impact of multi-drug resistant organism (MDRO) detection on renal transplant recipient (RTR) mortality and allograft function is paramount to mitigating morbid outcomes. We aimed to assess whether the detection of an MDRO or a comparative susceptible organism during the early post-transplant period was associated with increased mortality and allograft failure among RTRs.

Methods

We performed a retrospective cohort study of RTRs 2005 to 2021. Early post-transplant culture positivity was defined as a positive bacterial culture within 30 days of renal transplant. Incidence per 1,000 early post-transplant days at risk and prevalence of early post-transplant MDRO detection was calculated. The primary outcome was a composite of one year allograft loss or mortality following transplant. Differences between survival times were assessed using the log-rank test. Multivariable Cox proportional hazard regression modeling, competing risk analysis and a sensitivity analysis utilizing propensity score weighting was performed. A subgroup analysis of urine culture positive and RTRs transplanted between 2011-2021 cohort was performed.

Results

Among 3,507 RTRs, the prevalence of early post-transplant MDRO detection was 1.3% [95% C.I 0.31- 0.57] (44/3507) with an incidence rate per early post-transplant days at risk of 0.42 [95% C.I 0.31- 0.57] . Among RTRs eligible for survival analysis (N=3,432), 263 (7.6%) had a susceptible organism detected and 31 (0.9%) had an MDRO detected in the early post-transplant period. The composite outcome rate was higher among RTRs with an MDRO detected (12.9%, 4/31) compared to RTRs with a susceptible organism detected (6.8%, 18/263) and negative controls (4.3%, 135/3138). There was a significant difference from time of transplantation to the composite outcome when comparing negative controls, MDRO and susceptible organisms RTRs (MDROs: 20[76] vs. susceptible: 116 [166] vs. negative controls: 155[211]; log rank p =0.01)). Early post-transplant MDRO detection was significantly associated with the composite outcome (aHR: 3.19 [1.18, 8.63]) and allograft loss (cause-specific aHR*: 7.92 [1.01, 62.1], sub-distribution aHR 8.23 [1.17 54.2]). Similar results were seen in the sub-group and sensitivity analysis.

Conclusion

MDRO detection during the early post-transplant period was associated with increased allograft loss, suggesting the need for increased infection prevention efforts within this vulnerable population.  

Table of Contents

Introduction : 1

Background : 3

Methods: 7

Results: 11

Discussion: 16

References: 21

Figure 1. Study Flow diagram : 27

Figure 2. Waffle plot of all RTRS (N=3,507) stratified by early post-transplant culture status, 2005-2021: 28

Figure 3. Incidence of MDRO detection per 1000 early post-transplant days, 2005-2021 : 29

Figure 4. Kaplan–Meier analysis of composite outcome of Renal Transplant Recipients by Early Post Transplant Positive Culture status, 2005-2021 (N= 3,432): 30

Figure 5. Cumulative incidence curves for one-year mortality (solid line) and one-year allograft loss of Renal Transplant Recipients by Early Post Transplant Positive Culture status, 2005-2021 (N= 3,432): 31

Figure 6. Standardized mean differences for key covariates across weighting methods: 32

Table 1. Baseline Characteristics of Renal Transplant Recipients by Early Post Transplant Positive Culture status, 2005-2021 (N= 3,432): 33

Table 3: Outcomes of Renal Transplant Recipients Stratified by Early Post Transplant Positive Culture Status, 2005-2021 (N= 3,432): 36

Table 4. Results of Cox Proportional Hazards Regression Model for Primary Outcome by Early Post-transplant Culture Positivity Status (N= 3,432) : 37

Table 5. Results of Sensitivity and Subgroup Analysis of Cox Proportional Hazards of Composite Outcome among RTRs : 38

Table 6. Competing Risk Analysis Results Stratified by Stratified by Early Post Transplant Positive Culture Status (N= 3,432) : 39

Table 7. Cause specific Hazards of Allograft loss among subgroup and sensitivity analysis cohorts. : 40

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Palavra-chave	renal transplants MDRO
Committee Chair / Thesis Advisor	Jordan Kempker, Emory University
Committee Members	Jesse Jacob, Emory University Michael Woolworth , Emory University Colleen Kraft, Emory University

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