Clinical and economic consequences of first‐year urinary tract infections,sepsis, and pneumonia in contemporary kidney transplantation practice

We examined United States Renal Data System registry records for Medicare‐insured kidney transplant recipients in 2000–2011 to study the clinical and cost impacts of urinary tract infections (UTI), pneumonia, and sepsis in the first year post‐transplant among a contemporary, national cohort. Infections were identified by billing diagnostic codes. Among 60 702 recipients, 45% experienced at least one study infection in the first year post‐transplant, including UTI in 32%, pneumonia in 13%, and sepsis in 12%. Older recipient age, female sex, diabetic kidney failure, nonstandard criteria organs, sirolimus‐based immunosuppression, and steroids at discharge were associated with increased risk of first‐year infections. By time‐varying, multivariate Cox regression, all study infections predicted increased first‐year mortality, ranging from 41% (aHR 1.41, 95% CI 1.25–1.56) for UTI alone, 6‐ to 12‐fold risk for pneumonia or sepsis alone, to 34‐fold risk (aHR 34.38, 95% CI 30.35–38.95) for those with all three infections. Infections also significantly increased first‐year costs, from $17 691 (standard error (SE) $591) marginal cost increase for UTI alone, to approximately $40 000–$50 000 (SE $1054–1238) for pneumonia or sepsis alone, to $134 773 (SE $1876) for those with UTI, pneumonia, and sepsis. Clinical and economic impacts persisted in years 2–3 post‐transplant. Early infections reflect important targets for management protocols to improve post‐transplant outcomes and reduce costs of care.