Inpatient Mortality Among Solid Organ Transplant Recipients Hospitalized for Sepsis and Severe Sepsis

Abstract

<p class="first" id="d1167100e277">This study shows that among 903 816 severe sepsis and 410 623 sepsis hospitalizations at academic medical center–affiliated hospitals during 2012–2014, prior receipt of a solid organ transplant (kidney, liver, or co-transplant) was associated with reduced inpatient mortality. </p><p class="first" id="d1167100e280"> <b> <i>Background.</i> </b> Solid organ transplant (SOT) recipients are at elevated risk of sepsis. The impact of SOT on outcomes following sepsis is unclear. </p><p id="d1167100e288"> <b> <i>Methods.</i> </b> We performed a retrospective cohort study using data from University HealthSystem Consortium, a consortium of academic medical center affiliates. We examined the association between SOT and mortality among patients hospitalized with severe sepsis or explicitly coded sepsis in 2012–2014. We used <i>International Classification of Diseases, Ninth Revision</i> ( <i>ICD-9</i>) codes to identify severe sepsis, explicitly coded sepsis, and SOT (kidney, liver, heart, lung, pancreas, or intestine transplants). We fit random-intercept logistic regression models to account for clustering by hospital. </p><p id="d1167100e302"> <b> <i>Results.</i> </b> There were 903 816 severe sepsis hospitalizations (39 618 [4.4%] with SOT) and 410 623 sepsis hospitalizations (14 526 [3.9%] with SOT) in 250 hospitals. SOT recipients were younger and more likely to be insured by Medicare than those without SOT. Among hospitalizations for severe sepsis and sepsis, in-hospital mortality was lower among those with vs those without SOT (5.5% vs 9.4% for severe sepsis; 8.7% vs 12.7% for sepsis). After adjustment, the odds ratio for mortality comparing SOT patients vs non-SOT was 0.83 (95% confidence interval [CI], .79–.87) for severe sepsis and 0.78 (95% CI, .73–.84) for sepsis. Compared to non-SOT patients, kidney, liver, and co-transplant (kidney-pancreas/kidney-liver) recipients demonstrated lower mortality. No association was present for heart transplant, and lung transplant was associated with higher mortality. </p><p id="d1167100e310"> <b> <i>Conclusions.</i> </b> Among patients hospitalized for severe sepsis or sepsis, those with SOT had lower inpatient mortality than those without SOT. Identifying the specific strategies employed for populations with improved mortality could inform best practices for sepsis among SOT and non-SOT populations. </p>