Patients with sepsis who underwent organ transplantation had significantly lower 28-day and 90-day mortality than nontransplant patients with sepsis, according to recent findings.
This improved survival may be attributable to the immunosuppression required for transplantation patients, according to the researchers.
In a report published in Clinical Infectious Diseases, researchers evaluated 369 patients with blood culture-confirmed sepsis. Patients were identified from the organ transplant tracking record database of the solid organ transplant department at the University of Nebraska Medical Center, or from the hospital’s microbiology laboratory. Of the study population, 123 were transplant patients. They were matched in a 1:2 ratio with a control group of 246 nontransplant patients based on age, gender and location on the day of blood-culture acquisition. The researchers evaluated the following continuous variables: age, Systemic Inflammatory Response Syndrome and Sepsis-related Organ Failure Assessment (SOFA) scores on the day of initial blood culture. Several categorical variables also were analyzed, including donor type, antibiotic regimen, organ failure due to sepsis, presence of shock and 28- and 90-day survival rates.
The researchers hypothesized that transplant patients with sepsis would have worse short-term and long term survival vs. nontransplant patients with sepsis.
Of the allografts, 36.6% were kidney transplants, 34.1% were liver, 13% were kidney-pancreas, 7.3% were small bowel/liver, 5.7% were heart/lung, and 3.3% were multivisceral.
Logistic regression analysis indicated the following factors were more strongly correlated with solid organ transplantation vs. nontransplantation: more comorbidities (OR=8.2; 95% CI, 1.48-45.44); higher SOFA score (OR=1.2; 95% CI, 9.71-135.96); inappropriate initial antibiotic regimen (OR=0.04; 95% CI, 0.006-0.23); and lower white blood cell count (OR=0.93; 95% CI, 0.89-0.97). After adjusting for clinical presentation, illness severity and infection type, the researchers found that solid-organ transplant recipients with sepsis had significantly lower risk for 28-day mortality (HR=0.22; 95% CI, 0.09-0.54) and 90-day mortality (HR=0.43; 95% CI, 0.2-0.89).
According to the researchers, this is the first published study to document better survival outcomes in transplant patients with sepsis vs. nontransplant patients.
“This is contrary to the traditional belief that once transplant patients develop a bloodstream infection they would have worse survival outcomes due to their immunosuppressed status,” the researchers wrote. “A recent growing body of evidence strongly suggests that the overt inflammatory and coagulation responses associated with sepsis have more detrimental effects on survival outcomes than the infectious microorganisms themselves; hence, some degree of immunomodulation, more specifically, some degree of immunosuppression, may be of benefit to these patients.”
Disclosure: See the study for a full list of relevant financial disclosures.