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Master Thesis

Epidemiology and risk factors of multiple opportunistic infections after kidney transplantation: a prospective multicentric study

Abstract : Introduction. Kidney transplant recipients (KTR) are at increased risk of infections and infections are the second cause of mortality after cardio-vascular diseases and are reported to be associated with the risk of graft dysfunction and loss. Opportunistic infections (OI) also represent an important burden after kidney transplantation, even if prophylaxis and prevention programs. In a recent French study, specific risk factors for the different pathogens have been identified and extended donor criteria was the major risk factor was the main risk factor associated with the occurrence of any OI. No data exists concerning factors associated with the risk of recurrence in that population, thus, the aim of our study was to describe epidemiology of patients with opportunistic infections, especially with more than one OI, and to determinate the factors associated with multiple OI in KTR. Material and method. KTR included were transplanted in one of the six centers (Lyon, Montpellier, Nancy, Nantes, Necker, and Toulouse) participating to DIVAT cohort between January 1998 and December 2015, and follow-up ended in 2018. Patients were considered to present a multiple OI if they presented at least two OI. factors associated with the recurrence of an OI were analysed using a Time varying Cox proportional model. Results. Among the 9541 patients included in DIVAT over the period, 1872 presented at least an OI (19.6%), and 334 of them (17.8%) presented more than one OI representing a total of 2292 OI. CMV infections (550 patients) was the most frequent followed by VZV infections (531 patients), BKV nephritis ( 200 patients), Clostridioides difficile (173 patients) and Norovirus (160 patients). In multivariate analysis, factors associated with OI recurrence were age (HR per 10 years increase: 1.21 (1.11- 1.33), p<0.001), female gender (HR 1.37 (1.08- 1.74)), p=0.009), denutrition (HR BMI<17kg/m² : 2.27 (1.18- 4.38) decreased renal function (HR per 10ml GFR decrease: 1.14 (1.05 ; 1.22), p=0.001), an history of tuberculosis pre-transplantation (HR 2.13 (1.03 ; 4.39), p=0.02), the first OI being Clostridioides difficile colitis (HR 1.70 (1.19- 2.43), p=0.004), and among post transplantation complications, cytopenia (HR 1.30 (1.02- 1.65), p=0.035) and thrombosis (HR 1.47 (1.13- 1.93), p=0.005). Overweight and obesity were associated with less recurrence (HR 25-30 kg/m²: 0.73 (0.55- 0.97); HR >30kg/m²: 0.50 (0.33 ; 0.76)). As a first OI being VZV (HR 0.68 (0.48- 0.92), p=0.009). Conclusion. Clostridium difficile was the only pathogen associated with an increase of recurrence. Further studies are needed to adjust prevention programs after a first opportunistic infection.
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Master Thesis
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Submitted on : Wednesday, October 28, 2020 - 12:14:08 PM
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Romain Gueneau. Epidemiology and risk factors of multiple opportunistic infections after kidney transplantation: a prospective multicentric study. Human health and pathology. 2020. ⟨dumas-02981955⟩

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