Higher rate of bone, joint infections found in kidney-pancreas transplant recipients
Patients who received a kidney-pancreas or heart transplant were more likely to be diagnosed with a bone and joint infection compared with other transplant recipients, according to a study in the American Journal of Transplantation.
Further, kidney and kidney-pancreas transplant recipients experienced more treatment failures than other solid organ transplant recipients.
“In this largest cohort to date, we report that bone and joint infections [BJI] remain a relatively rare and late event in solid organ transplant recipients [SOTr], with some variability in the type of BJI and pathogens identified across different SOT types,” Truong-Thanh Pham, assistant physician in the infectious diseases division at Geneva University Hospitals in Switzerland, and colleagues wrote. “Clinical presentations were subtle and could lead to delays in medical care. Treatment includes a large variety of antibiotic agents and almost universally some type of surgical intervention. Clinical outcomes remain rather favorable in their majority with very low mortality observed, albeit with rather frequent recurrences.”
In a retrospective observational cohort study, Pham and colleagues studied data for 61 adult SOTrs with 82 BJIs to understand the epidemiology, predictors and clinical outcomes of osteo-articular and implant infections.
Data were obtained from the Swiss Transplant Cohort Study between May 1, 2008, and Dec. 31, 2019, and included patient information at their transplantation and at 6 months, 12 months and yearly after transplantation. A follow-upof 6 months was required for the study.
Risk factors for BJI in this cohort were found through a nested case-control study.
Incidence rates, common infections
In this study cohort, the incidence rate of BJIs in all SOTrs was 1.4%. The two highest incidence rates were found in kidney-pancreas SOTrs with 667.2 per 100,000 patients-years and heart SOTrs with 614.9 per 100,000 patients-years, according to the study.
Median time for diagnosis of BJIs after transplant was 18.5 months, but in lung and heart transplant recipients, researchers found that most infections happened within 1 year.
Overall, 46.3% of recipients had diabetic foot osteomyelitis, making it the most common infection the researchers observed, and the groups that experienced this specific infection the most were kidney and kidney-pancreas transplant recipients.
Non-vertebral osteomyelitis came in second at 31.7%, and lung and heart recipients encountered this infection the most, according to researchers.
Researchers found that gram-positive cocci were the leading pathogen category of BJIs at 53.4%. Gram-negative bacilli and fungi followed at 26% and 6.9%, respectively.
Predictors, treatment failure
Risk factors for developing BJIs were identified as male gender (OR = 2.94) and diabetes (OR = 2.97) in multivariable analysis, according to researchers.
Treatment failure, including infection recurrence, progression or reinfection, was recorded in 25.9% transplant recipients. Researchers found kidney-pancreas (42.9%) and kidney recipients (38.1%) were the main groups that encountered treatment failure because most instances were found in those with a diabetic foot osteomyelitis infection (66.7%).
Following BJI diagnosis, all-cause mortality for transplant recipients at 1 year was 14.8%.
“BJI remain rare and late complications in SOTr,” Pham and colleagues wrote. “The clinical presentation can be subtle and the risk of treatment failure high, probably related to the immunosuppression and frequent comorbidities of SOTr patients. Thoracic organ transplant recipients appear to be at higher risk of developing early onset BJI due to fungal and other pathogens, suggesting increased vigilance and high degree of clinical suspicion should be applied in this patient population. The relative rarity of BJI, even in the setting of multicenter cohort studies, makes clinical research complicated in SOTr.”
Collapse