Abstract
Objectives
Infection remains a major complication of organ transplantation. Paradoxically, epidemiological studies suggest better survival from serious infection. We analysed the relationship between organ transplantation and short -term mortality of patients with bloodstream infection.
Methods
Data on transplantation status was extracted from a large prospective, multi-centre clinical trial in bloodstream infection. Logistic regression for 28-day mortality was performed on the whole cohort and a propensity-matched cohort (3:1). Infective pathogen, focus of infection, and clinical variables were included in the model. Mediation analysis was performed on clinical variables to explore causation.
Results
4,178 participants were included in the full cohort, with 868 in the matched cohort, of which 217 received an organ transplant. Haematopoietic stem cell transplants (HSCT) were the most common transplant (n = 99), followed by kidney (n = 70). The most common pathogens were staphylococci and Enterobacterales. Transplantation status was associated with a reduced mortality in both the whole (Odds Ratio, OR 0.53; 95% CI 0.28, 0.77) and matched (OR 0.55, 95% CI 0.34, 0.90) cohort, while steroid use was robustly associated with increased mortality OR 4.4 (95% CI 3.12, 6.20) in the whole cohort and OR 5.24 (95% CI 2.79, 9.84) in the matched cohort. There was no interaction between steroid use and transplant status, so transplant patients on steroids generally had increased mortality relative to those without either.
Conclusions
Organ transplantation is associated with a near halving of short term mortality in bloodstream infection, including a cohort matched for comorbidities, infective pathogen and focus. Steroid usage is associated with increased mortality regardless of transplant status. Understanding the mechanism and causation of this mortality benefit should be a focus of future research.
| Original language | English |
|---|---|
| Pages (from-to) | 17-23 |
| Number of pages | 7 |
| Journal | Journal of Infection |
| Volume | 85 |
| Issue number | 1 |
| Early online date | 20 May 2022 |
| DOIs | |
| Publication status | Published - 1 Jul 2022 |
Bibliographical note
Funding Information:FH's time was funded by the GW4 Wellcome Doctoral Fellowship programme. PG was supported by the Ser Cymru programme funded by the Welsh Government and the EU ERDF.
Funding Information:
FH's time was funded by the GW4 Wellcome Doctoral Fellowship programme. PG was supported by the Ser Cymru programme funded by the Welsh Government and the EU ERDF.The National Institute for Health Research (NIHR) Programme Grants for Applied Research funded the RAPIDO trial (RP-PG-0707–10,043). The views and opinions expressed are those of the authors and do not necessarily reflect those of the NIHR HTA programme, the NIHR, the UK NHS or the Department of Health.
Funding Information:
The National Institute for Health Research (NIHR) Programme Grants for Applied Research funded the RAPIDO trial ( RP-PG-0707–10,043 ). The views and opinions expressed are those of the authors and do not necessarily reflect those of the NIHR HTA programme, the NIHR, the UK NHS or the Department of Health.
Publisher Copyright:
© 2022