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Solid organ transplant patients less frequently experience sepsis mortality
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Patients hospitalized with sepsis or severe sepsis are more likely to survive if they also have undergone a solid organ transplant, according to a recently published multicenter study.
More specifically, mortality risk was reduced for patients who underwent kidney, liver or co-transplant, and increased for lung transplant recipients, John P. Donnelly, MSPH, doctoral student in the epidemiology department at the University of Alabama School of Public Health, and colleagues found.
“Sepsis represents a common complication of transplant procedures, and [solid organ transplant (SOT)] recipients have been shown to be at increased risk for sepsis compared with the general population,” they wrote. “However, several studies have shown that the syndrome of sepsis has a wider range of causative organisms and differing presentation among immunosuppressed individuals compared with immunocompetent individuals. In addition, traditional markers of systemic inflammatory response syndrome may not be present among the immunosuppressed, despite active overwhelming infection.”
Previously, Andre C. Kalil, MD, MPH, professor of medicine and director of the transplant infectious diseases program at the University of Nebraska Medical Center, and colleagues reported reduced 28-day and 90-day mortality among sepsis patients with previous SOT at a single medical center. Although these results remained consistent after patient matching, multivariable regression and propensity score analysis, Donnelly and colleagues noted that these single-center finding may not be generalizable to the national population.
To expand upon these initial findings, Donnelly and colleagues conducted a retrospective cohort study using data collected from the University HealthSystem Consortium database between 2012 and 2014. The researchers examined outcomes among adult patients hospitalized at 250 facilities with ICD-9 codes for sepsis (n = 410,623) or severe sepsis (n = 903,816), comparing those with a recorded history of SOT with those who did not.
The researchers identified prior SOT among 3.9% of hospitalized patients with sepsis and 4.4% of those with severe sepsis. Those with prior SOT were more often younger, male and insured by Medicare or private insurance. Although less likely to be admitted to the ICU, they more frequently had hypertension, diabetes, renal failure, liver disease and deficiency anemia.
In-hospital mortality among SOT recipients was lower compared with nonrecipients for sepsis hospitalizations (8.3% vs. 12.7%) and severe sepsis (5.5% vs. 9.4%). These in-hospital mortality differences persisted following multivariate adjustment and analysis for both sepsis (OR = 0.78; 95% CI, 0.73-0.84) and severe sepsis (OR = 0.83; 95% CI, 0.79-0.87).
Analysis by transplant type revealed lower mortality among kidney, liver, kidney/liver or kidney/pancreas co-transplant patients, but higher mortality among those who received a lung transplant. Examination of a nonsepsis control population found no association between prior SOT and in-hospital mortality.
Although these findings “contradict the common perception that SOT recipients are at increased risk of death following sepsis,” the researchers wrote that the reduced mortality among patients receiving most types of SOT has several potential explanations. These include the receipt of immunosuppressive drugs and maintenance therapies, and the possibility that kidney, liver and co-transplant recipients could be experiencing lower risk infections or organ dysfunctions than the general sepsis population.
“Identifying the specific mechanisms contributing to lower mortality in this population could help to inform best practices for posttransplant care and sepsis prevention and treatment,” they concluded. – by Dave Muoio
Disclosures: Donnelly reports no relevant financial disclosures. Kalil reports research grants from Asahi Kasei and Spectral Diagnostics. Please see the full studies for a list of all other authors’ relevant financial disclosures.
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