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Published in: Infection 4/2015

01-08-2015 | Original Paper

Potential role of post-transplant hypogammaglobulinemia in the risk of Clostridium difficile infection after kidney transplantation: a case–control study

Authors: Julia Origüen, Mario Fernández-Ruiz, Carlos Lumbreras, María Ángeles Orellana, Francisco López-Medrano, Tamara Ruiz-Merlo, Rafael San Juan, Ana García-Reyne, Esther González, Natalia Polanco, Estela Paz-Artal, Amado Andrés, José María Aguado

Published in: Infection | Issue 4/2015

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Abstract

Purpose

To identify reversible risk factors for Clostridium difficile infection (CDI) after kidney transplantation (KT) that could lead to a reduction in its incidence and associated complications.

Methods

We performed a single-center case–control study in which 41 patients undergoing KT between February 2009 and July 2013 who developed a first episode of post-transplant CDI were included as cases. Patients transplanted at the same calendar day (±2 weeks) as each case with no evidence of CDI and comparable risk exposure period were chosen as controls (2:1 ratio). Serum immunoglobulin and complement levels were systematically measured at baseline and months 1 and 6 after transplantation.

Results

Multivariate regression analysis identified age-adjusted Charlson comorbidity index (odds ratio [OR] per unitary increment 1.31; P value = 0.043), delayed graft function (OR 2.76; P value = 0.039), prior cytomegalovirus (CMV) disease (OR 6.85; P value = 0.011) and prior acute graft rejection (OR 5.92; P value = 0.008) as risk factors for post-transplant CDI. Cases with their first episode of CDI occurring beyond the first month were more likely to have IgG hypogammaglobulinemia (HGG) at month 1 (P value = 0.002), whereas cases with CDI beyond the sixth month were more likely to have HGG of any class at month 6 (P value = 0.003). Poor outcome (graft loss and/or all-cause mortality) was more common among cases (adjusted hazard ratio 5.69; P value = 0.001).

Conclusion

The occurrence of CDI exerts a detrimental effect on graft and patient outcome. Post-transplant HGG was a potentially modifiable risk factor for CDI in KT recipients.
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Metadata
Title
Potential role of post-transplant hypogammaglobulinemia in the risk of Clostridium difficile infection after kidney transplantation: a case–control study
Authors
Julia Origüen
Mario Fernández-Ruiz
Carlos Lumbreras
María Ángeles Orellana
Francisco López-Medrano
Tamara Ruiz-Merlo
Rafael San Juan
Ana García-Reyne
Esther González
Natalia Polanco
Estela Paz-Artal
Amado Andrés
José María Aguado
Publication date
01-08-2015
Publisher
Springer Berlin Heidelberg
Published in
Infection / Issue 4/2015
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-015-0737-2

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