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      Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice.

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          Abstract

          We examined United States Renal Data System registry records for Medicare-insured kidney transplant recipients in 2000-2011 to study the clinical and cost impacts of urinary tract infections (UTI), pneumonia, and sepsis in the first year post-transplant among a contemporary, national cohort. Infections were identified by billing diagnostic codes. Among 60 702 recipients, 45% experienced at least one study infection in the first year post-transplant, including UTI in 32%, pneumonia in 13%, and sepsis in 12%. Older recipient age, female sex, diabetic kidney failure, nonstandard criteria organs, sirolimus-based immunosuppression, and steroids at discharge were associated with increased risk of first-year infections. By time-varying, multivariate Cox regression, all study infections predicted increased first-year mortality, ranging from 41% (aHR 1.41, 95% CI 1.25-1.56) for UTI alone, 6- to 12-fold risk for pneumonia or sepsis alone, to 34-fold risk (aHR 34.38, 95% CI 30.35-38.95) for those with all three infections. Infections also significantly increased first-year costs, from $17 691 (standard error (SE) $591) marginal cost increase for UTI alone, to approximately $40 000-$50 000 (SE $1054-1238) for pneumonia or sepsis alone, to $134 773 (SE $1876) for those with UTI, pneumonia, and sepsis. Clinical and economic impacts persisted in years 2-3 post-transplant. Early infections reflect important targets for management protocols to improve post-transplant outcomes and reduce costs of care.

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          Author and article information

          Journal
          Transpl. Int.
          Transplant international : official journal of the European Society for Organ Transplantation
          Wiley
          1432-2277
          0934-0874
          Feb 2016
          : 29
          : 2
          Affiliations
          [1 ] Division of Nephrology, University of Michigan, Ann Arbor, MI, USA.
          [2 ] Division of Nephrology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
          [3 ] Saint Louis University Center for Transplant Research, Saint Louis University Hospital, St. Louis, MO, USA.
          [4 ] Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
          [5 ] Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
          [6 ] Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH, USA.
          [7 ] Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.
          Article
          NIHMS738439
          10.1111/tri.12711
          4805426
          26563524
          236112e3-9596-4b88-b200-c2ed9fc3e3c1
          History

          medicare,registries,economics,infections,kidney transplantation

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